Wellness

• Schedule a Check-up: The American Academy of Pediatrics (AAP) recommends annual checkups from age 3 through adolescence. Schedule early to secure an appointment before the school year starts.
• Mental Health: Have open and honest conversations with children about their concerns. Speak with the pediatrician on tools to help with anxiety.
  • Parenting & Back-to-School: Emotional Safety Starts at Home
  • Raising Joy Podcast: Back to School Anxiety
• Oral health: Children should visit the dentist every six months. Make sure kids brush twice a day for two minutes and floss daily. Make an appointment.
• Update child vaccinations: Navigating vaccines can feel overwhelming. Talk to your pediatrician. The Texas Department of State Health Services requires certain immunizations before children can attend school.
  • To schedule an appointment, visit Cook Children's website or your county's health department website.
  • If a child is not of school age but attends daycare, other requirements may apply.

  • College students are required to receive the meningococcal vaccination.

    

• Sport physicals: The annual UIL pre-participation physical evaluation form applies to middle school and high school students. Sports physicals give doctors the opportunity to check for a variety of concerns, from vision issues and asthma to a lingering sprain or even a serious heart condition.

Healthy Routines

• Sleep: Sleep fuels a child's memory and concentration. Without consistent rest, children struggle to focus in class and retain what they learn, impacting their academic performance.
• Key elements for building a bedtime routine:
  • Establish a consistent schedule by going to bed at the same time each night.
  • Limit screen time at least one hour before bedtime.
  • Keep bedrooms quiet, cool and dark.
  • Create a calming routine, such as reading together.
• Transportation safety:
  • E-Bike and E-Scooter safety: Always wear a helmet.
  • Driving: Drive slowly through school zones and watch for pedestrians.
  • Car Safety: Ensure your child is in the correct car seat or booster for their age and size.
• Nutritious meals: Plan balanced breakfasts and lunches to keep energy levels stable throughout the day.
• Screen time: According to the American Academy of Child and Adolescent Psychiatry, children ages 8 to 18 in the United States spent an average of 7.5 hours a day using screens in 2025. Set clear daily limits for non-academic screen use.

Make a Plan

• Virtual care: If school district offers it, sign up for the Cook Children’s School-Based Virtual Health Program.
• Allergy action plan: Provide updated emergency allergy plans and medications to the school nurse.
• Medication management plan: Submit required doctor authorization forms for any daily or emergency medications needed during school hours.

“Teeth are so important in so many ways, forms and fashion,” Tonya Fuqua, D.D.S., director of Child Oral Health at the Center for Children’s Health, led by Cook Children’s Health Care System. “The mouth is the gateway to our body, and it is connected to the rest of our body. And it starts with once a kid is born.”

The assessment also revealed 57% of children (about 651,000) received at least two or more preventive dental visits aligning with the American Academy of Pediatric Dentistry recommendations.

 A Celebration to Sink Your Teeth Into

In honor of National Children’s Dental Health Month in February, the Cook Children’s Save-A-Smile program hosted a celebration this week in collaboration with the Fort Worth District Dental Society, the Texas Dental Association, and the Children’s Oral Health Coalition.

The organizations transformed the Cook Children's Medical Center Fort Worth Atrium into a dental-themed landscape. Patients received age-appropriate oral health kits, participated in arts and crafts, and chose a Build-A-Bear teddy bear or "tooth" to keep as a reminder of good oral hygiene.

“Healthy mouth, healthy body because if your mouth is healthy, that will hopefully lead you to a healthier body,” said Dr. Fuqua.

A child’s smile holds enormous potential for fostering emotional well-being, communicating happiness and building connections with others. It can also be a powerful indicator of physical health.

“There is a clear connection between oral health and overall mental and physical health,” said Tonya K. Fuqua, DDS, director of oral health for the Center for Community Health, led by Cook Children’s. “Teeth can be very telling about what is going on in a child’s life, the socioeconomic barriers they face and underlying health issues they may have. That’s why it’s so important for the dental health of children to be as high a priority as their physical health.”

