To a parent living through their most terrifying moment, only one thing matters - that help is on the way for their child experiencing a medical crisis. Nothing brings relief like the sight of

With a moment’s notice, this team of critical care experts can be wheels up in one of Cook Children’s air ambulances to travel to points all over the United States, Canada and Mexico. While these aircraft are known to air traffic controllers by their unique call signs, to the anxious parents waiting on the ground, these identifiers are more than a string of letters and numbers. They are a declaration of the help and hope on the way.

“We’re walking in on a family’s worst and darkest day, and we are always cognizant of that,” said Deana McLelland, RN, Cook Children’s Teddy Bear Transport nurse. “They are always relieved to see us. I like to say our name is ‘Oh good, they’re here’ because that’s what we always hear when we walk in to pick up the tiniest of babies or the sickest of kids. I love taking care of them and feel so lucky that this is my job. I get emotional just talking about it.”

McLelland has been doing this job for 29 years. She is an original member of the Teddy Bear Transport team, having joined during its start up after working as a critical care nurse at Cook Children’s Medical Center for 6 years.

In May, she climbed aboard and began flying the friendly skies in a new addition to Cook Children’s fleet of mobile intensive care units - a Pilatus PC24 twin engine jet. The aircraft replaces one of two Cook Children’s airplanes currently in operation and enhances the health system’s ability to transport sick and injured children to Cook Children’s Medical Center for care.

“Our older airplane, which is a 1982 Beechcraft King Air twin turboprop, has served us well, but it’s time to retire,” said Stacy Putman, Cook Children’s director of Transport. “Now, we’ll have two jets to transport children from all over the country and even internationally from Canada and Mexico.”

Rapid Response

In emergency medicine, every minute counts. Cook Children’s new jet is bigger and faster than its turboprop predecessor, and can travel further distances before needing to refuel. To sick children and anxious parents, this means they get the help they need sooner.

Teddy Bear Transport averages about 30 flights per month. Many of those bring children back to North Texas to receive care close to home after becoming sick or injured while traveling. Premature babies or critically ill children from rural areas of Texas and surrounding states who need advanced care in Cook Children’s neonatal, pediatric or cardiovascular intensive care units are transported by air, too. Teddy Bear Transport also regularly flies infants diagnosed with a rare and severe genetic disorder called congenital hyperinsulinism (HI) to Cook Children’s Hyperinsulinism Center, one of only six HI Centers of Excellence in the world. Congenital hyperinsulinism can lead to dangerously low blood sugar in infants. Without timely intervention, these infants are at risk of seizures and permanent brain damage.

Cabin Features

The new jet joins a transport fleet that includes a Cessna Citation Encore+ jet, an American Eurocopter 145 helicopter and six specialty/critical care ambulances. All are equipped with medical technology comparable to what is used in neonatal and pediatric intensive care units.

“We are a mobile ICU,” Putman said. “So everything we can do in our pediatric or neonatal ICU, we can do in the airplane. We can even transport cardiovascular ICU patients on ECMO (advanced life support).”

Every transport carries a team that includes a nurse, paramedic and respiratory therapist. They are the elite of the elite when it comes to pediatric emergency medicine, as they must be as proficient in caring for a micro-preemie born at 21-weeks as they are at caring for an 18-year-old teenager. Expert skill is a must, coupled with the composure to deliver care while flying through the air or traveling the highways below.

In addition to having a little extra in-flight leg room for the transport team, the bigger plane allows for more equipment, staff and passengers when needed.

“When we transport kids on ECMO, it doubles our equipment and our on-board staff,” McLelland said. “This jet gives us more room to take anyone we need with us, and that includes parents. In the past we’ve only been able to take one parent with us because of our team configuration, but this allows us the seating to bring two with us if necessary. Sometimes that child’s survival is on the line and we don’t feel good about leaving one parent behind if we don’t have to, so this is a really important feature for keeping the family together in these critical moments.”

Engineered for Safety

In addition to its critical care capabilities, both of Cook Children’s jets are equipped with leading-edge safety features, including a Wide Area Augmentation System (WAAS) and Traffic Collision Avoidance System (TCAS). The WAAS enhances GPS navigation, turning it into a precision guidance system that allows aircraft to land in lower visibility and at smaller regional airports, like those in rural areas frequented by Teddy Bear Transport. One of the most important safety features of modern-day jets, the TCAS prevents potential mid-air collisions by giving pilots a heads up warning of aircraft in the area and, if needed, escape guidance to avoid collision.

Other on-board assists, like a Nexrad weather radar and a terrain warning system, guide pilots in flying above storms, avoiding dangerous wind sheer and navigating obstacles on the ground.

Grounded, But Not For Long

Even after 29 years, McLelland says her job never gets old.

“Every time that motor starts, my heart skips a beat,” she said. “Every day is a new place, a new diagnosis and a new family, and I love the variety. I still say I cannot believe I get paid to do this job.”

When a breast cancer diagnosis last year temporarily grounded her, McLelland persevered and returned to work in March after a six-month leave of absence.

“When all of this cancer stuff started, my doctor asked what three things scared me the most,” McLelland said. “I told him leaving my job was one of them and he assured me I would go back to the work I love. I could not wait to get back. I’m really lucky to get to do it for as long as I have, and I’m not done.”

McLelland can’t wait to step aboard for her first transport in the new plane. Although flying on new wings, her wheels-up preparation will be the same as it has been for two decades—suit up and pray up.

“Every single morning on the way into work, I pray for my patients and their families,” she said. “And I pray for my crew that we will be wise and discerning and tender and take good care of the children we transport.”

Teddy Bear Transport by the Numbers:

• Operates 24/7/365

• 4,100 transports annually

• 10,000 referral calls handled each year by dispatch

• Staff includes 60 neonatal/pediatric nurses, paramedics and respiratory therapists

Of the more than 800 patients tested for RSV last week at Cook Children’s, more than 200 (29%) were positive. Four percent of those tested for COVID-19 were positive. The Emergency Department (ED) at Cook Children’s in Fort Worth is treating more than 500 patients a day. An additional 800 patients a day are seeking treatment at one of Cook Children’s seven Urgent Care Centers (UCCs). The influx is leading to over-crowded waiting rooms and long wait times across the board.

These numbers are expected to climb as we move closer to peak respiratory illness season, typically December through January.

Parents and caregivers can help reduce the stress on the system by knowing when to call your child’s physician and when to seek emergency care. Doctors say following these guidelines can reduce traffic to EDs and UCCs, reduce wait times for patients and reduce your child’s exposure to viruses.

Many viral respiratory illnesses can be treated at home with rest and lots of hydration. If you are concerned, call your pediatrician first if your child is experiencing mild symptoms without difficulty breathing or dehydration, or for illness-related symptoms (ear pain, sore throat, diarrhea or vomiting, rash, cough or other non-urgent health concerns). The pediatrician’s office can help you decide what steps to take.

In many cases, physicians can assess and treat a patient via a virtual health appointment. Not only is this a convenient option that saves time, but it keeps you and your child out of a waiting room where they could pick up another virus on top of the one they already have.

Download the MyCookChildrens app to schedule a virtual health/telemedicine appointment here.

Parents should not go to Urgent Care or the Emergency Department for an RSV, flu or COVID test. Your pediatrician can test for all of these.

When to Seek Immediate Care:

●      Any temperature greater than 100.4 in an infant under two months of age is considered a medical emergency. If your child has a fever for more than three days, contact your pediatrician or visit an urgent care center. 

●      Concerns for dehydration. In dehydrated babies, parents will see fewer wet diapers or a lack of tears. Their flat spot can also appear more sunken.

