Since he was 2 years old, Gaites Fisher has had trouble breathing. In addition to severe asthma, Gaites has a condition in which his right aortic arch compresses his trachea, making it difficult for him to breathe. His mom, Angelaka Johnson, tried everything to help; she bought an air purifier, tried to track what triggered his attacks and researched endlessly for solutions to his asthma attacks.

But despite her best efforts, Gaites still ended up being hospitalized six times between the ages of 2 and 5. Allergies or a cold would sometimes trigger the attacks, and she would quickly find child care for her other two children and rush Gaites to the hospital.

“(I felt) like I failed as a mom because I couldn't get his asthma under control. And I didn't know how to help him more,” she said. “And I always felt so defeated having to go to the hospital, knowing we’ll probably end up staying overnight.”

In June 2025, after another hospital stay at Cook Children’s, Angelaka got a phone call about a program that aimed to help her and her son with his asthma.

“I didn’t know what to expect. I thought we would just be on the phone and she would give me info that I already had; that it would be more redundant,’ she said. “And it ended up being a lot more helpful than that.”

The Cook Children's Healthy Homes Program, which celebrated its 10-year anniversary in January, provides free resources, support and education for families and children with severe asthma. Since its inception in 2016, staff have served 1,556 children across the eight-county service area. The goal of the program is to identify and manage the source of kids’ asthma - like dust, dander or mold - and keep families from getting to the point where they need emergency care.

Marquietta Jones was formerly a Healthy Homes program coordinator for eight years and was recently promoted to care coordination supervisor.

She explained how families are brought into the program. Community health workers reach out to families who have had multiple asthma-related emergency department or urgent care visits in the previous six months. The staff reach out to the family and schedule either an over-the-phone or in-person assessment and questionnaire about their home environment and asthma history.

Over three months, families get free one-on-one support by a community health worker to identify home environmental triggers, secure supplies and services and, if needed, obtain referrals to social and medical support.

Angelaka says she was a little skeptical when Community Health Worker Cristina Cantu took her through the assessment, but she quickly realized Healthy Homes didn’t just talk about resources and support; they followed through.

“Usually when you do these things where people say they aren’t going to charge you, they make you jump through hoops to get the things you need, or it wasn’t the things you need. Where in this case, they kind of over delivered. I was surprised,” she said.

The most common triggers for asthma are respiratory infections, weather changes, pollen and dust, but it can be difficult to narrow down what factors in a home exacerbate those triggers. For example, dirty A/C vents, dusty ceiling fans and leaky sinks are all commonly overlooked household issues that can make asthma worse. A large part of the Healthy Homes program is educating families on how to identify and clean those problem areas.

Angelaka had done plenty of research on her own about how to help her son’s asthma, but he still often had flare-ups that sometimes led to hospital visits. The mother of three is a full-time graduate school student, and Gaites’ asthma and hospitalization were hard for the entire family.

To help with Gaites’ breathing, Angelaka bought an air purifier, cleaned the house frequently, monitored his time outside when the weather changed and tried to track his triggers. So when Cantu from Healthy Homes called to talk to her about asthma, Angelaka wondered what the community health worker could tell her that she hadn’t already looked into herself.

But Cantu did not just dump information on Angelaka; she asked her questions. Through the program’s opening assessment, Cantu and Angelaka were able to figure out what she was already doing and what other resources could help further. Then, Healthy Homes provided those resources.

For example, Cantu taught Angelaka how to make her own cleaning solution that seems to be healthier for Gaites. Angelaka used to clean with a standard, store-bought cleaner and assumed any kind of dust removal was helpful for her son. But when she switched to the other cleaner made with Castille soap, vinegar, baking soda and hot water, she noticed he seemed to be coughing less.

Similarly, Angelaka didn’t realize that not all air purifiers clean the air in the way her son needs; Jones recommended an air purifier that has both a carbon and a HEPA filter. Healthy Homes gave Angelaka this more powerful air purifier, which she said has made the biggest change.

“I can’t explain enough the difference the air purifier makes,” she said. “It has definitely made a difference to me. When he’s in here, he’s playing, he’s not coughing, not sneezing. When he comes in from playing in the backyard, the air is clean in here.”

The Healthy Homes’ website includes a plethora of information and tips on identifying and managing asthma triggers. 

