In 2024, the U.S. Surgeon General recognized firearm violence as a critical public health crisis in the United States. Nationwide, firearms have risen to become the number one cause of mortality among children. Data from the CCHSC revealed that between 2024 and 2026, the hospital encountered 121 unintentional firearm injuries, alongside five pediatric fatalities stemming directly from firearm trauma.

The forum focused on community-driven solutions. A recurring consensus emerged among the panelists: sustainable intervention requires bringing the youth into the conversation, acknowledging and resolving the compounding personal traumas they carry before those crises escalate into violence.

Panelist Rodney McIntosh, Pastor and Director of the non-profit organization Violence Intervention and Prevention Fort Worth (VIPFW), urged community members to actively integrate young people into the safety dialogue, equipping them with foundational tools in social-emotional learning and actionable conflict de-escalation tactics.

Daniel Guzman, M.D., an emergency room physician and program director for Cook Children’s Aim for Safety program, brought a frontline medical perspective, illustrating the realities of firearm accidents in the home and emphasizing that responsible storage and education can reduce injury.

The evening closed with a powerful challenge to the audience:

“We challenge you to do something,” said Eric Gonzalez, Program Manager for Injury Prevention at the Center for Community Health at Cook Children’s Health Care System. “Ask your community, schools, family: why wait to have a conversation when we can do this right now?”

Fort Worth leaders urge parents, educators, and neighbors to initiate open, judgment-free discussions about firearm safety within their homes and community. Keep guns secured. Protect your children. Lock up all firearms.

Related Stories:   

• Experts Urge Safe Gun Storage as School's Out

• Expert Tips for a Safe Spring Break: Aim for Safety

• Empowering Families: Gun Safety

Keeping Warm and Having Fun

“If you are going to be outside, dress appropriately,” said Sharon Evans, injury prevention manager at Cook Children’s Health Care System.

Experts advise caregivers to dress little ones in several thin layers to keep warm and dry. Children are at more risk from the cold because their bodies lose heat more quickly. Insulated boots, mittens or gloves, and a hat are recommended.

Make sure children change out of any wet clothes as soon as they come indoors.

“While playing in the snow or “sledding” be aware of your surroundings, be careful to not run into trees or out into the street and mailboxes can be real dangers,” said Evans.

Know the Signs of Hypothermia 

According to the American Academy of Pediatrics, hypothermia, or abnormally low body temperature, "is a dangerous condition that can occur when a person is exposed to extremely cold temperatures." This is a medical emergency, and treatment should be sought immediately. 

 Symptoms of hypothermia include: 

• Blue skin
• Shivering
• A cool chest and stomach are signs that children may be dangerously cold.
• If you see these symptoms, take action immediately to get kids out of the cold. Seek immediate medical attention if you are not able to warm the body.
• Victims of hypothermia can include babies sleeping in cold rooms. 

 Warning signs for infants include: 

• Bright red, cold skin
• Very low energy 

 Warning signs for adults include: 

• Shivering, exhaustion
• Confusion, fumbling hands
• Memory loss, slurred speech, drowsiness 

Coats & Car Seats

While keeping kids warm is a priority during the winter, it should never come at the expense of car seat safety.

“Stay home and inside if possible. If you must be on the roads make sure everyone is buckled up correctly,” said Evans.

Bulky coats, such as puffy jackets, can create extra space between the child and harness straps or seat belt, which can increase the risk of injury in a car crash.  It is recommended to dress in thin layers and use a blanket or put the coat on backwards after the child is buckled in. 

If caregivers decide to start the car to allow it to warm up prior to entering the vehicle, it is important to make sure the car is in a ventilated area, such as an open garage, and that they lock the vehicle when they are not inside.  This will make sure that a child does not enter the vehicle unsupervised and become trapped in the vehicle.

Evans adds families should have snacks, water, and extra blankets in their car in case you get stranded. 

“If you are stranded and waiting for help on the side of the road, please make sure everyone stays buckled up,” said Evans, “often cars may slide/spin near you and hit your car.”

In addition, just as local officials advise people to stay off the roadways, if possible, ice can make dangerous driving conditions for ATV’s, Golf Carts and Go Karts.

 Safe Sleep

With winter weather, keeping infants warm is a priority for caregivers, and it is essential to do so safely.

“Caregivers often use extra blankets and hats for warmth, but these soft items can easily become a suffocation or entanglement hazard,” said Samantha St. John, program coordinator at Cook Children’s Center for Community Health.

A safer alternative is a sleep sack, also called a wearable blanket. A sleep sack provides warmth and comfort without risk because it fits securely around the baby's upper body and is sized so the fabric cannot cover their face, while still allowing plenty of room at the bottom for comfort and movement.

