Tears welled in his eyes as his sweet, pre-teen voice cracked, “Mamaw M died and then my friend died and now my other friend died! Plus, middle school is a lot different than elementary school! This year has just been hard and sad. I thought being a kid was supposed to be fun. This is the worst year ever, Mom!”

Sadness. Grief. Uncertainty.

Death is hard. Change is hard. The two often go hand-in-hand, especially during the holiday season, when kids are practically indoctrinated that winter holidays should be the highlight of their year, filled with brand new gifts, unlimited candy, and family traditions that make the eyes roll while their hearts burst with joy.

Just like being a kid is supposed to be fun, holidays are supposed to be fun. Holidays after the death of a loved one, however, are reminders that life is different now. Holidays highlight who is missing.

When someone is missing, sadness, grief, and uncertainty reappear year after year. It can be exhausting, especially if you are also grieving. You may grieve differently than the tween working to make meaning of multiples deaths and the new stress of middle school, and that’s OK. Everyone grieves differently and copes in their own way. 

Speaking to your children

Younger children often don’t have the verbal skills to express their grief and feelings. Instead, you might see their grief shown through an increased want for physical touch and reassurance, tantrums, regression, and the overall need to move their little bodies a lot! Caregivers can support young children by:

• Keeping the child’s routine as normal as holiday observations allow,
• Prioritizing one-on-one time with the child.
• Providing activities that promote physical movement. Keeping naptime in place and setting aside 20 minutes to play at the park are great ways to support a young, grieving child.

Older children who are grieving may approach holiday gatherings with a quiet, reflective spirit or they may share their feelings with any and every person they encounter, asking questions about death and dying, and talking very directly about the death. 

Caregivers can support older children by simply being present and allowing them to talk it out or sit with them in the silence. This crafty age group often find meaning in creating an art project or participating in rituals that honor the memory of their loved one. Drawing a picture, leaving an empty seat at the table, making a favorite recipe, or asking people to share their favorite memory are great ways for older children to process their grief throughout the holiday season.

The only thing more unpredictable than a teenager is a grieving teenager during the holidays. 

Teens are still learning how to cope with life in general, coping with grief is next level, especially when they are expected to show up, celebrate, and smile for the pictures. Caregivers can support grieving teens by acknowledging that it may be difficult to be around family and fostering their emerging sense of independence by working together to create expectations around holiday observations. 

Allowing teens to weigh in on when and how long they must be present, allowing them the freedom to leave and go to a friend's house when they need a break reinforces healthy coping skills as teens process their grief during this busy season.

An ongoing conversation

The holiday season may start the conversation about the grief in a child's life, but, in reality, it's an ongoing conversation. As children grow and develop physically and mentally, their conversations, understandings, and experiences of grief grow and develop too. Grief has no timeline, so if you, as a grown-up reading this, find tears welling up in your eyes and your voice cracking as you declare this is the worst time of year, know you are not broken or alone in your grief. Be gentle with yourself as you approach this holiday season. 

No matter if you are living with grief yourself, if this is your first year supporting a grieving child, or if grief has greeted every holiday in your recent memory, it's OK to miss the one who is still missing from your holidays because, no matter how many years have passed, death and change are still hard.

They shared how Cook Children’s is currently being impacted by a surge in COVID-19 cases and hospitalizations.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases, Corwin Warmink, M.D., medical director of Emergency Services, Kara Starnes, D.O., medical director of Urgent Care Services, and Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Pediatrics Haslet have all worked tirelessly to ensure our patients and families are receiving the best care throughout the pandemic.

During the news conference, the experts addressed what they are seeing in our urgent care locations, emergency department, and Cook Children’s system as a whole.

“We need compassion from the community and this is an illness affecting our children,” Dr. Starnes said. “We are hitting crisis mode and we can’t do it without your help.”

Cook Children's Urgent Care facilities are being stretched thin. Over the weekend, Cook Children’s was forced to close its Hurst location due to a lack of staff members and high demand for services.

"This is the first time we’ve had to take such measures. We closed in an effort to consolidate staff and safely take care of our patients,” Dr. Starnes explained.

On Monday, the six remaining urgent care locations saw 1,400 children. This is twice the number of patients the urgent care centers typically see.

Dr. Starnes stressed that if you believe your child has been exposed to COVID-19, it is best to find a local testing site in the community or use an at-home testing kit. You can find a list of local COVID-19 testing locations here. 

Cook Children’s Emergency Department (ED) is experiencing patient volumes not seen since the H1N1 pandemic in 2009. On Monday, the ED saw 601 patients with patients arriving every 2.5 minutes.

“We are breaking records we don’t like to break,” Dr. Warmink said. “I have been at Cook Children’s for 18 years and this is the worst it’s ever been.”

We encourage all families to come to the emergency room for emergencies but ask that they do not come for a simple COVID-19 test. This pulls resources away from critically ill and injured patients and takes up already limited bed space. Along with COVID-19, we are still seeing RSV cases but thankfully, they appear to be on a downswing.

“The adults in the room need to step up and do the right thing,” Dr. Warmink said. “If you send your kid to school without a mask, it’s not if they are going to get sick, it’s when.”

Dr. Warmink advises all parents, “Ask yourself if this can wait” before bringing their child into the emergency department.

Most children have mild illness with COVID-19, but that is not the case for everyone. Throughout the course of the pandemic, Cook Children's has hospitalized 1,129 children with COVID-19, with 241 of those admitted to the Intensive Care Unit (ICU). Throughout the pandemic, seven children with COVID-19 have died. Two died this past week. They were a 4 year old and a 15 year old. 

"We are seeing more severe illness than we have seen at any point during the pandemic. The January surge was nothing compared to what we’re seeing now,” Dr. Whitworth said.

As a result, on Monday, Cook Children’s opened up a third COVID-19 unit for the first time since the start of the pandemic. This unit has nine beds – and within the first 24 hours of being open, was completely full.

With Labor Day weekend ahead of us, Dr. Whitworth encourages everyone to be safe, mask up, and socially distance, as we cannot handle another influx at this time.

“Every child that has the virus inside of them has the potential to spread it to someone else, and they don’t mean to,” Dr. Whitworth said. “Much of what we are seeing is 100% preventable, children have to wear a mask.”

Cook Children's also set a record for COVID-19 hospitalizations on Wednesday with 35 patients. This is the highest number of COVID-19 patients hospitalized at the medical center at any point in the pandemic. The COVID-19 ICU was also filled. 

What can the community do to help?

All four experts we heard from on Wednesday have a few simple pleas:

1. Get vaccinated and get your child vaccinated as soon as possible.
2. Please have your children wear a mask to school.
3. Wash your hands frequently.
4. Re-think gatherings – if you gather, wear masks, stay socially distant and gather outdoors if possible.

Across the board, Cook Children's is seeing record numbers of families each day who are wanting rapid COVID-19 tests for their children.

"We understand this is a scary time, but want to remind families not to panic if your child was exposed to COVID-19," Dr. Starnes said. "We understand schools have requirements, but we need you to understand we do not want you to panic or rush in to be seen immediately after an exposure. Rushing to our urgent care locations puts a strain on our resources.”

The best thing you can do if your child was exposed is find a local testing-only site in the community or use an at an at-home testing kit.

Cough, fever, runny nose, sore throat, body aches, headache, vomiting and diarrhea are all common symptoms of COVID.

For children over the age of 3 months, these symptoms can typically be managed at home with symptomatic care. Medications such as acetaminophen or ibuprofen can help with fever and pain. You should encourage your child to drink plenty of fluids and it is ok if they do not have much of an appetite.

Parents should seek care for their child over 3 months of age if they have had 5 days or more of fever, difficulty breathing, inability to keep fluids down or stay hydrated (no tears or no urination for 8 hours or longer) or if their child is having pain or fever that is not helped by an appropriate dose of fever reducer/pain reliever.

Patients under 3 months of age who are sick should be seen in person and evaluated.

Also, if there is at least one known positive case at home and others are sick, it can be assumed that all have COVID and everyone needs to isolate at home for 10 days from the start of symptoms.