●      Your child is breathing faster than usual or you can see the skin between the ribs being sucked in.

●      If your child is requiring frequent use of their albuterol rescue inhaler or is having worsening asthma symptoms.

Signs and Symptoms

Symptoms of RSV in infants younger than 6 months may include:

●     Irritability

●     Poor feeding

●     Lethargy

●     Episodes where they stop breathing

●     Fever

Infants and children over 6 months may experience:

●     Runny nose

●     Loss of appetite

●     Cough

●     Sneezing

●     Fever

●     Sometimes wheezing

Flu and COVID-19 share similar symptoms as RSV and may also include sore throat, headaches, body aches, chills and change/loss of taste and smell.

Practice Prevention

When it comes to respiratory illnesses, prevention is always the best medicine, especially as we approach the holidays and the many indoor gatherings they bring. Vaccines can help reduce the spread and severity of illness and prevent hospitalization. It’s not too late to get your child’s flu shot or COVID vaccine. Call your pediatrician to make an appointment.

Remind your children to practice healthy habits such as washing their hands and coughing into a tissue or their elbow. If you or your child feels sick, stay home to prevent spreading illness, take time to rest and stay hydrated with lots of fluids.

Story by Eline Wiggins. Video by Tom Riehm. Photos by Reilly Ternan.

Every year, children in Texas are prone to vehicular heatstroke. So far this year, eight children have died of vehicular heatstroke across the US, including a 4-year-old boy in Houston, according to noheatstroke.org. In 2022, three children died of vehicular heatstroke in Texas.

On Monday, Cook Children's and Prosper Fire Department teamed up to remind parents about the dangers of hot cars. First responders showed a live demonstration at Cook Children’s Medical Center – Prosper to simulate a 911 call and emergency response for a child left in a hot car. Speakers included Prosper Fire Chief Stuart Blasingame, Viviana Esparza from Cook Children’s Center for Community Health, Meena Guirguis, M.D,, emergency department physician at Cook Children's Medical Center - Prosper and  Larry Lanar Dyer of El Dorado Chevrolet.

A digital thermometer displayed the internal temperature of a second demonstration vehicle to show how high and how quickly a vehicle can heat up. The temperature inside the vehicle surged passed 135 degrees. 

Young children are particularly at risk for heatstroke, or hyperthermia, because their bodies heat up three to five times faster than an adult’s. Because cars heat up so quickly, a tragedy could happen faster than you think.

“Heatstroke in children can happen in minutes, not hours,” said Meena Guirguis, M.D., emergency department physician with Cook Children's Medical Center - Prosper. “If you see a child left in a vehicle, call 911 immediately.” 

A car can heat up 19 degrees in just 10 minutes. And cracking a window doesn’t help. It’s never OK to leave a child alone in a car, even for a few minutes and even if the car is running.

“Parents suffer from exhaustion due to lack of sleep, stress and changes in their normal routing. Any one of these can cause your memory to fail at a time when you least expect it,” according to kidsandcars.org. “Even the best of parents or caregivers can unknowingly leave a sleeping baby in a car; and the end result can be injury or even death.”

Create reminders by placing something in the back of your car next to your child, such as one of your shoes, a purse or a cell phone, is especially important on days when you're not following a normal routine.

To reduce the number of child vehicular heatstroke deaths, parents should remember to ACT:

• Avoid heatstroke-related injury by never leaving a child alone in a car, not even for a minute. Always lock your doors and trunks— including in your driveway or garage. If a child goes missing, check the pool first, and then check the vehicles, including trunks.
• Create reminders. Routinely place something you'll need at your next stop—like a purse, briefcase or cellphone—in the backseat.
• Take Action. If you see a child alone in a car, take action. Call 911.

What to do if you see a child or pet alone in a vehicle from kidsandcars.org:

• Don’t wait for the driver to return. Call 911 right away. The 911 operator can help give you instructions on how to care for the child or pet.
• If the child or pet is not responsive or is in distress, immediately:
  • Get them out of the car by any means necessary
  • Move the them to a cooler environment (somewhere with AC or shade if AC is not available)
  • Remove child’s clothing to let the heat dissipate from their skin
  • Dampen them with cool water or wet rags, immerse in cool water (not in an ice bath) 
• If the child or pet is responsive and not in distress:
  • Stay with them until help arrives
  • Ask someone else if they can locate the driver. You might suggest they ask security of a store manager to page them

Warning Signs of Heatstroke:

• Hot, flush or red
• Slow, weak pulse or strong, rapid pulse
• Lethargy, confusion or strange behavior
• Nausea
• No sweating

Brothers Isaac Martinez, 7, and Jaden Alvarado, 13, are recovering at Cook Children's Medical Center after they were playing outside their home Wednesday afternoon when the tree above them was struck by lightning.

The lightning ricocheted and struck Jaden and Isaac, causing them to lose consciousness and collapse.

“It looked like fireworks were coming down the tree,” their mother Jessica Martinez Alvarado said. “I saw the boys lying on the ground when the fireworks stopped. ... I thought I had lost my boys. It's the worst feeling ever. I would never wish that on anyone.”

Isaac and Jaden were immediately rushed to Cook Children’s Medical Center Emergency Department. Doctors say that Jaden was primarily impacted by the lightning and likely suffered a cardiac arrest. The lighting ricocheted from Jaden to Isaac.

By Thursday morning, the boys were transferred to the Pediatric Intensive Care Unit, with their mother and family at their side as they rested and played video games.

Jessica said they were still processing what happened to them. The boys said they don't remember what had happened and they were feeling OK.

It wasn't raining when the boys were struck, Jessica said. She noticed the lightning was getting more intense and was about to tell the boys to go inside when the lightning struck the boys moments later.

“They're always outside playing. They love to play football or any kind of sports," she said. “Their favorite thing to do is play with their dog.”

Her advice to other parents: “Don't let their kids outside when it's thundering. I know it's a one-in-a-million chance, but you never know, you might be that one. It was two for me. Be very, very careful with your babies. Make sure you hug them and kiss them and hold them tight."

Taylor Louden, M.D., Medical Director, Pediatric Emergency Medicine at Cook Children’s Medical Center, said that parents should be cautious and keep their children indoors when there is a severe weather threat or thunder and lightning.

“The boys came in altered and confused," Louden said. "These boys are very lucky. We're glad everyone came out OK in this instance."

If someone is fatally struck by lightning, cardiac arrest is the immediate cause of death. Dr. Louden said it is crucial for a lightning strike victim to receive CPR as soon as possible or use an Automatic External Defibrillator (AED). Witnesses should call 911 immediately.

“Fortunately, lightning strikes are very rare, but we do have to be aware [of storms], especially in Texas where storms can come out of nowhere quickly," Dr. Louden said. "Even if storms are in the distance, you're still at risk.”

According to the Centers for Disease Control and Prevention, the odds of being struck by lightning in a given year are less than one in a million and almost 90% of all lightning strike victims survive.

For the second year in a row, Cook Children’s Emergency Department and Urgent Care Centers are seeing a big influx of parents bringing in children who have been exposed to COVID-19 but show no symptoms. This is causing long wait times at all locations and putting unnecessary strain on the health care system.

On Monday, Aug. 29, our Emergency Department (ED) staff saw 614 patients, which is equivalent to a patient checking in every 2 minutes for 24 hours straight. That’s nearly double the number of patients we typically see in the ED. Our seven Urgent Care Centers (UCC) saw 873 patients, which is also much more than usual.

“We are seeing patient volumes equivalent to our worst winters, and it’s taking a toll on our staff,” said Kara Starnes, D.O., medical director of Cook Children’s Urgent Care. “We need everyone’s help by staying home if you only need a COVID test or if your child has mild symptoms.”