St. John suggests a general rule to follow dress a baby in one more layer of clothing than an adult would find comfortable in the same environment.  In winter months this could mean baby is in a long sleep fleece onesie with a wearable blanket/sleep sack. When dressing baby for bedtime or nap time during the extremely cold temperatures, it may be necessary to add socks, mittens, or hats to baby. Caregivers want to make sure that these items cannot come off during sleep and become a loose item in the crib.  It is also important to make sure baby is not going to overheat.  Signs of overheating can include sweating, a hot chest, or flushed skin.  

 Remember the ABCs of Zzzs:

• Alone: The sleep space should be clear of any soft items, such as blankets, stuffed animals, pillows, and bumper pads, leaving only a mattress with a tight-fitted sheet.
• Back: Babies should always be placed flat on their back for every nap and every night.
• Crib: A crib, bassinet, or portable play yard with a firm, flat mattress and a fitted sheet is the safest sleep surface. 

Related Stories:

• Arctic Cold Front: Readiness Tips for Parents
• What To Know During The Winter Weather This Week
• Know When to Use Telemedicine, Urgent Care, or the ER for Kids

Cook Children’s Center for Community Health conducted the 2024 Community Health Needs Assessment (CHNA) to identify and prioritize health needs and resources available for children in the service area. The results indicate a complex set of factors that create obstacles in caring for children and accessing health services.

Every three years, the center compiles the CHNA by surveying and interviewing parents and caregivers in Cook Children’s service area. Survey responses came from more than 7,300 parents, caregivers, and community leaders in Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant, and Wise counties. That region encompasses almost 1.2 million children (0-17 years), according to U.S. Census estimates.

KEY FINDINGS

The 2024 survey showed about 390,100 children from birth to 17 years old live in households that sometimes or often couldn’t afford nutritious meals. 

Along with food insecurity, about 287,100 children have a caregiver who shared that they were unable to receive all needed health services for their child. Reasons cited include lack of insurance, high health care costs, transportation difficulty and the financial impact of parents missing work for their child’s medical appointments.

Barriers played a role in 139,600 children ages 1-17 not receiving needed dental care, and 79,900 children ages 6-17 going without needed mental health services. Immunization levels in the service area showed 89% of children up-to-date on vaccines. 

“What stands out most is how many families are dealing with overlapping challenges that all affect their children’s health and well-being,” said Mandy Wolever, Ph.D., Research/CHNA Manager at the Center for Community Health. “Caregivers shared that they’re constantly making tough choices -- between covering basic needs like food, housing and utilities——and trying to get their children the health care they need.”

Fewer caregivers reported they have a source of emotional support for raising their children. That finding aligns with the U.S. Surgeon General’s advisory in August 2024, calling attention to parental stress due to financial instability, work-life balance, lack of social support and other factors.

The struggle to put nutritious meals on the table or visit the pediatrician adds another layer of stress that impacts a child’s health and development, Wolever said.  

The top three health needs reported by caregivers were preventive health care, treatment for short-term illnesses and immunizations. Mental health care or counseling topped the list for community leaders, followed by wellness opportunities and preventive dental care.

Other takeaways from the parent/caregiver survey include:

• Eighty-four percent of children in the service area had “excellent” or 
  “Very good” health in 2024. That compares to 87% of children across Texas and 90% of children in the United States in 2022.
• In the past year, 1 in 5 children (about 217,700) in the service area experienced chronic or frequent dental problems. Children with poor or fair oral health are twice as likely to miss school due to dental problems.
• Approximately 237,000 children ages 6-17 have a diagnosed mental health condition such as anxiety, depression, or attention-deficit/hyperactivity disorder, according to their caregiver. Two out of every 5 children (about 304,100) have been bullied at school.
• Approximately 233,300 children received emergency care for an accidental injury.
• Asthma impacts 104,500 children in the service area. Asthma symptoms sent about one-fourth of those children to a hospital emergency department in the past year. 
• Almost 90% of children had continuous health insurance coverage for 12 consecutive months before completing the survey.

FROM DATA TO ACTION

These results, along with many other survey data points, give context to the center’s key priorities: children’s overall health and well-being, asthma, healthy lifestyles, caregiver support, injury prevention, mental health and oral health.

Becki Hale, AVP at the Center for Community Health, said takeaways from the survey will help the center respond to evolving needs in collaboration with more than 700 organizations across the region.

“We’re incredibly grateful to be part of such a strong, compassionate health care organization that invests and prioritizes giving back to the community and helping families thrive,” Hale said. “We also recognize that Cook Children’s is one of many partners committed to improving the health of our communities. Today’s health and social needs for families are too complex for any one entity to address alone. It takes all of us, working together.”

One example of how Cook Children’s utilizes the CHNA results in collaboration with others to implement innovative approaches that address the greatest needs: the Center for Community Health teamed up with Texas Health Resources in January 2025 to open a Good For You Healthy Hub at Fort Worth’s Eastside YMCA. The hub provides fresh fruits, vegetables and other nutritious foods for free to residents of the Eastside neighborhood.   