“We cannot magically create hospital beds at the drop of a hat,” Dr. Whitworth said. “Wear a mask no matter if you’re vaccinated or not, wearing a mask is not an option.”

Like an earthquake rumbling underfoot, crumpling the ground beneath, the suicide of a loved one has a way of knocking you to your hands and knees.

After the initial shock wave throws you, constant aftershocks of emotions—running the gamut from guilt to shame to horror to inconsolable sadness—may leave you struggling to regain footing long after your loved one has died.

Survivors of suicide often experience a complicated type of grief that differs from other types of bereavement, mental health experts say.

“With suicide grief, they’re dealing with a trauma on top of the loss,” says Sharon Walker, LCSW, a therapist in Arlington who specializes in complex trauma and trauma grief. “With most people who die by suicide, it’s usually violent or tragic in some way. So, the person grieving has to deal with the fact that a person chose to take their life and that how they died. That changes the grief process.”

Walker, a former longtime-facilitator of the support group Survivors of Suicide (SOS) in Fort Worth, says another dynamic comes into play—the social stigma attached to suicide.

“Death can be tragic, like a murder or a car vehicle accident. But the stigma around suicide still exists today, and so family members have to contend with that piece, as well,” she says. “It makes their grief different.”

In April 2020, the Centers for Disease Control and Prevention (CDC) ranked suicide as the 10^th leading cause of death based on its most recent data collected in 2018. It was listed as the second-leading cause of death for Americans ages 10-34 and the fourth-leading cause for ages 35-54, according to CDC reports.

It has long been accepted that when someone dies by suicide, six people are directly affected by it. But a researched-based estimate published on the American Association of Suicidology’s website suggests the ripple effect of one suicide extends far past that, personally affecting 135 people on average. Based on that, an estimated 6.9 million people are touched by suicide annually.

The Alliance of Hope for Suicide Loss Survivors, an international non-profit group that operates an online support group, lists the dynamics that can complicate suicide bereavement on its website. The factors include circumstances surrounding the loss; post-traumatic stress; stigma and isolation; prejudices involving suicide; investigations into the deaths; religious and spiritual beliefs on suicide; family and relationship tensions; and survivors’ questions about why their loved ones chose to take their own lives and whether they could have done something differently to prevent it.

Through her years working with suicide survivors, Walker has seen families experience all of these dynamics. And some, even more than a decade later, still wrestle with them.

“Grief is not something we ever get over, and it doesn’t ever stop. What we learn to do is grow around our grief, to encompass it and incorporate it or manage it into our own life,” she says. “We walk with it.”

When talking with families and friends facing a loss from suicide, she reminds them that they can get hijacked by their grief. And that everyone has their own process of grieving the loss.

“Every time you turn around—there’s a reminder, there’s a statement, there’s a feeling, there’s an emotion—and you are overwhelmed by your grief,” she says. “And as we walk with this, and you learn to understand your own grief process, it becomes something that you can manage.”

“It’s not that the grief gets smaller, but you grow big enough around it to start being able to manage it,” she says. “And then you can take it off the shelf and touch it when you want. It becomes something that you can eventually manage and live with and incorporate in your life. But as far as ever getting over it, there is no such thing.”

Many suicide survivors circle back to help other survivors find their way out of the devastation caused by a loved one’s suicide. They take the energy from their own grief and put it toward helping others, Walker says. The success behind the SOS group she ran for 18 years was because survivors returned to give back “because they knew how devastating it was to other people.”

“And the very act of sitting there and saying, ‘You can survive this. We didn’t think we were able to either, but we’re here to help you know that you can.’ Well, as a professional, I cannot convey that any more brilliantly than what a survivor can to another survivor,” she says.

Just Breathe

Brad Hunstable, CEO of electric motor company Linear Labs in Fort Worth and an Army veteran, understands firsthand the complexities that grieving families face after losing a child to suicide.

Nothing prepared him for April 17, 2020, the day a figurative “nuclear bomb” went off in his world, altering it forever. Hunstable had just finished a call when his daughter, then 8, ran to him, telling him something was wrong with her big brother Hayden. The 12-year-old had been playing his favorite video game Fortnite in his bedroom while his dad worked from their Aledo home.

Hunstable rushed upstairs to his son’s bedroom and found Hayden in the closet, unresponsive. He called 911 and tried unsuccessfully to revive him. Hayden—described as a fun-loving, active boy who enjoyed playing sports and loved life––died by suicide four days shy of his 13^th birthday.

Hayden didn’t suffer from depression or have any diagnosed mental health issues. No one could have predicted he would take his own life, his dad says.

Hunstable believes isolation during the initial COVID-19 stay-at-home mandate—attending school online and not getting to see friends regularly—took a toll on his son and factored into his impulsive decision to end his own life. It was also later discovered that Hayden had accidentally broken a large-screen gaming monitor just before his death—a monitor he used to play Fortnite and similar to one he’d broken months earlier but had worked to replace.

He was excited about his new replacement monitor and was set to have friends over to play Fortnite at his upcoming birthday party, says his dad, who founded Hayden’s Corner, which advocates mandated resilience classes for children and champions responsible gaming education, in honor of his son.

Hunstable—who also produced a short documentary about Hayden’s death titled “Almost Thirteen”—has spoken to various mental health experts about youth suicide and believes impulsivity plays a huge role. (Parental guidance and discretion is advised when watching Hunstable’s documentary because the disturbing subject matter may cause emotional distress.)

“When you look at youth suicide, 55% of them are impulsive and 50% don’t have a previous mental health diagnosis,” he says. “They may have something, but it’s not diagnosed. Impulsive suicide in youth happens because a boyfriend broke up with me…I got into a fight with my parents…a girlfriend just broke up with me…I’m being bullied.

 “In Hayden’s case, he broke his monitor for a second time right before his birthday, in the middle of a pandemic,” Hunstable says.

Developing resiliency is key in addressing suicide among children and teens, he says.

 “It’s always complicated. It’s never simple,” he says of life and what sometimes leads young people to impulsively choose suicide. “When you get the perfect storm of complexity, and they haven’t developed some resilience capabilities—and you haven’t taught them or had open dialogue about these things or it’s just too much—this is where you end up.”

Hunstable believes parents need to have “uncomfortable conversations” with their children about suicide so they know how to cope if the impulse ever hits them. Research shows that bringing up the topic of suicide in an age-appropriate manner does not plant the idea in children’s minds, he says, adding “that’s a myth.”

Find a way to help them contend with their emotions and impulses, like teaching them breathing techniques, meditation, playing guitar or screaming into a pillow, he says. Let them know it’s okay to talk about it, Hunstable adds, and if it happens when you’re not around, teach them to go to a trusted adult like a teacher or a grandparent.

What would he say to parents who are hesitant to discuss suicide with their children and methods to cope with their feelings?

“I’d say, ‘Do you want to be in my shoes?’ My son disappeared off the face of the Earth. I still struggle with that concept. He was there one minute—and then he went poof. You don’t want to do this,” he says. “It has nearly broken me. It nearly broke my family. It still might.”

“Hayden doesn’t have PTSD—we have PTSD,” Hunstable says of himself and his daughter, who found her brother. “I know it sounds like a cliché because I used to think the same thing. I’d hear parents say, ‘It can happen to your kid.’ Now, I’m that parent, saying that it can happen to your kid. And what’s scary is—it really could.”

Open up

Jamye Coffman, M.D., medical director of The Center for Prevention of Child Abuse and Neglect at Cook Children’s, knows firsthand it can happen to anyone. She lost her son Aaron, 20, to suicide on Aug. 10, 2010.

“I’ve been very open about his death, open about his suicide. And what I’ve found is that a lot of people came to me with similar stories, maybe it wasn’t their child, but with suicide in their family,” she says. “I was amazed at how many people have been touched by suicide. I think they just don’t talk about it because they don’t know how people will receive it.

“I want to talk about it because I want people to know it can affect anybody,” she says. “The rain falls on everybody, right? It doesn’t matter how good, how bad, how rich, how poor––none of that matters.”