Connecting the dots between oral and physical health to improve a child’s overall wellness is the purpose of a grant awarded by the American Academy of Pediatric Dentistry (AAPD) Foundation to Cook Children’s Health Care System’s Renaissance Neighborhood Health Center and the Center for Community Health’s Save-A-Smile Program. Cook Children’s is one of only two recipients nationwide to receive the grant.

“The AAPD Foundation is dedicated to making dental care accessible to all children by supporting nonprofit clinics providing routine cleanings, advanced treatments and ongoing care that helps kids in need,” said Douglas Keck, DMD, MSHed, AAPD Foundation president, pediatric dentist, and dental director of a Federally Qualified Health Center in Florida. “Our support of Save-A-Smile and its medical dental interface initiative represents a pivotal step in bridging the gap between oral health care providers and primary health care practitioners. By working together, we aim to provide sustainable compassionate care for children in need.”

The grant supports a three-year pilot project aimed at developing best practices for bridging the gaps between pediatric medical and dental care. It makes way for a community health worker (CHW) to be embedded with Renaissance Neighborhood Health Center to educate and support families while identifying and addressing any barriers that keep them from completing care.

Cook Children’s Renaissance Neighborhood Health Center is a primary health care home for children living in southeast Fort Worth. The center has both a dental and medical clinic under one roof, making it the ideal location to conduct the pilot. Many within the center’s patient population are considered financially vulnerable and qualify for government-supported health programs such as Medicaid and Children’s Health Insurance Program (CHIP). They may also face non-medical drivers of health such as food insecurity, housing issues and adverse childhood experiences.

Making Connections

Juanita Valles is the community health worker assigned to this medical/dental integration project at Renaissance.

“Families tell me their problems and I listen,” Valles said. “Right now, everyone is struggling financially. Sometimes they need transportation to appointments, childcare, clothing, diaper assistance, car seats for the kiddos, household items or even dental care for the parents themselves. That’s where I come in.”

When a family has a need, Valles works to clear the path to make it easier for them to follow through with medical and dental care. She even goes so far as to make in-home visits with her trusty stuffed assistant, Leo the Lion, when working to educate a family and overcome barriers.

“I take Leo with me everywhere I go and use him to show kiddos how to brush their teeth the right way,” she said. “We also teach them to drink lots of water and stay away from sugary drinks.”

Children with untreated dental problems often have difficulty with pain, eating, sleeping, self-esteem, school attendance and grades. Cook Children’s 2021 Community Health Needs Assessment revealed that more than 175,000, or 1 in 7, children living in Cook Children’s eight-county service area were not able to get the dental care they needed. This rate is 9 times higher than national estimates and 5 times higher than state estimates. Stated barriers included inadequate dental insurance coverage, difficulty scheduling and lack of education and resources for dental care.

“You really relieve all barriers by addressing the social service component of why families may not get the dental care they need for their kids,” Dr. Fuqua said. “And the pediatrician’s office is the perfect place to start because children often visit their pediatricians more frequently in their first years of life than they do dentists.”

Leveling Up

Results from year one of the pilot, which began in January 2023, have already triggered system-wide change, Dr. Fuqua says. Dental screening questions were implemented across all of Cook Children’s Health Care System for well-child visits ages 0 to 3. Children in the pilot project who screen positive are connected with the community health worker. Other opportunities to scale-up and implement new solutions for year two include streamlining pilot data collection and analysis, refining criteria for patient referrals to the community health worker and examining system-wide dental screening data.

In the first 10 months of the pilot, more than 1,000 patients responded to dental screening questions during a well-child check and subsequently scheduled a dental appointment at Renaissance. Of those, 429 patients completed initial dental appointments at Renaissance. In that same time, Valles attempted or completed contact with families 247 times and provided tailored oral health instruction in person or by phone to 50 families.

“That's the beauty of this program and having a community health worker,” Dr. Fuqua said. “It's not as simple as just saying, ‘Oh, your kid needs help and here's where to go.’ These families have so many barriers and so many reasons why they haven't gotten a child to the dentist, but Juanita and this program make a way for them.”

About Cook Children's Neighborhood Clinic Renaissance

At Cook Children's Neighborhood Clinic Renaissance, we're here to help you raise a healthy child from infancy through the transition to adulthood. We offer well checks, immunizations, school and sports physicals, injury treatment, and care for both short-term illnesses and longer-lasting conditions.