Chris Pedigo, senior vice president of system planning, health analytics and the Center for Community Health, pointed out that the CHNA provides insights that help Cook Children’s keep its Promise to improve the well-being of every child in our care and communities. 

“Our next steps include comparing this year’s results to those of previous years to identify areas where we’ve seen change, as well as identifying new communities that need focused programming,” Pedigo said.

Surveys were collected from a sample of households across the service area at large, not just Cook Children’s patients. Surveys were also collected from parents of special under-resourced populations, including those experiencing homelessness or living with an undocumented family member. The results are weighted to represent the actual population of children living in the service area.

The center takes steps to include a cross-section of the population through data collection and interviews. The team analyzed approximately 1.2 million data points, said Lauren Purvis, MPH, CPH, MCHES, Director of Child Health Evaluation.

“This approach can help partners feel confident using our data to inform their organization’s strategies to improve children’s health in their communities,” Purvis said.

Significant effort goes into developing and carrying out the research strategies that make the CHNA as inclusive and representative as possible.

“It’s important to us to gather a wide range of perspectives so we can thoroughly assess community needs,” Wolever said. “This approach helps us better understand how to support families and improve the well-being of children, ultimately living out our Promise.”

Regional Summits

Cook Children’s Center for Community Health is hosting two free, virtual Child Health Summits to share the survey findings with the media, community partners and other professionals.

• Part 1, May 6, 9-10:30 am: Cook Children's Child Health Summit Part 1 Registration, Tue, May 6, 2025 at 9:00 AM | Eventbrite

Focus areas: Overall Health and Well-being, Asthma and Healthy Lifestyles

• Part 2, June 3, 9-10:30 am: https://www.eventbrite.com/e/cook-childrens-child-health-summit-part-2-registration-1095338770749?aff=oddtdtcreator

Focus areas: Caregiver Support, Injury Prevention, Mental Health and Oral Health

For more survey results, please visit the data dashboard or contact CHNAFeedback@cookchildrens.org.

RELATED STORY

Parent Survey Underscores Need for Mental Health Focus

On Wednesday, April 16, several officers brought the celebration to Zoe! They stopped by Cook Children’s Medical Center – Fort Worth to present Zoe with a junior police badge and a collection of gifts and goodies. The officers spent time chatting with her and her family, offering words of encouragement and support.

“Zoe’s biggest thing that she’s always wanted to do is to be somebody who will makes a difference,” said Carmen Orozco, Zoe’s mother. “Ever since she was little, she has always wanted to help people. She’s always gone out of her way to be a peacemaker. She feels that she has an obligation to help her community.”

Zoe, you're an inspiration to all of us!

Since June, the physician’s offices, Urgent Care Centers and Emergency Departments at Cook Children’s have reported high numbers of patients with Mycoplasma pneumonia, sometimes called “walking pneumonia.”

The infection typically causes cold-like symptoms including cough, fever, headache and sore throat. Other symptoms can include nausea, vomiting and diarrhea. Some patients – those with sickle cell disease or autoimmune disorders, for instance – can become severely ill.

Last week at Cook Children’s, 63 out of 463 patients who were tested were positive, or 14%. The same week of September 2023 had a 0% positivity rate.

This type of pneumonia spreads through respiratory droplets in coughs and sneezes. If someone in your house has Mycoplasma pneumonia, there’s a 90% chance someone else in the family will catch it.

“There are patients who will have Mycoplasma infection in their upper respiratory tract like a cold, and there are patients who have Mycoplasma infection in their lower respiratory tract causing pneumonia in their lungs,” said Mary Suzanne Whitworth, M.D., Medical Director of Pediatric Infectious Diseases at Cook Children’s. “Some get sick enough to be in the hospital because they require oxygen.”

The U.S. Centers for Disease Control and Prevention says it can take up to four weeks for symptoms to appear after exposure to the bacteria. Symptoms can last several weeks. 

“It’s one of the most contagious infectious diseases we know of. It’s very contagious within families,” Dr. Whitworth said. “The concern is when you have so much more disease in the community, there are more patients presenting with the rarer presentations such as encephalitis, or inflammation of the brain.”

If your child has difficulty breathing or is short of breath, see a doctor right away.

Tips to stop the spread:

• If possible, avoid exposure to people who are sick.
• Keep your child home from daycare or school if they’re sick.
• Teach your child to sneeze or cough into their elbow or a tissue.
• Frequent handwashing helps.

RELATED STORY:

• Cook Children's Sees Rise in Cases of Mycoplasma Pneumonia (checkupnewsroom.com)

Last week, 80 out of the 398 patients tested were positive, resulting in a 20% positivity rate across our health care system. Looking at the same week last year, there was a 0% positivity rate. Children are spreading this when they're in close contact with others who have it, like at summer camps and swimming.  This specific type of pneumonia is spread through respiratory droplets. Good handwashing and staying home when not feeling well are the best ways to not spread this disease. 