Dr. Coffman still recalls getting the call while on vacation as she, her husband and daughter were about to enter Yellowstone National Park. The news sent her and the rest of the family reeling.

Less than a week before his death, she’d been on the phone with him. He was living and working in Lubbock, where his dad, her ex-husband, lived. He wanted to go to community college, so the two had discussed plans.

She didn’t know until after his death that his girlfriend had dumped him just before the suicide. He’d been drinking heavily that night and called a friend, who urged him to call his mom. But he never made that call.

“Obviously, he wasn’t thinking straight,” she says. “He was angry, upset, drunk, sad––all those things. But at the time, nobody really expected this to happen.”

Dr. Coffman wears a necklace with the letter “A” in memory of Aaron, who “gave the best hugs ever.” She describes him as “a super loveable guy,” who was a daredevil and enjoyed skateboarding. He was accepting of others and a good friend. He also was a great big brother to his half-sister, who was seven years his junior, she says.

“He was just a sweetheart. He would call me at times just to chat, which most boys don’t do,” she says, adding the step-family issues caused tension at times, as did Aaron’s troubles with alcohol and marijuana. “Sometimes things were strained, but we still managed to maintain a relationship through all that. We knew we loved each other.”

After Aaron died, Dr. Coffman says the pain was terrible, especially that first year. She wasn’t sure she could endure it and often found herself in her closet, her designated “crying spot.” She spent a lot of time in that closet, she says.

 “When it happens, initially, you don’t think you’re going to survive it,” Dr. Coffman says. “There’s no way around it…you have to work your way through it and own it. But even though you do, it still never goes away.

“It does get better,” she adds. “The really bad moments hit you less and less as the years go by. There are less triggers. I think it was the five-year mark when I figured out, ‘I can survive.’”

She also keeps a piece of paper tacked to a corkboard on her office wall. She doesn’t know who wrote it or even where she found it, but it has made a difference to her as a suicide survivor.

The typed words on the paper are simply put:

I don’t like it.

I don’t have to like it.

What I do have to do is make a choice about my living.

What I do have to do is accept it and go on living.

The choice is mine.

Dr. Coffman has read those words daily for more than 10 years as a reminder that the choice is hers.

Tackling the magnitude of this type of grief is different for everyone, she says. Some people do well with therapy, while others may not. Some may do better with families and friends who are present and just sit and listen. Try different things until you find what works for you, she says.

Something she learned early on at a grief support clinic and has found to be true is that there are three camps of people: Those who are hurtful. Those who are neither hurtful nor helpful. And those who are helpful.

“Go to the helpful, avoid the others,” she says for those grieving the loss of a loved one’s suicide. “There were some people that I had to just not communicate with because things they said were hurtful––things they didn’t mean to be hurtful. But, you know, things like, ‘God has a reason for everything.’ Well, when you have somebody die, there isn’t a good reason. That’s not helpful.”

What was helpful for Dr. Coffman was a supportive family and friends. Those who didn’t try to fix anything but would listen when she needed to talk and let her cry when she needed to cry. It made the difference because “it was somebody who really understood me, understood Aaron,” she says.

The family also continues to talk about Aaron, which was important, she says. They still laugh together about the “silly things he did.”

“Whether it’s the cousins or my parents or his brother or sisters…we still have memories and talk about them,” Dr. Coffman says. “I think that’s important––to keep that person alive in your heart. And I think it’s one of the hardest things for people who’ve not experienced something like this. They don’t want to say their name or talk about it because they’re afraid it’ll bring up something bad for you. Well, the bad is always there. But knowing people still remember him and can talk about him and remember the fun things about him, that’s important.”

Like many parents who lose children to suicide, Dr. Coffman also struggled with self-blame and guilt after her son’s death and battled her share of “what-ifs.” She needed reaffirmation that she was a good parent and a good person. That affirmation came from a woman who worked as a secretary at Cook Children’s Emergency Room at the time of Aaron’s death. The woman, who lost her brother to suicide, sent Dr. Coffman a letter, which she says she carried in her purse for many years.

In the letter, one of the things the woman wrote was, “We do the best we can with what we know at the time.” It’s a message that applies to most everything, she says, but as a grieving parent who lost her son to suicide, it was really helpful.

“I had to remind myself of that over and over because any mistakes I made as a parent weren’t intentional. They were done because I thought it was the right thing to do,” she says. “So, hearing that from her, in what she had gone through with her brother…when I would get into the depths of guilt, I would have to preach that to myself, and I would pull out the letter and reread it.”

The death of Aaron has had a lasting effect on Dr. Coffman and her family. It changed every part of her, and it was for the better, she says.

“I don’t think I could ever be the same person,” she says. “I always tell people it has changed me down to the molecular level. It affects every part of you. It can get changed for the worse…you can become bitter. Or you can choose to change in the sense of ‘let me learn from this, let me see what ways I need to change to be a better person.’”

After his death, she did a 180-degree turn on her parenting style “because it changes your ideas of what’s important and what’s not important,” she says. She became more accepting of others, something her son excelled at. And though she thought she was already a kind person, his death helped her become even more so, Dr. Coffman says.

She wants her son to be remembered and encourages others to talk to suicide survivors about their loved ones. It’s one of the most important parts in their healing process.

“It may help them to know that someone else is thinking about their child and has fond memories. And that that person, like Aaron, affected their life in a good way,” Dr. Coffman explains. “Especially when they die young and haven’t had the opportunity to really do a lot. But, even in a short life, they made a difference and still make a difference. Because (Aaron’s life and death) changed me. It changed my husband. It changed my daughter. It changed us to be better people.”

You matter

North Richland Hills resident Ellen Harris understands that sentiment. She lost her 22-year-old daughter Jordan to suicide on March 27, 2012.

Not long after, she and her husband Tom started The Jordan Elizabeth Harris Foundation to ensure their daughter would be remembered. The Fort Worth-based non-profit group focuses on suicide prevention training and awareness, as well as funding research efforts in depression.

“There’s no question that the foundation was and continues to be therapeutic for us because it’s our way to honor her life,” Harris says. “And to bring awareness to a subject that people weren’t willing to talk about.”

Jordan was a former valedictorian and National Merit Scholar in high school and named a Stamps Scholar at the University of Michigan, where she was about to graduate with a degree in organizational studies, a field that focuses on social justice. She had been diagnosed with depression the last six months of her life, which came as a surprise to the Harris family.

None of them would have described her as depressed. Instead, Harris used adjectives like “loving and joyful,” “funny,” “smart” and “full-of-life” to describe her eldest child of three, who loved to travel and help others.

“She didn’t want to worry us, so she never let on. I can remember my brother-in-law over Thanksgiving making the comment that she was the happiest depressed person he had ever known,” Harris says. “So, deep inside, she was struggling, and none of us knew the extent.”

Jordan had done well in college but wasn’t sure what she would do after graduation. She had high-performing roommates and friends who “all seemed to know what they wanted to do. And she didn’t, which weighed on her heavily,” her mom says. “I think she believed she was a failure.”

She had told her mom she was a disappointment to the family and hadn’t done much right in life. Which couldn’t have been farther from the truth, says Harris, adding she has no doubt her daughter was dealing with mental illness at the time of her suicide.

 “She became severely depressed, only I didn’t know what that meant,” she says. “I didn’t know what depression looked like.”

Looking back, she also believes Jordan had “hit a bump in the road” but didn’t have the resilience to overcome it, Harris says. Her daughter had excelled academically, had lots of friends and was pretty. Even though she worked hard for her grades, she hadn’t had to struggle for most of her young life, Harris says.

“I think resilience is a huge part of protection when it comes to suicide,” she says. “That’s part of my theory. I think she just didn’t have a good personal resource for bouncing back when she dealt with adversity.”

“It’s really important that children do (face adversity), even if it’s breaking up with a boyfriend or having acne or something that causes you to struggle a little bit,” Harris says. “I think you need to let your kids fail and figure out how to succeed again without you fixing it.”