Currently, 23% of COVID tests at Cook Children’s UCCs are coming back positive. In addition to COVID, Dr. Starnes says they are seeing a lot of colds.

“If your child tests positive for COVID at home, you can trust the test. You don’t need to have a health care provider confirm the results,” Dr. Starnes said. “If a COVID test comes back negative, it’s safe to monitor minor symptoms at home and re-test in 48 hours.”

Parents and caregivers are encouraged to reach out to their primary care physicians if their child is not feeling well.

Cook Children’s experienced a very similar situation in August 2021, likely triggered by kids going back to school.

Please avoid the emergency room and UCCS for COVID-19 testing. If your child has been exposed to COVID-19, please use an at-home test or schedule an appointment with a testing location such as a pharmacy.

“If your child needs emergency care treatment, our Emergency Department is here for you. That’s why we’re here,” said Natalie Carpenter, director of Emergency Services at Cook Children's. “But please don’t come to the emergency department for a simple COVID test.”

The ED should only be used for COVID-19 symptoms such as:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

If you are going to the ED, please limit the number of people you bring with you (if possible).

Where do you go when your child needs to be seen by a doctor?

Here’s a guide:

• Go to the emergency room if your child has trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition. 
   
• Call your health care provider if your child has ear pain, sore throat, diarrhea or vomiting, rash, cough or other non-urgent health concerns. The pediatrician’s office can help you decide what steps to take. 
   
• If you can’t get to your provider’s office or it’s after hours, go to an urgent care center. Urgent care centers manage the same problems as your regular health care provider plus services such as X-rays, stitches and splints.

Free COVID Tests Still Available to be Delivered to Your Home

Every home in the U.S. is eligible to order three rounds of at-home COVID-19 test kits from the government. You can easily sign up at covid.gov/tests and have the tests delivered to your home. The last day to order tests is Friday, Sept. 2.

For detailed information about what to do if your child tests positive or negative, download the PDFs attached to this article. 

On Oct. 19, the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP) and the Children’s Hospital Association (CHA) released a joint statement calling for more federal funding, support and access to mental health services and programs, as well as advancing policies that ensure mental health parity laws.

“Young people have endured so much throughout this pandemic and while much of the attention is often placed on its physical health consequences, we cannot overlook the escalating mental health crisis facing our patients,” AAP President Lee Savio Beers, MD, FAAP, says in the statement, adding the “declaration is an urgent call to policymakers at all levels of government—we must treat this mental health crisis like the emergency it is.”

The pandemic has caused children and teens “to face physical isolation, ongoing uncertainty, fear and grief,” the statement reads, and has exacerbated an already steady rise in mental health issues among youth—such as suicidality, depression and anxiety—noted even before the pandemic hit.

Nationally, the percentage of emergency department visits for children ages 5-11 rose by 24% and by 31% for children ages 12-17 between March and October 2020, according to the statement. And among girls ages 12-17, there was a more than 50% increase in suicide attempt emergency department visits in early 2021 compared to the same period in 2019, the statement read.

Also noted in the emergency declaration and based on research recently published in the AAP’s medical journal Pediatrics, more than 140,000 children have experienced the loss of a loved one, losing either a primary or secondary caregiver during the pandemic. Children of color have been disproportionately impacted, according to the research.

Reflecting the national trend, mental health experts at Cook Children’s Medical Center also have seen an increase in mental health issues among patients. From January through July 2021, for example, 261 patients were hospitalized for injuries following suicide attempts compared with 143 hospitalizations for the same injuries from January through July 2020.

 “We absolutely are in a state of national emergency when it comes to children’s mental health. Suicide has been the second-leading cause of death for young people ages 10-24 years since 2018, which is pre-pandemic,” says Kristen Pyrc, M.D., medical director of Cook Children’s Psychiatry Outpatient Services and Partial Hospitalization Program.

“The inability of families to access quality mental health care in a timely manner has played a significant role in the deterioration of young peoples’ mental health,” she adds. “I have to wonder how many of those suicides could have been prevented if a young person could have started mental health treatment when their symptoms first emerged.”

The increase in suicide attempts and mental health issues among children led Cook Children’s to launch the Joy Campaign in April. The campaign spotlights efforts being made to address the trend.

In the joint statement, AAP, AACAP and CHA urged policymakers to take the following measures to address the crisis:

• Increasing federal funding to ensure all families have access to mental health services;
• Improving telemedicine access;
• Accelerating the integration of mental health care in primary care pediatrics;
• Supporting effective models of school-based mental health care;
• Strengthening efforts to reduce risk of suicide in children and adolescents;
• Addressing workforce challenges and shortages so children can access mental health services no matter where they live;
• Pursuing policies that ensure compliance with mental health parity laws.

Such legislation would improve access to children’s mental health care for families and communities, Dr. Pyrc says.

“I have attended conferences through CHA that address mental health in our hospitals. Across the country leaders of these hospitals all say the same thing: They are overwhelmed by the mental health needs of the kids in their community,” she says. “If every children’s hospital across the country is struggling to address the mental health needs of their community, it says to me large-scale structural changes need to be made through legislation to increase access to mental health care for all families.”

Dr. Pyrc says she’s overjoyed the AAP, AACAP and the CHA “came together to write a comprehensive statement with recommendations that would benefit children’s mental health.” The organizations comprise more than 77,000 physician members and more than 200 children’s hospitals in the United States.

She’s hopeful new legislation would allow hospitals across the country, including Cook Children’s, to provide more help to children in need, she says.

“I know how frustrating it is for families to try to get help for their child who is struggling with mental health challenges. It breaks my heart that we cannot help every kid who needs it,” she says. “Cook Children’s is actively working to improve access to care for families in our community, and I am hopeful that new legislation will give us the tools we need to adequately address the mental health crisis.”

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.”

Beginning today, the following changes will take place:

• All Cook Children’s Urgent Care Center locations are available for walk-in only. At this time, the UCCs are not taking online check-ins.
• The outlying Cook Children’s Urgent Care locations will close at 9 p.m. and the Fort Worth location will close at midnight. 
• Urgent Care Center locations will offer two options for patients.
  • One option will strictly be a lab-only visit for those patients that simply need a COVID-19 test but don’t need to be seen for an urgent care visit.
  • The other option will be the usual urgent care visit for all other patient needs.

These changes are taking place to keep up with the high demand of recent patient volume. Yesterday, our seven UCC locations saw more than 1,000 patients in one day. Prior to the recent surge in patient volume, the average number of patients seen in one day was about 600.

The Urgent Care Clinics and Cook Children's Emergency Department are seeing a big influx of parents bringing in children who have been exposed to COVID-19 but show no symptoms. Please avoid using the Emergency Department for testing if your child is not showing symptoms. Click here to read more.

Cook Children’s Health Care System is among 33 hospitals in the world to receive the coveted Lantern Award from the Emergency Nurses Association (ENA). The group recognized Cook Children’s Emergency Department (ED) for demonstrating exceptional and innovative performance through leadership, practices, education, advocacy and research. The award is given to health care institutions both in the U.S. and internationally, and is a visible symbol of commitment to quality, safety and a healthy work environment.

“Despite dealing with the challenges of the COVID-19 pandemic, our emergency department leadership carved out time to showcase the preeminent and pioneering work their teams are doing each day,” said Rick W. Merrill, president and CEO of Cook Children’s. “This uniquely special award is a testament to this team’s daily commitment to excellence; and on behalf of our entire leadership team, we are extremely proud of this accomplishment.”