Mycoplasma pneumonia is very treatable and is most commonly seen in children over the age of 5. This summer, it is being seen in every age group, from infants to adolescents. 

Severe symptoms of Mycoplasma pneumonia include prolonged coughing, fever, rashes in the mouth, conjunctivitis (pink eye), and large blisters and rashes on the skin. Parents should seek medical care if they are concerned about cold-like symptoms. If your child has a fever for more than five days, difficulty breathing, or concerns for dehydration visit the Cook Children's Emergency Department.

Symptoms for Mycoplasma pneumoniae Infection

Information from the Centers for Disease Control and Prevention: It can take one to four weeks for symptoms to appear after someone's been exposed to the bacteria. Symptoms can last for several weeks. Some infected people may have no symptoms. Symptoms depend on the type of infection.

Chest cold symptoms

Common symptoms include:

• Feeling tired
• Fever
• Headache
• Slowly worsening cough
• Sore throat

Younger children may have different symptoms

Instead of chest cold symptoms, children younger than 5 years old may have:

• Diarrhea
• Sneezing
• Sore throat
• Stuffy or runny nose
• Vomiting
• Watery eyes
• Wheezing

Pneumonia symptoms

Common symptoms include:

• Cough
• Feeling tired
• Fever and chills
• Shortness of breath

M. pneumoniae can cause "walking pneumonia"‎

People with pneumonia caused by M. pneumoniae can seem better than expected for someone with a lung infection. With mild symptoms, people may not stay home or in bed. Thus, the phrase "walking pneumonia" was coined.

There were approximately 180 people who came to the event and dozens of volunteers from different organizations, including Fort Worth Police Department, Center for Community Health, Texas Christian University, North Texas Poison Center and LVT Rise. Organizations shared resources, information, fun activities and complimentary lunch. Community members learned about car seat passenger safety, gun safety, poison prevention, safe baby sleep, drowning prevention and much more from the Center for Community Health.

Community partners included:

• JPS Health Network
• Fort Worth Police Department
• Fort Worth Fire Department
• Fort Worth ISD – Parent Partnerships, Zero to Five
• Boys and Girls Club – Hemphill and Las Vegas Trail Branches
• Fort Worth Drowning Prevention Coalition
• Catholic Charities
• Cook Children’s (Injury prevention, oral health, healthy homes, ACEs, and trauma teams)

The Center for Community Health is dedicated to preventing injury and illness, and embracing wellness. Our teams focus on these key areas: Asthma, Healthy Lifestyles, Injury Prevention, Mental Health, Parenting & Family Support, Healthy Homes, ACEs (Adverse Childhood Experiences) and Oral Health. We served over 38,000 children and families in 2023. Our primary service areas consist of Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant and Wise counties. Learn more about our programs, how to find resources and how you can get involved here.

LVTRise is dedicated to helping residents of the Las Vegas Trail area improve their neighborhood and day-to-day lives. LVTRise is dedicated to collaborating with community partners, empowering community members through training and case management and impacting the Las Vegas Trail community addressing education, improved quality housing and reducing neighborhood crime.

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

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

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

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

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

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

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

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

Spreading the Word

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

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

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

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

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

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

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

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

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

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

Out in the Community

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

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

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

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

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

Related stories:

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

Before leaving your infant with a friend, grandparent, other relative or babysitter, it’s important to make sure the caregiver practices the basics of safe sleep. It might feel like an awkward or unnecessary topic to bring up with your mother or mother-in-law or favorite auntie who provides free babysitting. But not all caregivers are aware of the safe sleep practices backed by medical evidence, as they have been updated over the years.

At nighttime and every nap – whether at home or away, with parents or sitters -- the safest way for infants to sleep is: 

• on their backs
• alone (no co-sleeping)
• in a crib or bassinet with a firm and flat mattress
• without pillows, sheets, blankets, toys or other objects

More than 3,500 sleep-related infant deaths occur annually in the U.S., according to the Centers for Disease Control and Prevention. In 2022, 25 infants at Cook Children’s Medical Center in Fort Worth died from cardiac arrest, respiratory failure or other trauma due to unsafe sleep incidents that happened at their homes. A majority of those deaths involved co-sleeping with at least one parent or caregiver who awoke to find the child unresponsive.

So far in 2023, Cook Children’s has seen nine deaths due to unsafe sleep conditions, including co-sleeping with adults. Suffocation can occur if someone rolls onto the baby or if bedding covers the baby’s face.

Juan Cocjin, M.D., of Cook Children’s Neighborhood Clinic – Renaissance, said grandparents shouldn’t assume that it’s OK for babies to bed-share, even if that’s the norm the grandparents are used to or have done in the past.

It’s a sensitive topic because sleep customs get passed down in families from one generation to the next, Dr. Cocjin says.

Some of his patients are being raised by grandparents or even great-grandparents. He occasionally hears a caregiver say their baby shares a bed with others in the family. While these conversations can be tough, it’s important to break through misconceptions that co-sleeping is safe.