Jordan’s death left an “enormous hole” in her heart, Harris says, and she faced a difficult time, especially in the early days. She still can’t watch a video of her daughter, and “I don’t know how long it took me before I could even look at a picture of her without feeling crushed,” she says.

For suicide survivors, it’s important to get a support system in place to help them because the suicide rate for people who have lost someone to it is higher compared to the general public, Harris says. While trying to cope with Jordan’s death, she and her husband tried therapy and various grief support groups but acknowledged that neither of them is much of “a sharer.” Reading books about people who had experienced what she had seemed to help her, she says.

And she immediately put her son and daughter, who were both attending the University of Texas at Austin at the time, into therapy to help them deal with Jordan’s suicide. Both were extremely close to her and devastated by her death. That seemed to help them cope with the loss of their big sister, Harris says.

“Whether it’s going to your church or wherever you find comfort, I think it’s important” to get support, she says.

 It took more than a year for Harris to feel comfortable in large social groups.

“I hated the look in people’s eyes, you know, how sorry they were but how glad they were that it wasn’t them. I mean, let’s face it, that goes through people’s heads,” she says.

Harris also saw firsthand the social stigma attached to suicide. One of the foundation’s missions is to address that issue. From the beginning, she and her husband didn’t try to hide that Jordan had taken her own life. So many people with similar stories approached her, but they had never let on about what really happened with their loved ones, Harris says.

“I think death and serious illness, in general, kind of bring out interesting traits in people,” Harris says. “There were people who didn’t come around and didn’t call because they were obviously uncomfortable with what had happened and with the subject of death, perhaps, and especially the death of a child.”

“But there were other people, who were not necessarily our best friends, who just really stepped up and supported us,” she says. “Some people don’t know how to talk about things like that, and death especially is a really difficult subject. But death by suicide––there’s still such a huge stigma attached to it.”

The foundation’s goal is to have conversations with the public to eliminate that stigma and create an understanding of what’s actually behind the act of suicide. For instance, a common misconception is that those who die by suicide are just selfish, Harris says.

But, in their minds, they’re doing the opposite of selfish, she says. Many of those who kill themselves think they’ll be a burden to their loved ones for the rest of their lives and everyone would be better off without them. With the love she had for her family, Harris says, Jordan wouldn’t have taken her own life if she had been thinking clearly or really understood what her family and friends would face for the rest of their lives.

“It’s not a selfish act on their part,” she says. “This is reaching a depth of hopelessness so deep that they can’t even see anything except how they get out of this pain.”

“They don’t want to die,” she adds. “They just don’t see any other way out.”

“She was always so happy. Everybody was her friend,” said Mary, Julia’s adoptive mother. “She did not know a stranger.”

Julia was the kind of person who trusted people easily. So years later, when a young woman reached out to her on social media, she didn’t think much about the individual wanting to be her friend. She began to correspond and eventually started meeting her at a local park where Julia liked to skateboard.

“We were so protective of her, and only started letting her go to the park by herself when she was 17,” said Mary. “Still, I would drive around to check on her. She would always say, ‘Mom, why are you always worrying?’ I would tell her, ‘That’s my job.’”

Mary was worried about the new friend in Julia’s life. Something seemed off. But, like most teenagers, Julia didn’t want to listen to her parents. After all, she had finished high school early and was working toward her dream job as a nursing assistant. Julia completed school in December, but hadn’t graduated yet. It was the week of prom when Mary last heard her daughter’s voice.

“She called me after her job interview and told me how it went, and then she said, ‘I’m going to stay with my friend for a couple of days, but I’ll be back in time to do prom stuff later this week,’” said Mary.

At the time, Julia was 18 and Mary knew she couldn’t tell her daughter what to do. Still, she didn’t like the plan.

“I said, ‘Okay, I can’t tell you not to, but I don’t want you to go,” she explained.

At 7:30 the next morning, two state troopers arrived at Mary’s home. They told her and her husband that Julia’s body had been found on a tollway in Dallas. From there, the truth about Julia’s friend unraveled. She was what law enforcement officials call a “bottom girl,” someone who manipulates and baits vulnerable victims into human trafficking. It turned out that Julia’s ‘friend’ had been paid by a human trafficking ringleader to deliver the teen for commercial sex trade. Mary believes Julia was thrown out of the vehicle when she would not comply.

Julia died on May 2, 2018, just 20 days before her graduation.

“Two hours later, my phone rang. It was the person who interviewed Julia calling to let her know she got the job,” said Mary. “That broke my heart all over again.”

This month, a grand jury in Collin County is expected to hear the case against the ringleader charged in Julia’s death. If the grand jury decides to indict, Mary says it will be the first ‘Death by Human Trafficking’ trial in Texas.

Mary and Chris are hoping their daughter’s death can save the lives of others. Working with Rep. DeWayne Burns, R-Cleburne, they’ve created a bill that, if signed into law, will require driver’s education students across Texas to be educated about human trafficking. It’s called ‘Julia’s Act.’

On April 7, Julia’s family testified in favor of the act in front of the House Committee on Licensing and Administrative Procedures. In an uncommon move, the act was voted out of the committee the same day, setting forth a high probability it will move to the full Texas House for a vote.

“People need education. They have to know that this happens. I wasn’t educated, and now I’m looking every day to see what else I can learn,” said Mary. “I felt like, if we could get it into the schools, then maybe kids would listen since it’s coming from someone else besides their parents.”

What is Human Trafficking?

A lot of confusion exists about human trafficking. It is not the same as human smuggling, and it rarely involves victims being kidnapped at random. Human trafficking is the process of “trapping people through the use of violence, deception or coercion and exploiting them for financial or personal gain.” Trafficking victims can be exploited for sex and/or labor. It occurs anytime anything of value is exchanged for sex, such as money, food, shelter or gifts.

At Cook Children’s Medical Center, the Child Advocacy Resources and Evaluation (CARE) Team treats human trafficking victims under the age of 17.

“Usually, these are kids who have already been abused. They may have a history of sexual abuse, or are runaways because they don’t have a stable home or are in foster care,” explained Stacey Henley, RN, nurse manager of the CARE Team. “We also see a lot of LGBTQ kids whose parents kicked them out because of their sexual orientation.”

Henley describes human traffickers as ‘master manipulators’ who prey on the vulnerable.

“They are really, really good at understanding human needs and behaviors,” said Henley. “I know that sounds crazy to say, but they are looking at what the person needs, whether it’s love, food or a place to live and they’re fulfilling that need.”

She says knowing how many human trafficking victims are out there is nearly impossible because it’s heavily underreported. Part of the issue is that those being exploited often don’t see themselves as victims.

“A lot of times, the victim will say the trafficker is their boyfriend. They’re being manipulated, which is part of the problem because often teachers and medical professionals are looking for someone who’s wide-eyed and mouthing, ‘Help me,’ but that’s not what happens,” Henley said. “They’re not going to say, ‘I need help, get me out of this,’ so we have to look for other clues.”

To aid with this, Henley is leading the implementation of a child sex trafficking screening tool currently in use at Cook Children’s. Her hope is that a few questions asked by clinical therapists may uncover victims hiding in plain sight.

She also points out that human trafficking is a form of child abuse and should be treated as such. Sadly, the CARE Team has seen many cases of parents trafficking their own children, usually for drugs.

“It’s really sad. The best thing we can do is get them into a stable environment and help them get the resources they need for counseling,” said Henley.

Taking Down Predators

The Human Trafficking Unit at the Tarrant County Sheriff’s Department is dedicated to taking as many predators off the streets as possible. With three investigators and a lieutenant, the unit carries out operations each month focused on helping victims and arresting human traffickers and their clients.

“When we find people who are being trafficked, we look at them as victims and set them up with an organization called Unbound Fort Worth that will help them get out of that situation,” said Detective Chris Jarvis, an investigator on the Human Trafficking Unit.

The unit also performs operations focused on the online solicitation of minors, in which they go undercover online posing as children. Detective Jarvis says they regularly catch adults who are trying to solicit sex from kids on the internet.

“Parents need to be involved with what their child is doing online,” he said. “Check their phones, make sure you’re reading their messages and know who they are talking to.”