Some of the key initiatives that helped Cook Children’s win the Lantern Award include:

• Implementation of a sepsis-screening process
• Suicide-risk assessments for all ED patients over the age of 10
• Enactment of a COVID-19 command center response team
• Routine disaster drills, including participation in community exercises
• Critical stress management training to help build resiliency for ED staff before and after stressful events
• Improvements in the blood culture process

“We’re proud to have an emergency department staffed with nurses who go above and beyond every day to do the very best for the children and families in our care,” said Cheryl Petersen, Vice President and Chief Nursing Officer at Cook Children’s. “This is the first time we have received this award, but I can truly say our staff has a long history of exceptional performance. We’re simply excited to know leaders outside of Cook Children’s are taking notice of their great work.”

The ENA Lantern Award is named in honor of Florence Nightingale, who worked to improve and change nursing in the 19^th century. A list of all 33 Lantern Award winners can be viewed here.

In Cook Children’s Emergency Department, treating gunshot victims requires all hands on deck. The moments are precious as staff work against the clock to save young lives. The goal? To rescue every child who comes through the sliding doors. The reality? Children with gunshot wounds are among those most likely to die from their injuries.

For emergency room physicians like Dan Guzman, M.D., caring for shooting victims is particularly bothersome because gunshot wounds are preventable. He fears he will see many shooting victims in the coming months as summer is typically a busy time for this type of injury.

“Kids are out of school, and parents are working,” he said. “Children will find a gun that’s not locked or hidden, and a matter of seconds can change a family’s life.”

As of May, 35 children have already been treated at Cook Children’s with gunshot wounds in 2021. Two died. Compare that to 2019 when 41 children were treated for gunshot wounds, including five deaths, and 2020, which totaled 47 patients and four deaths.

“We are five months into 2021 and are on track to exceed prior years,” Dr. Guzman said. “We haven’t reached the halfway point and we’ve already lost two patients.”

While most of the situations stemmed from unintentional gunshots, Dr. Guzman says all of the incidents could have been avoided.

“The vast majority of the kids that we see suffer from head and neck injuries. It's almost impossible to save a life because the damage has been done to the brain.” Dr. Guzman said.

Celeste Calhoun and Jill Plunkett are emergency room nurses with a combined 20+ years of experience. They both agree that seeing gunshot victims coming through the emergency department has happened more often than they’d care to see.

“Gunshots are preventable for children,” Calhoun said. “Children don't go out with an intent to harm each other. They usually obtain the gun because it was left open or out, and by playing with it. Not knowing that it's loaded or what it can do when they aim it at someone and squeeze the trigger.”

Plunkett says her husband was raised around police officers and guns, she and her husband made it a point to teach their two children about gun safety and education at a young age.

“We have guns in our home, they were never loaded and my children didn’t even know the code to the safe until they were adults. They knew the guns were in our home, and if they ever wanted to see them or had questions, my husband would take them out and educate them, but they were never accessible,” Plunkett explained.

Dr. Guzman agrees that education is key. He says he understands why parents may feel they need guns for the safety of their family, however, there is a safe way to have a weapon in the home - locked up.

“Let's put our guns away. For the safety of our children, let's make sure that we're making the right choices,” Dr. Guzman said. “If you can buy a safe, 100%, get a safe and put that gun away. This is not about who can have a gun or who shouldn't have a gun. The bottom line is our children’s safety.”

Dr. Guzman worries that recent state legislation coupled with a spike in gun sales nationwide could lead to more unintentional child shootings.

“Last year (2020) was a bad year, we saw more injuries than we’d seen in the last five years,” Dr. Guzman explained.

The plea is simple. If there are guns in your home, educate your children and make sure they are in a safe and secure place.

“We want to help people avoid having to be in our emergency department, to be safe at home, and live a long life without ever having to see us,” Dr. Guzman said.

Calhoun, who is also a mother, shares another piece of advice that is often forgotten by parents.

“Make sure you know where your child's going to visit and play,” Calhoun said. “If they're going to another home with another child, have that awkward conversation with the parents to find out if they have guns in their home and what safety precautions they take to protect their children.”

Lastly, Dr.Guzman says when educating families, it is important to note that handguns are not the only kind of gun that can injure a child.

“We hear about handguns and firearm accidents in the news,” Dr. Guzman said. “We can’t forget children are injured by BB guns and pellet guns too. I’ve seen children die from BB guns and pellet guns, so we have to be cognizant at all times.”

“We’ve seen gun sales increase significantly nationwide over the past several months,” said Dan Guzman, M.D., a Cook Children’s emergency physician. “Now, with many children being in the home for longer periods of time, curiosity and boredom are something we need to expect. We have to stay vigilant and make sure we’re doing everything we can to prevent a tragic accident.”

According to Small Arms Analytics and Forecasting, this year’s gun sales have already eclipsed 2019 by more than one million firearms.

“With the hunting season about to begin in earnest and the presidential election season about to start in earnest as well, 2020 will without doubt exceed the previous high of 16.6 million units sold in 2016,” SAAF chief economist Jurgen Brauer wrote in an emailed statement provided to FOX Business.

Last year, 41 children were admitted to Cook Children’s for injuries related to guns (including handguns, rifles, shotguns and other firearms such as BB guns.) With 23 children already injured in 2020, Dr. Guzman fears he could see more of these patients this year than last.

“I think most people think this ‘won’t happen to us’ because we’ve taught our kids to never touch guns,” Dr. Guzman said. “But if you aren’t taking the proper precautions as the adult and parent, it’s probably only a matter of when, not if, your life may be affected by an unintentional discharge involving someone you know, and maybe even your child.”

Building awareness for gun safety is a passion for Dr. Guzman. He’s the medical director of the Aim for Safety program at Cook Children’s, which promotes firearm safety for children. The program, which has been featured in several news stories, is a multi-step interactive experience that provides parental awareness and teaches children the steps they should take when they encounter a firearm.

“As parents need to feel comfortable having open-ended conversations with others where our children may play and stay,” he said. “That includes family members and close friends. Don’t be afraid to ask if there’s a gun in the home and if so, how it is stored. Keep the conversation focused on safety and not politics.”

Dr. Guzman offers these safety tips:

The 3 Ts of firearm safety and children

Talk – This includes your family, neighbors and friends. When your child visits other homes, ask the owners if there are guns in their homes and how they are stored. Dr. Guzman said this question is not to be insulting, but to keep your children safe from unsecured firearms.

Teach – Have a conversation with your kids about what to do if they see a gun:

• Stop
• Don’t touch the gun
• Run away
• Tell someone

Take – Dr. Guzman is asking gun owners to take action and store their firearms properly. And, to take personal responsibility for our children’s safety.

But choosing the best place to go for your child's care  can be a difficult one for some parents. After all, Cook Children's offers several options within its system, ranging from primary care, urgent care, the neighborhood clinics and the emergency department.

So how do you know where to go? To begin with, visit the handy infographic to the right or click here.

"Every patient who comes into our Emergency Department is important to us. However, some patients may be able to receive the care they need from their primary care physician, a neighborhood clinic or an urgent care center," said Corwin Warmink, M.D., medical director of Cook Children's Emergency Department. "The best thing a parent can do is know what constitutes an emergency, so they know where to go when that time comes."

When it comes to choosing where to go, Kara Starnes, D.O. medical director of Urgent Care at Cook Children's, advises parents to think about the severity of the issue.

For instance, your child's Cook Children's pediatrician can see a number of ailments, including allergies, the flu, migraines, pink eye, sprains and vomiting.