If your child needs additional help, we can connect you with more than 60 Cook Children's specialty clinics. We're always ready to answer questions and share resources. Feel free to reach out. We're looking forward to your visit with us in Fort Worth. Learn more about our pediatricians, services and support here.

About Save-A-Smile – Cook Children's Center For Community Health

Save a Smile was founded in 2003 by Cook Children’s to address a gap in oral health services for underserved children. Save a Smile is an innovative, nationally recognized, collaborative program dedicated to providing restorative and preventive dental care to children from low-income families in the community through volunteer dentists. Children eligible for the program are pre-kindergarten through sixth grade at high risk for dental disease from schools pre-selected by the Save a Smile program and participating school districts. 

Going to the dentist and taking your kids to the dentist may bring up a lot of emotions and most likely some anxiety for many of us. One of my own traumatic memories as a child was at a dentist appointment. I was scheduled to have several teeth pulled for orthodontic purposes, and in short, I refused to let the dentist touch me. My mom called my dad from the dentist office to convince me to do it, and then they both decided after complete refusal that it would be better if I went to a pediatric dentist where there may be more options for me as a kid. This was in the 1990s, and thankfully things have changed for the better over the last thirty years. However, the fears that we experienced ourselves as a child can very much affect how we approach the dentist with our own children. I often tell people that my dental experiences may be the very reason I became a child life specialist.

While there may be fears and hesitancy, oral health among children is incredibly important. The CDC reports, “On average, 34 million school hours are lost each year because of unplanned (emergency) dental care, and over $45 billion in US productivity is lost each year due to untreated dental disease.” They also report that “By age 8, over half of children (52%) have had a cavity in their primary (baby) teeth.” In our area, Cook Children’s Community Health Needs Assessment found:

• 1 in 4 children in our 8-county service area does NOT have excellent or very good dental health.
• 1 in 7 children (ages 1-17) in our 8-county service area did not receive all needed dental care.

This month is National Children’s Dental Health Month, and we want to help you know how to prepare and support your children as they visit the dentist. We know that this area can be challenging for kids and parents to navigate, and we want to give you tools so that you and your child can feel more comfortable in the dentist chair. Lack of dental care can lead to even more traumatic medical and dental experiences for children. Our hope is that these tools can empower you and your child to not fear their next dental visit. In speaking with Betsy Hillyard, CCLS, oral health program coordinator at Cook Children’s Center for Community Health, she shared some top things to remember in preparing for the dentist. As a certified child life specialist (CCLS), Betsy not only helps and prepares children, she also educates parents, community partners, and dental professionals on working with children through dental experiences.

1. Know what to expect! If it is your child’s first-ever dental visit, make sure that you know what your children will be doing once they are there. The American Academy of Pediatric Dentistry recommends for children to see a dentist by their first birthday or once their first tooth has emerged. Often between the ages of 6 months to 3 years, children visit the dentist only for a lap visit for the dentist to count teeth, address any early concerns that may come up and educate families on proper oral health. Parents are often invited to be a part of these visits. As it becomes time for your child to begin getting their teeth cleaned, it is important for them to know whether you will be with them or not, what processes their dentist has (x-rays, cleaning, fluoride, etc.), and what they can do while they are in the dentist chair (watch a movie, listen to music, etc.). Betsy encourages to even ask your dentist if you could go and take a tour of the office before the visit. The more information you know about your child’s visit will help you be able to prepare your child more effectively for the most positive experience.

2. Prepare your child. It is so important for your children and you to know what to expect before going to the dentist so that you can use that information to help prepare your child for their specific appointment. There are lots of tools available to help you prepare them and provide you with child appropriate language. You can read books about the dentist, play dentist with some stuffed animals or dolls, practice opening big and wide, and watch some videos to help them have an idea of what to expect. Betsy created a video to help kids know what to expect when headed to the dentist. Seeing the tools that will be used and the process is very helpful to your child. Betsy recommends having your child draw a picture of what they expect about their visit before they go and then having them draw another picture about their experience after their appointment.