He says some of the apps that predators use most often include:

• Facebook
• Kik
• Instagram
• Whisper
• Grindr
• Skout
• Meet me

“These are some of the biggest sites that children get on. People can go on there and talk to your child. The more experienced ones can actually find locations, even without asking,” said Detective Jarvis.

This situation is not unusual to the CARE Team at Cook Children’s. Though not always through human trafficking, young patients are frequently seen after being sexually assaulted by an adult they met online.

“I recently saw a victim who met a man on Whisper. It happens, and parents need to be looking for these apps on their kids’ phones,” said Henley.

If lured into human trafficking, Detective Jarvis says it can be extremely difficult to escape. He says traffickers isolate victims from friends and family members, take them to places that are unfamiliar and watch everything they do. They also tattoo victims as a way to brand them. Common human trafficking tattoos include bar codes, lips, cartoon characters, initials and crowns.

Life expectancy for human trafficking victims is much lower than the average person. They’re often murdered or suffer the detriments of drug use and sexually transmitted diseases. That’s why it’s so important to get victims the help they need to overcome the manipulation, which often involves long-term counseling.

A Problem Everywhere

Christi Thornhill, APRN, director of the Trauma Program at Cook Children’s travels all over Texas speaking to medical professionals about human trafficking. She says there’s not a place she’s been that hasn’t seen this problem.

“Before I speak to a group, I always Google ‘human trafficking’ and the name of the town and it never fails,” said Thornhill. “I was in Mineola, Texas, with a population of 5,000 and found an article about a bust.”

She’s also seen victims from upper-class communities like Southlake and agrees that the hardest part about this crime is the manipulation piece.

“We’ve had people from all walks of life arrested for paying for sex with young victims. Police officers, judges, coaches, doctors, clergy members, teachers. Do you really think these kids are going to tell anyone?” she said.

Thornhill points out that believing claims of sexual abuse is one of the key things that people can do to prevent a child from falling into human trafficking. She says children who are sexually abused, but not believed by their adult caretaker, stand to suffer mentally, including loss of self-esteem and self-worth, making them easy prey for traffickers.

In addition to monitoring what children and teens are doing online, parents need to know who their kids are hanging out with.

“We’ve seen cases where kids are being recruited in schools, so it’s really important to be aware of what your child is doing and who they are friends with,” said Detective Jarvis.

It’s also important to note that not all trafficking victims are runaways or missing. The CARE Team at Cook Children’s has seen cases where kids are being trafficked while still living at home with their parents.

“I’ve seen kids who have been trafficked after school, but still make it home and sleep in their own bed at night,” said Henley. “When someone is profiting from someone else having sex with a child, that’s trafficking.”

Fighting Back

You can help deter human trafficking by keeping an eye on your neighborhood. Watch for suspicious activity such as multiple cars coming and going from homes, as well as different people at all times. If you see something strange, call the police.

Red flags to watch out for in kids include:

• Missing school
• Changes in demeanor and attitude
• Odd tattoos
• Seeming like they can’t make a decision or are being controlled

“It takes a community to keep an eye out and be aware of this,” said Detective Jarvis. “We can’t do it alone.”

As for Julia’s parents, they are continuing their push for human trafficking education and hoping to extend the requirement for all state license holders. They’re also hoping to enact stiffer penalties for those convicted of human trafficking.

“The thing that really got me is that we are in a small town,” said Mary. “But going through the process and learning what I’ve learned, it doesn’t matter where you live. These people are looking for anyone willing to talk to them, and they prey on the brokenhearted.”

One year into COVID-19, it’s clear the pandemic is taking a toll on the mental wellbeing of children and teens.

In March, a record 43 patients were admitted to Cook Children’s Medical Center after attempting suicide. This staggering figure is nearly double the number of suicidal patients seen during the same time period of 2020. Even worse, kids are dying. Last year, Cook Children’s recorded seven suicide deaths, marking the first time suicide was the leading cause of trauma deaths at the hospital, surpassing child abuse and car wrecks.

“The mental health crisis was already happening, then it met a global pandemic and these are the consequences,” said Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s.

“They’re less engaged and have less interaction with others, and instead are spending more time online and in virtual settings. And it’s hard for them to be hopeful about anything because so many things, like prom and graduation parties, are canceled.”

The issue is not unique to North Texas. Doctors and nurses from across the nation are reporting similar statistics. In February, NPR released an article titled “Child Psychiatrists Warn That The Pandemic May Be Driving Up Kids' Suicide Risk.” It found that children’s hospitals across the U.S. are seeing up a 250% increase in suicidal patients in emergency rooms since the pandemic began. While there are no nationwide numbers on child suicides in 2020 available yet, experts agree there is reason to be concerned.

The Impact

More children are suffering from stress, anxiety, depression, and suicidal thoughts than at any time in recent memory. Pediatricians like Kathleen Powderly, M.D. from Cook Children’s Pediatrics Magnolia say children as young as 7 are needing help.

“I’ve had a couple of elementary school students, which you don’t see very often, who are actively suicidal or have already had a suicide attempt. I’ve also managed more kids on antidepressants since the pandemic because it’s hard to get into doctors right now,” Dr. Powderly said. “COVID-19 is not as impactful in terms of volume of cases in pediatrics, but our volume of psychiatric patients has increased quite a bit.”

Previously, Dr. Powderly was the medical director of Cook Children’s Hospitalist Group, the attending physicians who care for children in the hospital. She says her team was seeing an increase in suicidal patients before she transitioned into the office setting five years ago and that the pandemic created a perfect storm. On top of the stressors kids were already dealing with, they’re now struggling with isolation, virtual school, and a loss of activities.

“We’re not going to be able to flip the switch and just go back to normal when this is over,” said Dr. Powderly. “This is going to take some time to come out of. I’ve even had patients tell me they’re struggling with being around people.”

Members of Cook Children’s Youth Advisory Council shared similar experiences in a recent meeting. The teens said they feel more anxious being around their friends in person because they’re so used to only seeing people online now. In addition to new stressors, there is a severe lack of mental health resources across the board.

A Growing Need

“There weren’t enough psychiatric beds to begin with, and then COVID happened and the capacity was reduced because you can’t have patients sharing rooms,” said Dr. Pyrc.

The need for more inpatient psychiatric beds for children and teens has been known for years. In 2017, Cook Children’s opened the Rees-Jones Behavioral Health Center to help address the issue. The unit has 15 inpatient beds available for children between the ages of 2 and 12. As we reported when the center opened, the kids who end up here are patients with complex trauma, medical and social needs. They are often suicidal or have tried to hurt someone else. Eight out of 10 have had something traumatic happen to them. They have either been abused physically or sexually, or they have experienced some sort of neglect.

Teenagers who need inpatient psychiatric care have to be treated elsewhere but often end up waiting on the medical floor of Cook Children’s until a bed opens up in the community, which can take days. With more kids needing these services, it’s not uncommon for Cook Children’s to have a dozen or more patients waiting in a regular hospital room for a transfer to a psychiatric facility that can care for them.

“There are just not enough resources in general,” said Dr. Pyrc. “It’s an awful place to be in. This is a national problem, but it affects us here locally. We need more funding and we need more mental health professionals to care for these patients.”

On the outpatient side, finding a licensed therapist to see a child can take months. The waitlist just to see a counselor at Cook Children’s can be as high as 250 days at any given time. Even with easier access to appointments with virtual visits, there are not enough mental health professionals to meet the need.

Kia Carter, M.D., co-medical director of Psychiatry at Cook Children’s, has been a vocal advocate for increased mental health funding. Testifying in front of the Texas Senate’s Committee on Health and Human Services recently, she said early identification, intervention and treatment is essential to preventing further complications from mental illness. But there are roadblocks.

“We get insurances denying a specific level of care saying that a child doesn’t need an inpatient level of care. We also get a lot of pushback about medication,” Dr. Carter said.

She also asked lawmakers for increased support and to consider giving mental health care providers more leverage with insurance companies.