“I share with them the hazards of co-sleeping,” Dr. Cocjin said.

Creating a safe sleep environment for your baby takes consistent practice until it becomes automatic. Dr. Cocjin urges grandparents to seek out reputable sources of information and have an open mind about what the experts say. As he puts it: You can’t stick with unsafe habits hoping “maybe it’ll be OK.’’

Communication

Cook Children’s social worker Lorie Palacios, LMSW spreads the word in English and Spanish as a Safe Baby Sleep Council member, a coalition of partners including the Cook Children’s Center for Community Health. She shares safe sleep education at injury prevention at community events.

Palacios emphasizes the importance of sharing your safe sleep plan with everyone who cares for your baby. If mom and dad don’t live together, for instance, they should communicate about their baby’s sleeping arrangements in both residences. Ask if your baby’s caregivers have a crib or bassinet.  

“We want to make sure that conversation is happening,” she said. Transparency and communication are key.

Palacios pointed out that licensed day care facilities in Texas are required to follow protocols for safe sleep. That’s not the case when a friend or family member volunteers to watch your infant. And if a parent feels indebted to the babysitter, she said, they might worry that they’ll be seen as critical or questioning the sitter’s abilities if they speak up about safe sleep.

“If you’re dependent on a family member, especially a grandparent, that’s a very difficult conversation to have with someone you love and trust,” Palacios said.

When Palacios’ children were little, their grandmother kept them while Palacios worked. One day she found her 3-month-old daughter sleeping on the grandmother’s bed with a pillow and blanket.

“I had a playpen. I had a bassinet,” Palacios said. “All these things were available, but those were not the things that my mom used when she was raising her babies. To her, the bassinet felt awkward.”

Prior to that day, Palacios said she and her mom had only touched on the topic of safe sleep.

“The toughest thing is this idea that you’re questioning your elders,” she said. “I wasn’t really pushy because I wanted to maintain my respect.”

After that day, Palacios clearly and specifically told her mom her expectations for the baby’s sleep environment going forward. The words weren’t easy to say; but her mom respected Palacios’ wishes.

When you rely on a network of relatives or neighbors to help care for your baby, she said, you need to stand your ground on matters of safety. A caregiver might mean well but be misguided.

“It definitely takes a little more courage to find your voice when you’re part of a big village,” Palacios said. 

--------------------------------

More about safe sleep from Cook Children’s Checkup Newsroom:

• Safe Sleep Starts With Babies in Their Own Separate Sleep Area (checkupnewsroom.com)
• Safe Baby Sleep: Keep Decorating 'Extras,' Blankets Out of Infant Cribs (checkupnewsroom.com)
• Pediatrician's Advice: Straight Talk About Sleepless Nights (checkupnewsroom.com)

Editor's note: This story was originally published on Nov. 4, 2021.

Results are in for the 2021 Community Health Needs Assessment parent survey conducted by Cook Children’s Center for Children’s Health and one thing is clear—the mental health of children is top-of-mind for parents, particularly during the pandemic.

Half of all children ages 6 to 17 living in Cook Children’s eight-county service area have a parent who is concerned that the pandemic will have a negative impact on both their child’s education and mental health, according to the survey. The impact of COVID-19 was also noted by parents and guardians as one of the top three barriers to children receiving necessary health services, along with a lack of insurance coverage and the scarcity of needed services available in the area they live.

These barriers played a role in 137,000 children not getting needed medical care, more than 180,000 kids being deprived of needed dental care, and 63,120 kids going without needed mental health care. When compared to the same demographics from the 2015 and 2018 parent surveys, all of these numbers represent an increase in children not getting the health care they need.

The survey revealed that parents need support, too. More than 30,000 children have a caregiver not coping “very well” or not “well at all” with the day-to-day demands of parenting, and 24% of children live with someone who has a mental illness, or is suicidal or depressed.

“Parents of teens score lower when it comes to coping well with the demands of parenting than those with kids ages 6 to 11,” said Blair Williams, community health analyst at the Center for Children’s Health. “So the question becomes what do we do for parents to help them grapple with those daily parenting demands and the really tough topics that they face with their teens that are relatively new to us adults and changing almost every day.”

These results, along with many other survey data points, were shared Tuesday at the Virtual Children’s Health Summit presented by the Center for Children’s Health. Nearly 300 community members representing a number of area schools, health agencies and community organizations attended the summit.

“We recognize and acknowledge that Cook Children's isn't the only one working to improve the health of children and families in our communities,” said Becki Hale, director of Child Health Evaluation within the Center for Children’s Health. “We have such strong community partnerships and these issues around children's health are so complex that it can't just be one entity. It has to be all of us working together. We're so grateful that we have such a strong community that comes together to support one another to help families.”