During times when your pediatrician's office is not available, the Urgent Care Centers at Cook Children's can handle the same ailments, along with most fractures (broken bones) and cuts. Fractures with severe deformities or open fractures should not come to the Urgent Care but instead should go to the Emergency Department (ED). The ED has more equipment to handle the most severe cases, and the child can be admitted quickly to the medical center for continuing care.

If your child has multiple injuries, neck injuries or head injuries with loss of consciousness and/or vomiting, they should go to the ER. These kids typically need the ER because the UCC is not as equipped in imaging and other sophisticated tests available at the medical center.

"Possible surgery, such as appendicitis, is tough for parents to determine because most of the time, abdominal pain is caused by something simple like constipation," Dr. Starnes said. "But severe abdominal pain, testicular pain or swelling, bleeding when vomiting or severe bleeding with bowel movements are reasons to go to the ER."

You should visit the ED with your child in case of a medical problem that could cause death or permanent injury if not treated right away.

Daniel Guzman, M.D., a Cook Children's Emergency Department physician, adds “when in doubt of the severity, always visit the higher level of care such as the Emergency Department” and if immediate attention is required call 911.

And of course, we are right in the middle of flu season. Last week (Jan. 5 to Jan. 11, 2020), 837 kids were tested for the flu. Of those kids, 141 tested positive for Influenza A, 187 for Influenza B and another 102 for RSV. 

For those kids, Cook Children’s has a variety of options for care including the primary care offices, neighborhood clinics and urgent care locations.

“If your child is over 3 months old and has a fever, even a high one, it’s OK to see your pediatrician as long as they are breathing comfortably and drinking well,” said Diane Arnaout, M.D., a pediatrician at Cook Children’s Forest Park. “If your child has mild wheezing, we can give breathing treatments in the primary care offices. If you’re not sure whether your child’s issue is an emergency, our nurses can talk to you over the phone about symptoms and help you decide between the ER, urgent care and a primary care visit.”

Food allergies are a frequently discussed topic among parents and medical professionals. If you are not a parent of a child with food allergies, chances are high that someone you love, or someone you see daily may be dealing with this challenging diagnosis.

According to FARE (Food Allergy Research and Education), 32 million Americans are living with food allergies. If you take the statistic a little further, that means 1 in 13 children have food allergies. For a parent, it can be terrifying to have to think about leaving their child at school all day.

Now that school is in full swing, you may have questions, or may be wondering if there is more you can do to keep your child safe. As a pediatric ER nurse and parent of two with food allergies, I am here to tell you that knowledge and preparation are keys to a smooth year! Here are some ways to ensure your child is safe at school.

1. First and foremost, visit your child’s allergist every year. (If your child is newly diagnosed and awaiting your first allergist visit, your pediatrician can help you.) Make sure your child has an updated prescription for Epi-Pens. Make sure you have 2 sets; one for home and one for school to keep with the nurse.
2. Ask your child’s allergist or pediatrician to fill out a personalized action plan. The FARE website has action plans that are simple to understand, and can be found at www.foodallergy.org. Make multiple copies of these plans. Give them to your child’s teachers and the school nurse. These are absolutely essential to have! They outline exactly what to do in the case of accidental exposure to an allergen.
3. Know your rights as a parent. Your school should be accommodating your child in the best way possible. Your child is protected by law due to their food allergy. You can request a 504 meeting at your school. During this meeting, you meet to determine how to best meet the needs of your child at school. As an example, in my children’s 504 plans, we specify that they need to not be seated around anyone eating nuts during the lunch period.
4. Make sure your children know to never, ever eat food that you either did not pack for them, or did not provide for the classroom. Get your kids in this habit early, and it will become second nature.
5. Prepare for classroom celebrations. Elementary school especially seems to have many, many food centered celebrations. Provide a box of safe treats to keep in your child’s classroom so that they are not completely left out.
6. Read every label! Food companies are not required to label for allergens, so it is essential to read every ingredient, even if it’s a food your kiddo has consumed before, as production lines can change.
7. Take care of yourself. Caring for a child with food allergies can be stressful. Take heart in knowing it will get easier over time. Reach out to other food allergy families and know you are not alone.

The National Weather Service in Fort Worth has issued a heat advisory from 1 p.m. Tuesday through 8 p.m. Wednesday. According to the Star-Telegram, it could feel as hot as 111 degrees in parts of our region.

The range of the heat-related incidents seen at the ER has included children left in hot cars to kids being treated for heat exhaustion after working out.

"As the outside temperature rises, your family's risk of heat stroke rises right along with it," Corwin Warmink, M.D., medical director of Emergency Services, said. "On 100-degree days, it's best to stay inside when it gets that hot. If temperatures exceed 90 degrees, stay in the shade and keep an extra eye on the kids."

Children today are spending increasing amounts of time in air conditioned environments, lured indoors by the constant upkeep of social media accounts and online gaming. Studies show the average American child spends 4 to 7 minutes a day in unstructured play outdoors, compared to more than 7 hours a day in front of a screen.

"The more you're out in the heat, the more your body gets used to it, or 'acclimatizes,'" Dr. Warmink said. "Children who are always inside are more prone to heat exhaustion and heatstroke than those who are frequently outdoors and active."

Play it cool

But don't mistake what Dr. Warmink is saying. Too much time out in the heat can cause heat-related illnessess such as heat exhaustion and heatstroke.

Lack of acclimatization has led to an uptick in heat illness among children in recent years, according to Dr. Warmink. Most incidents occur during the first two weeks of school athletics training when kids begin cross country, football, cheerleading or band practice.

"More is being demanded of young athletes during the late summer months," Dr. Warmink said. "Kids who spend all summer indoors and then go out for training in August are setting themselves up for heat illness."

For more information on this topic:

• Tips for Preventing Heat-Related Illness - CDC
• Heat Exhaustion and Heat Stroke
• Child Safety Center
• Vehicle/Car Safety
• Drowning Prevention

But when it comes to newborns, forget everything I’ve always taught you about fever. If an infant has a fever, it is a sign something is wrong and a serious cause for concern

In older children, fever is almost never an emergency, the exact degree of the temperature doesn't really concern me and unless there are other reasons to do so, a workup isn't indicated.

In babies up to 3 months of age, the opposites are true.

Fever in a newborn is an emergency. When a newborn has a fever, parents should have a sense of urgency.

An accurate temperature really matters for newborns. You don't need to go around checking your baby for fever randomly. But if they feel warm, are not eating well or you're otherwise worried, we recommend taking a rectal temperature. Rectal temperature is important because it's the most accurate way to determine the temperature and the studies that tell us what to do with your baby are based on rectal temperatures.

Once you have an accurate temperature, I recommend that you call your doctor with any temperature over 100 degrees. Technically fever is anything over 100.4, but it's good to let us know so we can coach you on what you should be looking for. It also helps us decide what should prompt a visit to the emergency room if it rises overnight.

Fever is such an emergency in babies because they can be an early sign of serious, even life threatening infections and babies can't tell us if something hurts. Babies can have blood stream infections, meningitis or urinary tract infections with little other symptoms. They also can get all the other things that older kids get too like stomach bugs, flu and other viruses but we would rather be safe than sorry.

Because of these risks, babies with fever will typically receive some type of lab work to determine if infection is present. This can include blood work, urine test and possibly a spinal tap to rule out meningitis.

While it's scary and no one wants to think of your baby needing this work-up, the fear of missing one of these serious infections or leaving them untreated, even for a short period, is even scarier.

Most babies with fever will be started on antibiotics while we wait in results from the test. This prevents babies from getting worse while we wait for results to come back.

So, as you can see, fever in newborns is a LOT different.

But, the important thing to remember is to call your doctor if the fever is over 100 and we'll help you keep your baby safe from there.