Hoping for JOY

In the meantime, Cook Children’s aims to bring awareness to the mental health crisis affecting children and teens with the launch of a new suicide prevention campaign.

The Joy Campaign is an acronym that stands for:

Just breathe.

Open up.

You matter.

“If we can just get kids to slow down, realize that what they are experiencing is temporary and that they have a long life ahead of them, I think we can make an impact,” said Dr. Powderly.

For the next month, Cook Children’s will be releasing a series of articles on Checkup Newsroom weekly that address many of the issues at play, such as the pandemic, the role of over-the-counter medications, social media, as well as how minorities and LGBTQ+ young people are impacted. We’ll also be speaking with families who have lost a child to suicide to examine the effects on parents and siblings.

If you feel your child might be struggling, here are some of the warning signs to watch for:

• Anger
• Declining grades
• Lack of concern about appearance and hygiene
• Changes in eating and/or sleep
• Self-injury such as cutting
• Less motivation
• Alcohol/drug use
• Acting highly anxious or agitated
• Recklessness
• Giving away possessions 

If you’re concerned about your child’s mental health, seek help early. Schedule an appointment with a licensed counselor. If your child is actively suicidal, call 911 or take them to the nearest emergency room.

Read this story in Spanish here.

The last few weeks have been hard, to say the least. Although the new year brought hope that we would begin to look to a “return to normal” after one year of the COVID-19 pandemic, things haven’t felt so positive. It is only natural to yearn for what once was - allowing my kids to participate in group sports without the worries. To do in-person learning without the fear that we will receive an email indicating our child was exposed to the virus, and to go on a dinner date with my husband (to make up for the canceled date from last year as the lockdown and worries began).

In the last few weeks, losing my own grandmother to COVID-19 reminded me of all the families that have experienced a loss of a loved one in the last year. Although this happens routinely as part of the cycle of human life, I am reminded that there has been “extra” loss of life, and likely many more families impacted by loss than would have occurred otherwise.

The loss of a loved one is experienced at different stages for most. A difficult part of this process sometimes goes unnoticed but is worth highlighting. Being a parent and responsible with the difficult task of explaining death to a child in a way that is developmentally appropriate is not easy.

The best way to approach this situation is to be aware of how children understand death and this will help you pick the right thing to say. It’s important to remember that even young children who don't understand death will react to grieving parents. Older children will themselves grieve. Parents should support their children through this process in order to resume their lives without significant distress or interruption.

Children have a different understanding of the finality of death. Your approach to discussing death will depend on your child's level of understanding of four main concepts of death:

• Irreversibility (i.e., death is permanent)
• Finality (i.e., all functioning stops with death)
• Inevitability (i.e., death is universal for all living things)
• Causality (i.e., causes of death)

Babies and Toddlers

Infants and toddlers do not understand death but do sense what a caregiver may be experiencing. It is important to take care of yourself and progress through your own grief while maintaining routines that will help foster healthy progress through the life event.

Preschoolers

Preschoolers see death as temporary. They are concrete thinkers and usually see things for what they appear and hearing things literally. It is important to avoid euphemisms like, "She has gone to sleep," or "…traveled to the great beyond." Children at this age cannot understand these phrases and can sometimes even generate fears about traveling or sleeping. Be prepared for this age child to ask again and again where the deceased is and or when they will come back. Always answer with a clear message, which of course can be softened with the mention that the memories will remain. At this stage, children typically have a hard time talking about what they feel and their fears may come out at unexpected times such as during play.

School Age

School-age children begin to understand death as a final event but can have difficulties understanding it is universal. Make sure to offer clear, simple, and honest explanations about what happened and allow them to ask questions. Help them when they have difficulties finding the right words to explain their feelings. At this age, they may not understand the causality of death and they may personify death. Sometimes at this age, they may worry they will be left alone and begin to think about the death of a significant caretaker. Things that are important to do at this point include:

• Remind your child that not everyone who gets sick will die.
• Reassure them of your health.
• Let them know how many people in their life care for them.
• Support children to do things to reduce their anxiety and be sensitive that they may not want to talk or think about the deceased because it is too painful.
• Take care of yourself and make sure you have support.

Adolescents

Adolescents understand death the way adults do but can have difficulties or be resistant to expressing their feelings. They begin to think abstractly and this can cause some difficulties which can lead to risky behavior or even guilt about being alive. Supporting teenagers in finding healthy ways to express their feelings is very important.

Being aware of normal responses to death, as well as signs that they may need professional help, is an important part of supporting the grieving child. Younger children can revert to immature behaviors or angry outbursts. These typically are a result of unexpressed emotions such as frustrations or confusion. In school-age children, difficulties concentrating, sleeping, or physical complaints including stomachaches and headaches can occur. Teens often experience a wide range of emotions including sadness, anger, guilt, and helplessness. Teens may either withdraw or do the opposite, and engage in risky behavior.

This time is difficult for the entire family and it is important to take the time for yourself to deal with the grief. Kids of any age can sense the emotions of a caretaker and respond accordingly. If you ever have a concern that the child is experiencing extreme symptoms and/or the symptoms of grief are not resolving, ask your child’s pediatrician for help.

Despite repeated calls from experts to lifeguard your child, 19 children have been rushed to Cook Children's for drownings and four children have died since May 1.

Corwin Warmink, M.D., medical director of Emergency Services at Cook Children’s, said parents and caregivers should take important steps to save their children from drowning, including taking CPR lessons.

"Seconds really do matter," Dr. Warmink said. "Quick, efficient CPR performed before EMS arrives has been shown to improve outcomes. Learning CPR should be an important part of any family's safety plan. You want to be prepared in critical situations."

Studies show CPR doubles the victim’s chance of survival. Learning CPR can save a child’s life by restoring breathing and circulation until advance life support can be given by health care providers. Please watch the following video from Steve Muyskens, M.D., medical director of the Cardiac MRI at Cook Children's.

Dr. Warmink describes drowning as the inability to breathe, normally due to submersion in a liquid, usually water. The outcome, including death, of the person who drowned depends on how long she or she is under water.

"Everything is based on getting oxygen to vital organs,” Dr. Warmink said. “The outcomes of drowning and the adverse effects are based on the lack of oxygen. The most effected parts of a drowning victim are the brain, lungs and the kidneys. The one that is most catastrophic and the one that will kill you is the brain.”

The amount of time children spend under the water while drowning usually determines their outcome. The lack of oxygen destroys brain cells and that causes damage to the brain, ranging from short term (forgetful, clumsy …) to severe (can’t walk to vegetative).

Dr. Warmink says there are several variables that shape how severe the brain damage will be, including how long the child was submerged in the water and how quickly he or she received CPR.

Once a child arrives at Cook Children’s Emergency Department, treatment begins that may include oxygen, X-rays, intubation or medication.

“But a lot of what we do is supportive care for the children that come in here,” Dr. Warmink said. “We may have to support their lungs because they have been damaged and they have difficulty breathing. Their kidneys could be damaged, so we will do lab work to see what’s going on there. But our biggest concern is the brain and honestly, there’s not a whole lot we can do. The vast majority of treatment for drowning is supportive. We see what we can do to keep that child alive. That said, the earlier you can intervene, the better. One of the things that helps outcomes is early, good CPR. By the time they get to us, it may be too late.”

Lifeguard Your Child 

It's time to make Texas #1 in drowning prevention. Drowning is the leading cause of accidental death for children ages 1 to 4, and the second leading cause for kids 1-14 in Texas. But with your help, we can change that. Please join us in our drowning prevention effort. Together, we can Lifeguard Your Child around water.

Want to know how you can get involved or create an awareness campaign in your community? Contact Dana Walraven, Safe Kids Tarrant County coordinator at 682-885-1619 or email safe.kids@cookchildrens.org.

More resources for you:

• Cook Children's Upcoming CPR Classes
• Project Adam
• Red Cross CPR Training
• Fort Worth Red Cross Safety Class, Including CPR
• American Heart Association
• Texas Heart CPR Training 
• DFW CPR Training Center
• Texas OnSite CPR
• CPR Training in Fort Worth, Texas
• CPR Training in Denton, Texas
• Drowning prevention page at Cook Children's
• Is your baby ready for swim lessons?