Every three years the Center for Children’s Health surveys parents and guardians within its service area, including Denton, Hood, Johnson, Parker, Tarrant and Wise counties. This year the Center added Grayson and Collin counties into the surveyed region in preparation of meeting the needs of children served by the new Cook Children’s-Prosper, slated to open in late 2022. It also increased the child age range from 0 to 14 to 0 to 17.

A total of 5,715 surveys were collected from a sample of households across the surveyed region at large, not just Cook Children’s patients. Surveys were also collected from parents of special underserved populations via partners within community shelters and other local aid agencies. The results are weighted to represent the actual population of children living in the service area. That means data percentages are translated into the actual number of children within the population the percentage represents.

“We use this data to see how we might need to adjust our current programs to best address the needs we already know exist within our community because of what we see within Cook Children’s Health Care System,” Hale said. “Mental health is a good example. Because of what we are seeing in our health system data around self-harm and suicide, we’re particularly looking a little closer at what the survey reveals about mental health knowing that there may be some opportunity to adjust our programming to address that issue, especially within the adolescent and teen population. It’s another piece of the puzzle to help us figure out how to best support families and children.”

Parents reported that 19% of children ages 6 to 17 have been told by a health care provider they have anxiety, and 10% have been told they have depression. That’s higher than the national numbers of 13% and 6% respectively. In addition, Cook Children’s has recorded a record number of suicide attempts by children within the last 12 months.

“The survey reinforces what we have seen over the past year with skyrocketing numbers within our mental and behavioral health services,” said Rick W. Merrill, President and CEO of Cook Children’s Health Care System. “In 2022, we’ll dive deep into mental health access and behavioral health services. We owe it to the hurting children in our community to continue to make this a top priority.”

In addition to addressing mental health, the Center for Children’s Health will work with its community partners to explore new and innovative approaches for increasing access to food, personal health care providers, insurance, oral health care, parent support networks, injury prevention education, and opportunities for physical activity.

“The information we shared at the summit was just the tip of the iceberg,” said Chris Pedigo, senior vice president of system planning, health analytics and the Center for Children’s Health. “We’ll continue to dig deep into these issues to understand how to join with our community partners to best address these needs.”

Other notable findings include:

• 55,570 children are living in households that “sometimes” or “often” can not afford enough to eat.
• 57% of children ages 3 to 5 have a caregiver who is coping “very well” with daily parenting demands, which is lower than the national percentage of 63%; and 51% of children ages 6 to 17 have a caregiver who is coping “very well” with daily parenting demands, also lower than the national percentage of 61%.
• 70% of children ages 3 to 5 are ready for school according to their caregiver, which is slightly lower than the national percentage of 75%.
• 8 in 10 children have “excellent” or “very good” health.
• 9 in 10 children had continuous insurance coverage for 12 consecutive months prior to completing the survey.

In February, the Center for Children’s Health will release part two of its Community Health Needs Assessment, which will include a report of the “why” behind many of the survey results learned from parent focus groups and community leader interviews. That information will be combined with the parent survey results as well as the results of a community leaders survey to complete the Community Health Needs Assessment, which will be released in spring 2022.

Partners from health care and other fields are teaming up in an expanded collaboration geared to brainstorm and implement strategies to prevent suicides in North Texas.

Participants represent a variety of vantage points including mental health, housing, poverty alleviation, youth services and education. Yet they share the same concerns about the escalating rates of anxiety and depression that can lead to suicide. The Center for Children’s Health, led by Cook Children’s, summoned the partners together earlier this year through the Adverse Childhood Experiences (ACEs) Task Force.

“It just works better from a community perspective if it’s really a community-driven need and a community-driven response, than if it’s just one organization pushing it out. We need everybody’s support in tackling this issue,” said Lenee Bassham, who oversees the ACEs Task Force in her role as director of child safety.

The Task Force has existed since 2017, working to mitigate the effects of trauma on children who live with domestic violence, neglect/abuse, a parent’s incarceration or other chronic adversity. The Center for Children’s Health last May bumped up the Task Force membership to about 25 people in an effort to address the implications of the COVID-19 pandemic.

In meetings over the spring and summer, the participants shared their observations, concerns and vision for improving access to mental health services in Tarrant County. Organizers hope that the dialogue will eventually lead to agreement on top priorities and a plan for action.

One theme that already has emerged? The need for a clear and consistent message that could be promoted by schools, medical providers, agencies or anyone who works with families. Bassham cited the Cook Children's Aim for Safety® initiative as an example of cohesive communication. Aim for Safety® simplifies the need-to-know message into three steps to prevent accidental gun injuries: “Safe storage. Safe children. Safe play.”

A similarly cohesive message when it comes to suicide, she said, could equip parents to know the warning signs and to find help for kids and teens who struggle with mental health. And the appeal broadens when multiple voices weigh in to shape the message’s content.

“When we have everyone’s buy-in, it’s much better to push messaging out in the community,” Bassham said. “We could take years on a messaging campaign, but we don’t want that to happen. We want to move as quickly as possible.”