Related Topics:

• My Child's Fever Isn't Going Away. Should I Be Worried?
• 7 Types of Thermometers and to what Degree You Should Trust Them
• My Child has a Fever. Should We Go to The ER?
• 5 Days of Fever. Now What Should I Do?
• When It Comes to Your Kids It's Never Just a Virus
• Let's Learn About Fevers
• 4 Reasons Why This Pediatrician Doesn't Alternate Tylenol and Motrin for His Kids

NBC 5 reports that a toddler was shot in the head at a Fort Worth home last week. Police said the child’s mother and father were at the house and twin 2-year-olds were present at the time. 

While few details have been released about the shooting, Dan Guzman, M.D., an emergency physician at Cook Children’s and a gun owner himself, wants to make gun safety a priority in family’s homes. According to a 2017 Pew study, 30 percent of Americans own guns. Last year, 24 children were treated for gunshot wounds at Cook Children’s.

“Unfortunately, the tragedy of children falling victim to unsecured firearms continues to happen daily,” Dr. Guzman said. “These preventable incidents, and the pain and suffering they inflict can be reduced by properly securing your firearms.”

Dr. Guzman began the new Aim for Safety program at Cook Children’s, which gives parents the real-time opportunity to see what they would do if they found a gun.

Dr. Guzman stressed that children are curious and impulsive which can be deadly when paired with a firearm. Storing a loaded firearm under the mattress, in a bedside table or in a closet is placing your family at risk, Dr. Guzman added.

The safest place for your firearm is in a safe with the ammunition stored separately. Unsecured firearms should always be in your possession. If you are unable to purchase a gun safe, then separating the ammunition from the firearm and using a cable or trigger lock will help reduce the risk of unintentional injury to your child.

“It’s important to assess and evaluate your home injury risk and find ways to reduce the hazards in your home whether it is related to firearms, water safety, poisonings or any other safety risks,” Dr Guzman said. “Discussing with your children the importance of what to do when they encounter a firearm can help to reduce unintentional injury in your home.”

Teaching children basic firearm safety tips can save a child’s life such as:

• Stop
• Don’t touch
• Run away
• Tell a grown up

In addition, when your children visit other homes ask the owners of the home – parents of your child’s friends, your children’s grandparents or other close family members – if there are guns in their homes and how they are stored. Dr. Guzman said this question is not to be insulting, but to keep your children safe around unsecured firearms.

Aim for Safety focuses on protecting children from firearms. The program can help to answer any questions about your child’s safety and help to direct you to any resources to find the appropriate storage device.

Aim for Safety will begin a new program soon to show parents what can happen when their children encounter a firearm. For more information, please visit aimforsafety.org.

For more on this topic:

• Aim for Safety
• Program Aims to Protect Children from Accidental Shootings

But when his daughter was diagnosed with pneumonia and admitted to Cook Children’s, he became every other worried parent … except with way too much knowledge of medicine for his own good.

Everything started a couple of weeks before Christmas.

Dr. Guzman was at work when he received a phone call from his wife, Abbie. She told him that Sophia Grace, their 6-year-old daughter, didn’t feel well.

Rarely do any of the Guzman children get sick. So this wasn’t normal for any of them, but especially Sophia. She is the “crazy child.” The one Dr. Guzman says will someday be the death of him because of her rambunctious nature.

When Dr. Guzman came home that evening, Sophia’s temperature was up to 104. He gave her a fever reducer that worked for a little bit, but he noticed his daughter wasn’t herself. She wasn’t running, playing or dancing like normal.

By the third day, he knew “something was weird.” Sophia wasn’t showing any other signs of being sick, except a fever and she was lethargic. She didn’t have a runny nose, congestion or cough.

“So I went into doctor mode,” Dr. Guzman said. “I looked at her ears and throat. I listened to her lungs. There was a change in there. Typically, these are the lungs of a kid with pneumonia.”

Dr. Guzman made an appointment for his daughter to see her pediatrician, Ben Worsley, M.D. Sophia was still running a fever steadily at 104, despite taking antibiotics. An X-ray confirmed what Dr. Guzman already expected. His daughter had pneumonia.

“I see kids every day,” Dr. Guzman said. “But when it is your child … Oh man … Your mind starts to go to places that are bad. I know the worst that could happen.”

Karen Schultz, M.D., the medical director of Pulmonology at Cook Children’s, took over Sophia’s care. Dr. Schultz and Dr. Guzman trained together during internship and residency in pediatrics and have known each other for more than 20 years.

Dr. Guzman admits to being a bit of a mess while his daughter was in the hospital. He continued to work in the Emergency Department for the first couple of days his daughter was at the medical center, until someone could take over his shift. He compartmentalized. In the ED, he was in complete control. But his heart was upstairs where he watched helplessly from the sidelines.

“I knew Sophia was in great hands,” Dr. Guzman said. “I knew we were in the right place and at a great institution. I trust everyone implicitly. I knew early on I needed to be just the dad and let everyone else do their jobs. I just felt helpless. I had no control of what was going on. It was so hard from a physician standpoint.”

Dr. Guzman learned his daughter shared his fear of needles. Yes, the emergency physician still has a fear of needles to this day and so did his daughter after being poked a few times during her stay. Suddenly the fun place her daddy worked became a hospital.

The night after being admitted, Sophia experienced breathing problems and her fever continued to spike. She wasn’t getting better.

John “Chip” Uffman, M.D., a surgeon at Cook Children’s, and Dr. Schultz met with Dr. Guzman and Abbie. Their little girl needed surgery to insert a tube into her chest and drain the fluid off her lungs from the pneumonia.

“I’m a wreck at this point,” Dr. Guzman said. “I know too much. It’s my job to calm parent’s fear, but I knew all the risks too. It was all going through my head and I just wasn’t thinking clearly or rationally. I knew for my wife and for my little girl, I had to keep it together.”

Dr. Guzman gathered his composure, but couldn’t help but think about the scared parents he sees as an emergency physician. He says he has become more aware of that process. He wants to be even more patient while talking to families and really make sure they understand everything he’s telling them.

But that would come later when he returned to work. For now, he focused on his daughter’s health.

The worst part for him was watching his daughter being taken away for surgery. She held out her arms to mom and dad. “That was heartbreaking,” Dr. Guzman said.

What Dr. Guzman didn’t realize was his daughter wouldn’t remember anything about the surgery.

“It was the hardest hour and a half of our lives, waiting on some news,” Dr. Guzman said. “But Sophia just says, ‘I took giggle juice.’”

The tube drained fluid from Sophia’s lungs and she continued to receive antibiotics through an IV.

Over the next couple of days, Dr. Guzman saw Cook Children’s through a patient family’s eyes. He saw the work of the therapy dogs and the music therapy program. She received a Build-A-Bear and even a visit from Santa.

“Everyone did such a great job to get her to smile and feel good,” Dr. Guzman said. “We are so blessed to have all of these things at Cook Children’s. I didn’t appreciate it as much as I should have. For the first time since she was in the hospital, I watched Sophia’s face just light up. It was so nice to see her happy again.”

Nearly a week after being admitted to the medical center, Dr. Guzman and Abbie were finally able to smile too. The chest tube was removed and after 18 hours of sleep that Dr. Guzman calls the “dark black spot,” Sophia woke up at 5:30 in the morning. She was ready to eat. She was ready to play. Her parents were ready to finally sleep. Their daughter was on her way to recovery.