Much like Bowdy and Brock Shoff, Dr. Olvera's twin boys found themselves in a gut-wrenching situation after they were put down for a nap. They were 3 years old at the time and decided climbing on the tall dresser in their room would be more fun than sleeping.

"I had also laid down for a nap and heard a loud noise," said Dr. Olvera, pediatrician at Cook Children's Southwest Primary Care location. "When I ran in their room, one of the boys was trapped underneath the dresser."

She rushed the boys to her pediatrician's office, and luckily both were OK.

When she saw the story about the Utah incident on Checkup Newsroom, she posted the following message on Facebook:

Dr. Olvera's boys are 12 years old now, and the big brothers to twin sisters.    

Since 2009, Cook Children's has seen 137 furniture-related injuries. One child even died in 2014 as a result of furniture tip-over.

About the Source
Rebecca Olvera, M.D. is a pediatrician at Cook Children's Primary Care Location in Southwest Fort Worth. She has been recognized as a Mom-Approved Doctor by DFW/North Texas Child magazine in 2012, 2013, and 2014. Find out more about Dr. Olvera here.  

According to noheatstroke.org, 32 children have died in the U.S. as a result of being left in a car. In all of 2015, 24 kids died. 

On Sept. 21, 2016, a 7-month-old baby died in a hot car in Huntsville, Ala. The temperature was 94 degrees. The following day, a 4-month-old child died in Geronimo, Okla. The temperature at the time was 96 degrees. 

As anyone who lives in a state like Texas can attest, summer-like temperatures can occur even in winter. But it doesn’t take a scorching hot day for a child to be in danger. Heatstroke deaths have been recorded in 11 months of the year in nearly all 50 states.

“It truly doesn’t have to be a ‘hot’ day in Texas for a death to occur,” said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County coordinator. “The temperature inside a vehicle can quickly climb over 20 degrees hotter than outdoor temperature. So even a cool day in Texas can become dangerous very quickly. Since children’s body heat rises three to five times faster than adults, it’s important to know that temperatures can become deadly any time of year.

Heatstroke, also known as hyperthermia, is the leading cause of non-crash, vehicle-related deaths for children. It occurs when the body isn’t able to cool itself quickly enough and the body temperature rises to dangerous levels.

Young children are particularly at risk as their bodies heat up three to five times faster than an adult’s. When a child’s internal temperature gets to 104 degrees, major organs begin to shut down. And when that child’s temperature reaches 107 degrees, the child can die.

Because of this, and because cars heat up so quickly – 19 degrees in 10 minutes – tragedies can happen faster than you think. Symptoms can quickly progress from flushed, dry skin and vomiting to seizures, organ failure and death.

“We still have to get the word out that there’s never a safe time to leave your child in the car,” said Sharon Evans,Trauma/Injury Prevention coordinator at Cook Children’s, said. “We’ve seen children die in February. We hope people will take extra precaution in never leaving a child in the car.”

Safe Kids Worldwide says that heatstroke is the leading cause of non-crash, vehicle related deaths for children and that young children are particularly at risk as their bodies heat up three to five times faster than an adults’.

It’s hard to imagine someone forgetting a child is in the car, but human error, and people make these mistakes during their busy day-to-day lifestyle. Safe Kids recommend the “ACT” method to prevent tragedy to your child or to a child you see left in a car:

• A: Avoid heatstroke-related injury and death by never leaving your child alone in a car, not even for a minute. And make sure to keep your car locked when you’re not in it so kids don’t get in on their own.
• C: Create reminders by putting something in the back of your car next to your child such as a briefcase, a purse or a cell phone that is needed at your final destination. This is especially important if you’re not following your normal routine.
• T: Take action. If you see a child alone in a car, call 911. Emergency personnel want you to call. They are trained to respond to these situations. One call could save a life.

"This case just goes to show that you should never leave a child alone in a car," said Sharon Evans, Trauma/Injury Prevention coordinator at Cook Children’s. “We’ve seen children die in the winter months before. We hope people will take extra precaution and know that there's never a safe way or time to leave a child in the car.”

An autopsy shows the child's cause of death was hyperthermia, or being exposed to heat for a long period of time. According to deputies, the temperature inside the car swelled past 100 degrees.

Hyperthermia, also known as heatstroke, is the leading cause of non-crash, vehicle-related deaths for children. It occurs when the body isn’t able to cool itself quickly enough and the body temperature rises to dangerous levels.

Young children are particularly at risk as their bodies heat up three to five times faster than an adult’s. When a child’s internal temperature gets to 104 degrees, major organs begin to shut down. And when that child’s temperature reaches 107 degrees, the child can die.

"In 2015, 24 children died in hot cars across the country, which is the lowest number since records started being kept in 1998," said Evans. "It doesn't matter what the temperature is outside, if you see a child alone in a car, call 911 or break a window. Do whatever you can to help that child."

But recently, a mom wrote in for help, looking for advice to help her with a heartbreaking problem. Her husband is dying and she wanted to know how to talk to her young children about what her family would be going through in the very near future. For the answers, we went to our experts.

“It’s important to explain to children that a parent is sick, and it’s a type of sickness in which he or she will get sicker, not better,” Joy Crabtree, Psy.D., a licensed psychologist at Cook Children’s Urgent Care and Specialties in Southlake, Texas. “The dying parent should be involved as much as that person is able in terms of planning and engaging in special activities with the kids (together and separately) during periods that he or she is well enough to do so.”

Crabtree suggests lots of pictures be taken and the parent write special letters to each child to be opened later at specific ages or milestones. In the future, after the parent passes, there will be periods of grief that pop up and perhaps a sense of sadness or a feeling from the kids that they were robbed the opportunity to share proud moments or special occasions with both mom and dad.

“If that comes up, the kids can be encouraged to write those thoughts down, either randomly or in letter format,” Crabtree said. “They can simply keep an ongoing journal of what they wish they could tell the parent who died or even write it on a note and tie it to a balloon and set it free. They might keep a box of drawings or notes that they make for mom or dad.”

Crabtree suggest the children go into therapy and the dying parent join as well if possible to address and get support/guidance for questions/behaviors that are coming up for the kids. “There is certainly no guidebook or specific right or wrong way to handle the process,” Crabtree said. “It will be tough no matter what, but with open communication, sharing memories, and the understanding that all questions and thoughts are welcome, they can work through it together.”

Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Behavioral Health for Cook Children’s in Denton, said she has seen a family go through this first-hand. She said the young father did an “incredible job of leaving a legacy” for his 2 year old by writing a book for her and lots of letters for her at critical points in her life, such as starting kindergarten, middle school, high school, graduation, turning 13 and 16, getting married and becoming a mom. The parents also bought charms for their daughter to be given to her on those critical dates.

Lena Zettler, MA, LPA, director of Psychology at Cook Children’s, said finding the right words to describe what’s happening will be crucial to helping the child through such a difficult time and the way the message is delivered will depend on the age of the child.

• Very young children will not understand the abstract concept of death, and saying that “daddy is passing on” may be more confusing.

• Children should know that their parent will not be asleep, and some concrete things like “death happens when our heart stops beating."

• Kids will usually ask questions that they are ready to hear the answers to, so listen to what they are actually asking about and answer that. Most times they need more concrete answers than we expect.

• When answering, give kids some time to process … say a few sentences, and then wait until the child is ready to hear more.

“We often use a lot of words and kids under 10 may not be able to process more than a few sentences at a time,” Zettler said. “Make sure all the kids get the same info, but it may mean talking separately to the children if their age ranges are broad (example, a 3 year old and a 10 year old). Include both parents in the conversations if both parents able physically.”

Zettler says if you don’t know the answer to a question, it’s OK to say you don’t know (for instance, “How long can daddy play ball with me?”). Also, kids of all ages need the same information over and over again, so be prepared to have many conversations. They may ask you a serious question and after a brief, but accurate answer from the parent, they may go right back to playing and acting normally. That is OK … they are taking in the amount of information they can process at that time.