The urgency stems from a dramatic rise in suicide attempts, which experts link to emotional distress during the COVID-19 pandemic. Cook Children’s, for instance, saw 261 patients hospitalized due to injuries following suicide attempts from January-July 2021. That compares to 143 hospitalizations for injuries in the aftermath of suicide attempts from January-July 2020.

In response, Cook Children’s has launched the Joy Campaign, a series of news articles and materials that spotlight the efforts being made to turn the trend around. The Joy Campaign focuses on avenues of hope and resiliency.

Bassham said the ACEs Task Force members plan to meet again in September to continue the teamwork approach. Their discussions could eventually pave the way for proposals that raise suicide awareness and improve the outlook for families in the Fort Worth area.

The World Health Organization (WHO) describes community engagement as an essential and effective aspect of suicide prevention globally. WHO advises that the process should involve stakeholders from diverse backgrounds who know the community’s demographics. Diversity improves the input by enlarging the group’s base of skills and creative thinking.

“Prevention of suicide cannot be accomplished by one person, organization or institution alone; it requires support from the whole community,” according to a WHO publication in 2018. “Each community can adapt and design its own plan, tools and activities to ensure that these best fit the community and are acceptable and appropriate to the local context.”

Bassham said it’s too soon to predict just yet what concrete action might arise from the ACEs Task Force talks. Each partner brings a unique viewpoint to the conversation. Let’s hear from three of the members.

Lachelle Goodrich, licensed professional counselor

Lachelle Goodrich suggested that the Task Force develop a process map that breaks down the path to treatment for suicidal kids in North Texas. She envisions a chart that directs parents when to act and places to turn, depending on the child’s age.

“Sometimes parents just don’t know the questions to ask or the signs to look for,” said Goodrich, who also serves as director of the Stop Six Choice Neighborhood Initiative for Fort Worth Housing Solutions. “Parents are stuck because we don’t know where to begin, where to start. ‘Do I call a therapist? Do I go to the hospital? What do I do?’”

She urges parents to have courageous and regular conversations about mental health. Be your child’s biggest advocate, and don’t be afraid to reach out for intervention, she said.

“The more I work with teens, the more they educate me. I feel like it’s my duty to turn around and educate the parents and the community.”

Ottis Goodwin, Fort Worth Independent School District

When an assessment finds that a student is considered at-risk for suicide, the Fort Worth Independent School District provides a list of area options for treatment. But that list doesn’t indicate which facilities have current openings for new patients, said Ottis Goodwin, director of Family & Community Resources for FWISD.

“When we give families that information, we have no idea who’s full and who’s not full,” Goodwin said. “The family may show up and not be able to be admitted.” He would like to see a system that tracks up-to-date bed availability.

Another suggestion from Goodwin: Closer ties between the district and the inpatient facilities, to ease students’ transition back to campus after hospitalization.

“Oftentimes we don’t know that they’re coming back into school, so we don’t really have a good support plan for their return, because it wasn’t communicated to us,” he said.

Last school year, Goodwin distributed magnets and crisis contact information sheets – developed by the Joy Campaign, in English and Spanish – to counselors and other staff throughout FWISD. He applauded the Task Force for tackling the weaknesses where improvements could be made.

“The fact that we’re together and having these conversations is huge. We need those people pushing and organizing like what Cook has been doing. If you get the right people at the table, then you can make the change.”

Virginia Hoft, Mental Health Connection of Tarrant County (MHC)

Through the Recognize and Rise education campaign at MHC, executive director Virginia Hoft shares information about healing in the aftermath of trauma. Hoft would like to see the Task Force find a way to identify gaps and duplications in local mental health services.

Hoft also recommends adopting age-appropriate curriculum that equips young children with skills for coping with stress. Don’t wait until junior high to talk about suicide, she said. “Just like we’ve done with ‘Stranger Danger’ and drug education, it’s information that kids need to grow up with.”

By working in tandem, the ACEs Task Force partners and other advocates can make a collective impact to prevent suicide and improve mental health in our region, Hoft said.

“What brings me hope is the open-mindedness around having collaborative conversations about how we can work on this in the most efficient manner, to get us all rolling in the same direction.”

Three kids have been ejected total, with one child surviving. It probably doesn’t come as a surprise the cause of the tragedies – the children weren’t restrained properly or not at all in their car seat.

Since April 2015, Cook Children’s Trauma team has treated 13 children who were ejected from a car.

Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s, says it’s so frustrating because she has seen wrecks where one child who was properly restrained live and the other child not buckled in dies.

“Honestly, it’s just so infuriating,” Evans said. “These accidents are totally preventable. It’s because the adults in the car aren’t doing something that could save their child’s life. I don’t think people think it can happen to them. But it can happen to anyone. It just breaks my heart because these are deaths that shouldn’t occur if people would just place their kid in the proper car seat and buckle them up with a seat belt.”