“Now for Sophia, this has become a badge of honor. She tells her two siblings, ‘I was poked six times. I have a scar on the right side of my chest. I had a tube inserted. I was the first one in the family to have surgery,” Dr. Guzman said. “She wears this proudly. At the time, we were deathly afraid. It’s nice to see how she’s been able to cope and find so many positives about her stay. It’s just so great."

An average of 132 tornadoes occur in Texas each year.  

At some point, probably in the near future, one of those tornadoes will be in our area. Then what?

First of all, have a plan in place.

Sometimes, it’s just as important to know what you shouldn’t do. Kaysey Pollan, Environmental Safety and Emergency Management officer at Cook Children’s, offers these five things you should never do during a tornado:

1. Be unsure of your safeplace. Whether if it’s at your home or your office, know where you are going to go during severe weather. If you don’t have access to underground shelter, move to the interior room or hallway on the lowest floor and get under a sturdy piece of furniture. If you live in a mobile home, get out and find secure shelter.
2. Turn off your TV or radio. You hear it all the time. People calling in complaining to TV stations because their favorite program was interrupted for the weather. Don’t be that person. Pay attention to the weather forecast.
3. Depend on your fast car. Sorry, you can’t, or shouldn’t want to, outrun a tornado. Find shelter. If you can’t find shelter, get out of the car and find the most low-lying area (ditch, ravine, etc.). Lay flat your stomach and cover your head with your hands.
4. Open the windows. It’s been proven that this serves no benefit whatsoever. All an open window does is allow more wreckage to enter your home. During a severe storm, stay away from windows and keep them closed.
5. Drive underneath an overpass The National Weather Service Forecast Office says, “Seeking shelter under an overpass is more dangerous than standing in an open field while a tornado is approaching." When a tornado passes over an overpass, the wind is funneled under the bridge. In turn, this actually increases its velocity.”

Learn more from the source material for this article at the following sites:

• ready.gov
• knowhat2do.com
• accuweather.com/

“Last year during that first week of school, we saw more kids coming to the ED for playground falls, sports injuries and pedestrian accidents with kids walking or riding their bike to school,” said Denise Doherty, RN, director of the Emergency Department at Cook Children’s. “But with the new ED I think we’ll be better able to handle what comes our way.”

The new $14.2 million expanded ED provides larger exam rooms that are designed so families and caregivers can better share the space. The room layout allows for the family to be on one side of the room, but also provides plenty of space on the other side, so the caregiver can be more mindful of the patient.

Cook Children’s new Emergency Department, features:

• 10 intake rooms.
• A new CT (computed tomography) room with a CT scanner that is 5 times faster than the previous one.
• 76 general exam rooms (five that can be used for resuscitation), up from 56 rooms in the old ED.
• All rooms are private and without curtains.
• Radiology scanning will now be embedded within the ED and all initial imaging will occur at bedside.
• Two X-ray rooms.

“The new ED allows ultrasound technicians to bring their technology with them and the patients don’t have to leave the exam rooms,” Doherty said. “With the additional imaging capabilities and lab services in our ED rooms, patients won’t have to be moved around as much as in our previous ED. This will be helpful with the amount of sports and pedestrian injuries we see during that first week of school.”

Pedestrian safety

Kids walking or riding their bikes, scooters or skateboards can be dangerous when not done correctly. The next few weeks, while everyone is getting adjusted to kids going back to school, can prove especially hazardous. More children are hit by cars during September than any other month of the year, according to Safe Kids Worldwide.

Safe Kids recommend teaching your kids these safe behaviors:

• Look left, right and left again before crossing the street. Cross when the street is clear, and keep looking both ways while crossing.
• Walk, don’t run.
• Understand and obey traffic signals and signs.
• Walk facing traffic, on sidewalks or paths, so that you can see oncoming cars. If there are no sidewalks, walk as far to the left as possible.

Practice safe behaviors:

• Don’t allow a child under age 10 to cross streets alone as he may not be able to fully appreciate the speed of cars on the road.
• Require children to carry a flashlight at night, dawn and dusk. Add retro-reflective materials to children’s clothing so that a child can be seen by motorists, even in the dark.
• Don’t let kids play in driveways, unfenced yards, streets or parking lots. Drivers may not see or anticipate children playing.

Doherty reminds parents that bike helmets should be worn at all times for kids riding a bike to school. Bike helmets should sit on the top of the head with the chinstrap fastened, holding the helmet in place if the child is to shake his or her head or fall.

KrisDi Ingermann went to Cook Children’s in 2007 close to death from toxic shock. Once she arrived, an Emergency Room physician almost immediately diagnosed her. Over the next six days KrisDi was unconscious in the Cook Children’s pediatric Intensive Care Unit.

“I have never been so scared in my life,” said Theresa Ingermann, KrisDi’s mother. “She had doctors and nurses at her bedside 24/7 until she was out of the woods.”

As they watch the drama of Rylie play out on national television, the Ingermanns hope their story will help others understand not only the difficulty of recovery, but also the stigma attached with toxic shock.

KrisDi’s symptoms began almost immediately after she used a tampon for only the second time in her life. Later the Centers for Disease Control and Prevention took the new sports tampon brand she used and interviewed the family in hopes of preventing other users from suffering a similar fate.

KrisDi was embarrassed at the situation. She was even concerned because the CDC would report on her illness and that a record would be kept of what she had gone through as a child. More than eight years after she nearly died, KrisDi fights back tears remembering not only her near-death experience but what she dealt with from her peers who didn’t understand her condition.

“At the time, it really messed me up in high school,” KrisDi said. “The first thing people said after I got it was that I was dirty and that I didn’t take care of myself. There are always mean kids in school and they thought it was because I didn’t change my tampon. They didn’t know why I got it, but that was not the reason.”

Little did those kids know the true story. The family had gone to Lake Whitney near Waco, Texas. Theresa had gone to the grocery store. She wasn’t gone a half hour, but when she returned she found her daughter in horrible shape.

KrisDi’s skin was “beat red” and throwing up. They rushed her to a nearby small clinic. The medical team gave her oxygen but it did little to help. KrisDi had a defibrillator for a heart condition and the pacemaker was working against the medication she was given at the time.

After three hours, the medical team at the clinic called an ambulance to rush her to Cook Children’s Medical Center in Fort Worth. KrisDi remember saying she was going to die. Her mom says when her daughter opened her eyes they were a frightening blood-shot color, as if KrisDi was bleeding from them.

The next six days was a battle for KrisDi’s life.

“It kept getting worse and worse, for a while the medical team didn’t know if she would make it,” Theresa said. “Fortunately, KrisDi doesn’t remember any of it. But for me, it was the worst time in my life. I wish I could forget it. It’s hard to even think about it now.”

On the fifth day everything changed for the better. KrisDi opened her eyes and looked around. By the next day she was out of the ICU. She spent another week at Cook Children’s before getting discharged.

After the harsh reaction she received when she returned home, it was almost a year later before KrisDi told anyone that she had toxic shock because of the stigma involved with the condition. The family eventually moved to Kentucky to put that time behind them.

“KrisDi was always a very outgoing person but she just shut down after she got out of the hospital. She didn’t want to see anybody. She felt shamed because of it,” Theresa said. “She received counseling for help. But kids that age are going to talk. It wasn’t the truth the things they said about her. It was horrible. I don’t think people understand she had done everything right and we still almost lost her.”

Today, KrisDi is doing well and is the mom of a 7-month old daughter named Vera. KrisDi suffers from migraines and muscle aches, but she’s not sure if it’s related to toxic shock.

“I hope that more studies are done on toxic shock and I also hope that people take time to learn more about it,” KrisDi said. “I have good hygiene. I did as a young girl too. I had done my research when I had my first period and did everything I was supposed to do. I want people to know that it can happen and I want girls like Rylie to know that it’s not something she should feel guilty about or embarrassed by it. I was embarrassed for a long time because people thought I was dirty.