1.  A note about children with sensory needs: If your child struggles with certain noises or other sensations, it is important to work with your dental office to discuss possible comfort items and adaptations that are available to help your child. Having a conversation or appointment before to discuss this can be very helpful. Often weighted or warm blankets, earphones and sunglasses can be provided to help your child. Also, if your child has a certain comfort item, plan to bring that along like you would for a doctor’s appointment.

3. Keep it positive. It can be difficult for some adults to be positive about their own dental appointments and experiences. However, children pick up on our fears and worries and will often adopt your feelings before ever having their own experience. So, when preparing your child for the dentist, be careful and intentional with your words. When discussing the dentist and dental hygienist with your children, be careful not to use the dentist as a threat or a bad thing that they will experience. Make sure that you remind your children that dental appointments are necessary and helpful to our health and dentists help keep our mouths and teeth healthy. If you have your own fears of the dentist, make sure that you do not project those fears on your children. While validating their nerves and addressing their fears is encouraged, it is important not to make going to the dentist seem like a negative place or punishment. Use encouraging language with your children when discussing their appointments and be sure to praise your children when they do a good job at their appointments. 

When you know what to expect, take the time to prepare your children for their visit, and keep it positive, the dentist can be a great experience for your kids. Preventative dental care and oral health is so important to our children’s overall health and development. The more that we can do to prevent unplanned and emergent dental care, the more we support our children’s healthcare experiences and emotional safety. Thankfully my kids are having a much more developmentally appropriate and positive experience at their dental appointments than I did as a kid. We want to continue to support our children in making good choices for their health including their oral health.

“Proper dental care actually begins before the baby’s first tooth appears,” said Tonya Fuqua, DDS, director for the Save a Smile program, led by Cook Children’s. “As soon as the baby’s born, it’s extremely important to make sure that parents begin wiping the child’s mouth and gums with a nice clean baby wash cloth. The cloth should be soft and easy to get wet.”

The early cleaning with the cloth removes any remaining milk from babies’ mouths and helps them become accustomed to something going in their mouth for cleaning. So when babies begin getting teeth and brushing starts, they will be used to the parents placing their hands in the mouth for brushing.

Once you see the first baby tooth, you can begin using a toothbrush. You aren’t doing a lot, but you are introducing that feel of the bristles in the mouth so that as the baby develops more teeth, he or she will be used to a toothbrush in the mouth. Make sure you are using a soft bristled, age appropriate toothbrush. As your child has more teeth, a routine should be established of brushing two times a day, the morning and at bedtime. Dr. Fuqua gave us 10 other helpful tips parents should know about when caring for their child’s teeth:

1. Know the rules of twos. You should always brush your children’s teeth twice a day – every morning and every night for two minutes, regardless of how many teeth are in his or her mouth.
2. Did you know: A baby should never be put to bed with a bottle or sippy cup filled with anything other than water.
3. When should you schedule your first dental appointment? Find a dental home and take your child to the dentist by age 1 or earlier if you notice problems.
4. How dangerous is tooth decay (cavities)? Tooth decay (cavities) are the No. 1 long-lasting disease in young children – even more than asthma.
5. Can you catch a cavity? Germs that cause tooth cavities can be passed from parent or caregiver to a child. Choosing healthy behaviors from an early age will help prevent tooth decay (cavities) and improve a child’s overall health throughout his or her lifetime.
6. How do you prepare your child for visiting the dentist? Read your child a book about going to the dentist, schedule a tour of the offices before the first visit and role play at home on what to expect for the visit.
7. How long should you supervise your child’s brushing and flossing? As general rule, keep up with your child’s brushing and flossing activity until he or she is about 9 years old.
8. Which toothbrush should you get for your child? Choose a soft or extra soft toothbrush with the right size handle and head for his or her mouth.
9. How often should a toothbrush be changed? Every 3 to 4 months, when the bristles become worn or after there has been an illness.
10. What toothpaste should you use for your child? Use a rice-sized smear of fluoride toothpaste when the first tooth appears around 6 months until age 3. Then use a pea-size amount of fluoride toothpaste.

For more information:

The Children's Oral Health Coalition is working hard in the community to educate parents on the importance of caring for their children’s mouth and the impact their children’s oral health can have on their overall health. Find dental health resources here.