“Celebrate mom or dad’s life NOW while that person is still here; talk about what is happening,” Zettler said. “Don’t forget that kids need to play. That doesn’t change when something like this happens. In fact, playing is the best way that kids have to learn new coping skills.”

Remember to provide support for the children and notify caring adults at the children’s schools. There may be additional support that teachers, nurses and counselors can provide.

Read age appropriate books on grief/terminal illness together (parent and child, or as a family). Books on death may not seem relevant while the parent is “just sick,” but books on death/loss may be more helpful after the death. Zettler says examples of books on terminal illness and coping with that for kids are: “Beyond the Rainbow” and “Help me Say Goodbye.”

Zettler says some children may struggle academically early on. Some kids, however, may seem less disrupted and more able to keep up their school work. That doesn’t mean they aren’t grieving, or that their academics may not suffer later. If they are getting behind academically, and they have not had school problems, before, don’t panic. They will catch up. If they have had problems before in school, definitely reach out to school personnel and consider getting the help of a psychologist or therapist.

“Kids will be afraid, unhappy and may act out more than usual,” Zettler said. “Don’t see this as abnormal or behavior ‘problems.’ You can still enforce rules especially if kids get aggressive but be patient with each other. Try to help them find words to express their feelings. Tell them that it is OK to have feelings. Reassure kids with words, with your presence, and with other comforting things like maybe a stuffed animal. It is OK if they “regress” during this time and do things they stopped doing when they were younger. If they really struggle with this or with difficult behavior, see a psychologist or therapist who has experience with pediatric grief or loss.”

Resources

“Preparing Your Children For Goodbye: A Guidebook for Dying Parents” by Lori Hedderman.

http://www.centerforloss.com/wp-content/uploads/2014/10/A-Childs-Grief.pdf

http://www.cancer.org/treatment/childrenandcancer/helpingchildrenwhenafamilymemberhascancer/dealingwithaparentsterminalillness/dealing-with-a-parents-terminal-illiness-toc

About our sources

Cook Children's Behavioral Health services provides a broad range of care that focuses on children from ages three years through 17, and their families. We also have some limited services available for children age 2. 

As part of family-centered care all of our professionals are qualified both through education and experience to work with children who have behavioral and emotional challenges. Our psychiatrists are board certified in child and adolescent psychiatry and our psychologists and therapists are all licensed independently in Texas.

To access any of our services, please contact our Intake Department. To expedite your call, please have your child’s date of birth and insurance information ready.

School physical season is one of my favorite times of the year for many reasons:

• It’s really fun to see kids grow up and get big over time.
• I love watching my patients’ personalities mature.
• I love that the visits become progressively more about my relationship with the child in addition to my relationship with their parents.
• For the most part everyone is healthy and happy.
• For most children, the promise of a new school year and new beginnings is exciting.

I have a few things on my agenda for each back-to-school checkup.

I want to talk about diet, exercise and sleep. I want to talk about how school went last year and what the plans are for the upcoming year.

But checkups are more than just about what I want. In order for the checkup to be a success, it must meet the goals of the child and parent. Parents are all over the place when it comes to their expectations for physicals.

Here are just a few examples:

1.“Let me get out my list.”

Whether your weapon of choice is a spiral-bound notebook or long thumb-scrolling iPhone lists, you know who you are. And frankly, I love you. Having a guide that directs the visit through any questions and concerns that you have is beyond helpful. It keeps me from having to talk about stuff that’s not important to you and wasting both of our time. So, bring it on, Listers, and I promise not to roll my eyes.

2.“I’m just here to get my form signed.”

No worries. That may be all you need and that’s great. In the meantime I can provide a quick screen for height, weight, body mass index, high blood pressure, heart murmurs, risk for sudden cardiac death, hearing and vision (and much more). I can also screen for drug/alcohol abuse, depression, attention problems and other school issues. “Here’s your form, thanks for coming in.”

But seriously, even in those children who come in with no apparent concerns or complaints, we do pick up health problems that need to be addressed to maximize your child’s ability to function well in school or compete at their best in their chosen activity.

3.“I’m not worried, but __________ wanted me to ask about __________.”

This is a tricky one. I’m totally cool with it, but it can be hard to get at exactly what the concerns is if that person isn’t there to ask questions. My advice … if that person is close enough to be providing this type of advice, they could probably come to the appointment. If the concern is coming from the child’s teacher, a quick note explaining what is going on can be really helpful.

Just don’t leave it up to chance that we can figure out what the problem is, especially if you don’t quite understand why they are concerned. Get specific information about the concern or have them come along.

I’m sure there are many more ways that parents think about their children’s checkup, but these are some common ones I notice.

No matter what, regular checkups are an important part of helping you maintain your child’s health. Good health increases their ability to be present for and to participate fully at school and extracurricular activities.

Which category do you fall in? Is there a different one you think I should include?

Sports EKGs are free through the month of August at specific locations in Arlington and Fort Worth. Cook Children's offers a $25 Sports EKG (electrocardiogram) screening test at our Cardiology offices in Mansfield, Southlake and Denton. Adding a sports EKG to your child’s physical can help detect most heart conditions that may lead to sudden cardiac arrest. Click to learn more. 

For school physicals, visit your local Cook Children's pediatrician. Click to find one near you. 

A young person with a history of depression is obviously at a greater risk of suicide. Parents want to be alert for any changes in their adolescent’s typical behavior. They may have been very active in sports in the past, or band, theater, or cheerleading, and now are less interested or involved. They may be isolating themselves, not only from family, but also from friends. Motivation may be dropping, along with grades. You may see sleep patterns change and the teenager may be sleeping for extended periods of time and be difficult to wake in the morning. One may also notice their need for sleep is decreased or they are having difficulty falling asleep. Appetite may change as well and they may eat a lot more or a lot less, and actually be losing weight.

If a young person is talking more about death, dying, and have a sense of hopelessness, that is a big concern. Drug use and other impulsive or risky behavior can place them at a greater risk of suicide as well.

When there is a suicide in a community, parents should discuss it with their kids, particularly since they have likely already heard about it at school or from friends. Use it as an opportunity to discuss their possible feelings of grief or confusion and be a listening ear and support them. Additionally, parents can ask their child if they have ever had any extreme feelings of sadness or thoughts about hurting themselves. If current feelings about wanting to hurt themselves are acknowledged, parents should let their therapist or psychologist know right away. If they do not have a therapist or psychologist, or they are not available, they should be taken to a local mental health facility or hospital emergency room for an evaluation.

Even if a young person does not have a desire to harm themselves, their feelings of grief and sadness about a peer’s suicide can be significant, regardless if they were a close friend or just an acquaintance. Again, be a support for them and encourage them to discuss, and work through their feelings. Answer any questions they may have and explain, if appropriate, any similar feelings the parents may have as well. This may also be an opportunity for the adolescent to make a positive out of a negative experience. They may consider starting a grief support group, work on a memorial for the person who has passed away, or engage in volunteer activities. Sometimes putting feelings of sadness into positive activities can be helpful in the grieving process.

Above all, parents should be “tuned in” to their children. When unusual behavior changes are occurring, ask about them. Additionally, reassure your children you are always there for them, no matter what issue they are facing.

If you feel your child needs help, please call 682-885-3917 for a referral into Cook Children’s Psychology department.

Additional resources:

• Cook Children's Psychiatry and Psychology department
• Dealing with depression
• Resources & education
• 5 ways to fight depression
• When depression is severe

About the author

Joy Crabtree, Psy.D., a licensed psychologist for Cook Children’s, sees patients at Cook Children’s Urgent Care and Pediatric Specialties in Southlake, the first such pediatric facility in town. Previously, she worked seven years in Denton at Cook Children’s Psychology. She moved to Southlake to be closer to home. She sees patients Monday through Thursday, and on Friday she evaluates patients for conditions such as ADHD or autism Joy is married to Tim Crabtree and they have three children. If you feel your child needs to speak to a psychologist or psychiatrist, talk to your pediatrician or call 682-885-3917.