Statistics show this is especially a problem for Hispanics in the community. Ninety percent of the ejections that have occurred since April 2015 were Hispanic.

“I think a lot of it has to do with our culture,” said Magdalena Santillan, Trauma Injury Prevention specialist at Cook Children’s. “These are people who love their kids and they want to hold their baby. A lot don’t want to hear their baby cry and so it’s easier to hold their baby in the car. They are showing love, but the consequences are too high. This can be a deadly mistake.”

According to the Centers for Disease Control and Prevention, car crashes are a leading cause of death among children ages 3 to 14. From 2002 to 2011, about 9,000 children under the age of 12 died in car accidents, the agency’s statistics show. Correctly using a child safety seat can reduce the risk of death by as much as 71 percent.

“We know that car seats are working,” Evans said. “Research shows that a properly installed rear-facing car seat is five times safer and can dramatically reduce the risk of head, neck and spinal cord injury if your child is involved in a crash.”

Call 682-885-2634 to set up a FREE car seat checkup to ensure your seat is properly installed.

Since Oct. 1, 2014 to present, 40 drownings have been seen here and three of them have been fatal.

Those numbers are chilling and once again place an emphasis on water safety in the area.

Dana Walraven, community health outreach manager for Cook Children’s, wants to make sure that parents are prepared for warm weather and children in the water. She said the safety begins with making sure a grownup is watching the kids in the water at all times.

“Active adult supervision and layers of protection such as door alarms and a fence can lower the risk for your child,” Walraven said. “The majority of these water-related incidents happen in the child’s own backyard pools and to children 4 years old and younger. Drowning prevention around the pool starts with adult supervision.”

Children are protected by layers of protection by using these safety techniques whenever children are around the pool:

· Always have adult supervision present when children are swimming or around pools.

· A fence with a locking gate should surround the pool.

· Install door alarms to alert adults when a child is entering the pool area.

· Require life jacket use for non-swimmers.

· Enroll children in swimming lessons.

· Parents and caregivers should undergo CPR training.

In nearly nine out of 10 child drowning –related deaths, the parent or caregiver said the child had been with them in the house or pool within five minutes of the accident. Walraven says she knows it is difficult to supervise children 100 percent of the time. She said the levels of protection provide barriers in case the child should slip out of supervision.

Safe Kids Tarrant County, led by Cook Children’s, also offers Water Watcher tags to anyone or group who will use or distribute them. These are especially helpful at parties around the pool or lake to help designate adults that are watching the water. After 15 minutes, the tag is given to another responsible adult – letting everyone enjoy the party while ensuring that the kids are being properly watched. To receive a Water Watcher Tag, call 682-885-4244.

In large pools, it’s ideal to split up in groups and take sections of the pool.

“If you are somewhere where children are in the pool, insist that an adult be on watch,” Walraven said. “It should be done by a sober adult and that should be his or her only focus during their time watching the kids.”

Aside from supervision, four-sided isolation fencing with self-closing/self-latching gates is the best protection for your child and pets. It could prevent 50-90 percent of childhood drowning and near-drowning incidents. This type of fencing goes beyond the yard, to fencing in the pool itself, preventing direct access from the house.

Door and gate alarms give another signal that a child may have access to the pool area without supervision. The tendency is to disconnect it – especially at parties where people are going in and out. But these are also the times when small children are the most vulnerable for injury because of the confusion.

Learning CPR can save a child’s life by restoring breathing and circulation until advance life support can be given by health care providers.

Swim programs for children should teach good water safety behaviors in and around the pool but should not be seen as the sole way to decrease the risk of drowning.

Use a U.S. Coast Guard approved lifejacket with children who can’t swim. It should fit snugly when the child is buckled in and should not go beyond the top of the ears when lifted at the shoulders. Many air-filled, float-type toys are thought to be lifesavers but are not.

Check your pool and spa for cracked or broken drain covers on a regular basis. The suction around the drain can catch hair or clothing, pinning the child underwater. Anti-entrapment drain covers are available for as low as $40 and serve as another level of protection.

Since beach balls, noodles and other toys are attractive to curious young children – put them away when not at the pool.

For more information

Cook Children's has many resources on drowning prevention, beginning here. Click the links below with downloadable information in both Spanish and English, as well as videos. 

• Drowning prevention tips - English
• Drowning prevention tips - Spanish
• Water safety resources
• Drowning prevention education (English and Spanish)

Videos:

• Pool safety video step 1: Supervision
• Pool safety video step 2: Fencing
• Pool safety video step 3: Pool and spa covers
• Pool safety video step 4: Alarms
• Pool safety video step 5: Safety drain covers
• Pool safety video step 6: Swimming lessons
• Pool safety video step 7: Learning CPR
• Safe Kids Tarrant County Drowning Prevention Tips
• Safe Kids Tarrant County sugerencias de prevención de ahogamientos