But I wasn’t dirty and I’m not embarrassed anymore.”

On behalf of my family, I would like to congratulate you on your retirement and successful career. I know that you changed the lives of many families but I wanted you to know how much you changed ours.

From the very beginning, I trusted you and you never failed William. Maybe it is experience or maybe it is luck; I have nothing but confidence when I think about all the times you were called to consult on his case or help him through surgery. My first memory is when you put in his PD (Peritoneal Dialysis) catheter. So much was at stake for this boy in renal failure. Not only his life, but a family who wanted him to live. I asked to pray with you and the anesthesiologist before the procedure. I still remember the way you took off your surgical cap and bowed your head. Thank you for praying with me even when I could not understand myself through fearful stuttering.

The standard measuring system for a kidney transplant is your fist. I can still see you holding your fist to Will’s tummy to show me how much more he needed to grow. Every month we would work for each advance in height and weight. I remember showing up for a check-up like a student eager to have her project graded. You were as excited as I was for 10.2 kg and a torso that could hold a kidney the size of your fist. At 20 months old, you and your team transplanted a kidney in my son that “pinked up right away.” I can still see your smile and hear you answers to our rapid questions. Our son went into your OR in renal failure and came out with the first normal renal panel in his life. Thank you for guiding us through those months and thank you for all of the beautiful stitches.

William was your patient, but we are his family. Thank you for repeating your opinion over the phone with my husband when he had to be at work. Thank you for letting grandparents ask how a procedure had changed since they had children. Thank you for letting us interrupt your sleep, schedule, and rounds over and over because Lord knows Will loved to do something interesting at 3:45 on a Friday afternoon. Thank you for listening to me. Thank you for looking me in the eye when the news was not the best. Thank you for rejoicing when the news was momentous.

I have no idea how many lives are changed because of your work. But I know how much better the world for our family is because you were in it.

God bless you and keep you, may His face shine upon you.

Katie, Chuck, Will and John Spiekerman

Warren and Lori Carver

Chris, Kathy and Jacob Carver

Charlie and Vicki Spiekerman

Ailments run the gamut from respiratory and fever issues (RSV and influenza) to gastroenteritis with vomiting, diarrhea and severe dehydration. And while there’s not one illness that stands out, one thing is for sure – children in the ED are sicker than they’ve ever been.

“Our ED is running beyond full capacity and has been since December. But in the last few weeks we’re seeing a larger number of very ill children than even during flu season.” said Corwin Warmink, M.D., assistant medical director of the Emergency Department at Cook Children’s. “The sicker the child, the longer it takes to diagnose, treat and properly care for them.”

In December, 20 to 30 kids were admitted for treatment per day from the Emergency Department, but by February, those numbers jumped to about 40 to 50 children a day.

The Emergency Department is averaging nearly 400 patients per day, and during its busiest times a patient will check in every two minutes.

Overall, children appear to be sicker this year. Compared to this time last year, Cook Children’s has seen a 60 percent increase in the percentage of children who need critical care.

As the number of patients admitted and treated in the ED increases, so does the time physicians spend with each child, which contributes to the much longer waiting times.

Depending on the severity of the illness or injury, it could take 4 to 6 hours to care for a child. But it’s not just one physician treating that child. Nurses and health care providers may be brought in too.

“Many of the children we see are dealing with very serious emergencies and they receive immediate care,” Dr. Warmink said. “We use all necessary resources and manpower to care for those children. Unfortunately, that means longer wait times for the families in the waiting room.

“Families could spend anywhere from 5-10 hours or longer in our waiting room, depending on the day they visit. We are actively bringing in extra doctors, nurses and support staff to try and improve these times.”

Dr. Warmink advises parents that Sundays and Mondays are the busiest days of the week in the ED. Evenings after 5 p.m. seem to be popular too.

Families with sick kids who aren’t experiencing emergencies do have other options. The first line of defense is your child’s pediatrician. Making an appointment with a child’s doctor may help avoid a long wait at the ED. Cook Children’s also has several Urgent Care Clinics for non-emergent needs.

Previous articles on this topic:

• More flu, longer waits in the ED
• Emergency? 6 signs from an ER doc
• Cook Children's to build new South Tower on main campus
• Is it RSV?
• 8 flu myths I wish would go away

The Emergency Department at Cook Children’s sees eye and face injuries from projectiles (fireworks that launch or that have parts that explode off), hand and finger injuries from holding items while they explode and burns of every type, especially when children are running around barefoot.

U.S. Consumer Product Safety Commission (CPSC)’s annual death and injury report on fireworks incidents indicates that nearly half of these injuries occurred to children younger than 15 years of age. The culprits? Firecrackers, bottle rockets and sparklers – yes, sparklers.

Sparklers are considered by many to be the “safe” firework. But even an innocent looking sparkler can get as hot as the flame on some blow torches and can easily ignite clothing?

“Every firework has its dangers and there simply isn’t one that I would consider completely safe,” said Justin Smith, M.D., a pediatrician in Lewisville. “Parents would be safest to take their children to an event and watch fireworks. You will have a good time and can view from a distance.”

Remind your friends and neighbors, before they touch a flame to any fireworks, to make sure it’s legal to do so where they live.

Prevent the Tragedies

If fireworks can be used legally where you live and you do want to use them, here are a few guidelines CPSC recommends they follow:

1. Never allow young children to play with or ignite fireworks. Adults should always supervise fireworks activities.
2. Never try to re-light or pick up fireworks that fizzle and don’t go off.
3. Never point or throw fireworks at another person.
4. Keep a bucket of water or a garden hose handy in case of fire or other mishap. After fireworks fully complete their functioning, douse the spent device with plenty of water from a bucket or hose before discarding to prevent a fire.

More guidelines are at CPSC’s Fireworks Information Center. 

moment. So, while you have a calm moment, we thought it would be a good idea to take a look at what’s an emergency and when you should go the ER. Otherwise, you probably should take your child to the urgent care center.

Kimberly Aaron, M.D., medical director of the Cook Children’s Emergency Department, gives us six things to check in helping make this decision.

Here are 6 signs your child may need to go to the emergency room. Is your child having:

1. Difficulty breathing
2. Poor skin color
3. Abnormal or altered behavior  
4. Major trauma
5. Severe pain
6. Persistent bleeding

When in doubt, always call 911. Cook Children’s has four Urgent Care Centers to treat your children, Fort Worth, Mansfield, Southlake and Northeast Hospital.

Related Links:

• Medical emergencies: are you prepared?
• Emergency contact sheet
• "What do I do?!" - First-aid and safety information
• Going to the emergency room
• Teaching your child how to use 911
• Is it a medical emergency?
• Poison first aid
• The well-stocked first-aid kit 

A few days later we went to an allergist who had to prick his back 100 times to tell me he is deathly allergic to tree nuts, peanuts, fish, shellfish and eggs. I learned this information almost 10 years ago and despite my best efforts to educate my son and everyone in my family, I still make mistakes. These *#!@ foods can be hidden.

Here’s my top 5 list of the strangest places to find deadly allergic foods:

1. Hamburger patties and meatballs. Eggs can be used as a binder in these.
2. Kids multivitamins. Check these for fish oil.
3. Frying oil. Ask every restaurant every time if they use peanut oil. Someone different could order the oil from the last time you ate there.
4. My own mouth. I stopped eating all nuts in case he drank after me or I gave him a bite from my fork.
5. Read all food labels. I have found egg in bubble gum.

Where have you found allergic foods? Please share.