Perhaps most importantly, Cantu gave Angelaka emotional support. Gaites is on the autism spectrum, and Cantu showed Angelaka a Facebook group for moms of children with autism. She checks in with the family about once a week and sends Angelaka info on community resources. She and Angelaka created a binder with all of Gaites’ medical information, triggers, and emergency plans that Angelaka gave to family members, babysitters and Gaites’ school.

The binder of emergency information has made Angelaka more confident that Gaites’ teachers or school nurses will be able to help him if he has a flare up. That sense of security has made it easier for her to focus in classes, because she’s not constantly worried about him.

“When you’ve exhausted all your other resources that you may know on your own to do, it's good to have a program like this that helps you find resources…so that you can be more proactive instead of reactive with those asthma symptoms,” Angelaka said.

Healthy Homes is intentional about providing that all-encompassing support for families, Jones said. Aside from providing families with supplies, the program can provide resources for financial support and other basic needs. Community health workers give parents information about all kinds of community resources, not just those related to asthma. And with monthly check-ins throughout the three-month program, community health workers help families feel less isolated.

Beyond the initial improvement in child’s asthma, community health workers want families to be empowered to continue that care for the rest of their lives.

“We encourage our parents to be advocates for their child,” Jones said. “We want to be able to empower those parents to find ways to eliminate those triggers and to make sure everyone that's in contact with that child is on one accord.”

About 9% of the children in Cook Children’s eight-county service area have asthma. While serious, asthma is manageable.

For families who don’t qualify for the full program, Healthy Homes mails out information that includes a link to the Healthy Homes website. The website has videos on common asthma triggers and medication methods, as well as downloadable booklets available in nine languages.

For families like Angelaka's, the Healthy Homes program can mean all the difference for kids with asthma. On average, families who go through the Healthy Homes program have a 75% decrease in the number of emergency room visits, according to Healthy Homes’ data. In the six months since Gaites completed the program, he has not been to the emergency room at all.

This is a change, his mom said, from the two visits per year he has had since he was 2 years old.

Angelaka said she’s glad that Gaites and his siblings can focus on just being kids instead of worrying about being sick.

“Because he likes to run, he likes to run and he likes to jump. And that means a lot to me for him to just be happy and to just play without worrying,” she said.

If your child has asthma, you can check out Healthy Homes website for resources on identifying and managing asthma triggers.

With the holidays in full swing, accidents and illness may happen at any time. It is always recommended that you try scheduling an appointment with your primary care doctor first. If that is not an option, Cook Children’s Health Care System ensures that our families can access health care at any time through a telehealth visit, an urgent care center, or an emergency department. To prepare for when you need care, know when to use Cook Children’s telemedicine, urgent care, and when to rush to the emergency department.

“For simple fever, cough, and congestion, your child can be seen in urgent care or by their pediatrician,” said Taylor Louden, M.D., medical director of emergency services at Cook Children’s Medical Center- Fort Worth. “Your wait times for simple illnesses will be much longer and visits much more expensive in the emergency department than if your child is seen in urgent care or by their pediatrician.”

He explains that doctors expect a fever to return after the Tylenol/Motrin wears off; however, for fevers lasting more than five days, or if a child appears ill, the emergency department is the appropriate place to be evaluated.  

Urgent Care

When your child needs urgent care for things like X-rays, stitches, and illnesses that are not life-threatening but need medical attention the same day, you'll find the medical care you need at a Cook Children's urgent care clinic.

Cook Children’s Urgent Care clinics are not just kid-friendly; they are kid-only.

When to use Cook Children’s Urgent Care

• Ear infections/pain
• Strep/sore throats
• Cold symptoms
• Flu
• Mild dehydration
• Respiratory illnesses – including respiratory syncytial virus (RSV), bronchitis, bronchiolitis, pneumonia and asthma without severe breathing difficulty
• Sprains and possibly broken bones
• Minor cuts
• Prolonged vomiting
• Persistent diarrhea
• Infected bug bites
• Foreign body removal (marbles, beans and other interesting things)
• Urinary infection symptoms
• Pinworms, ringworm, rashes and pink eye
• Painful muscle strains
• Head injuries without loss of consciousness or vomiting

Virtual Urgent Care

Cook Children's patients with a MyCookChildren's account can video chat with one of our medical experts for non-urgent medical conditions without visiting the doctor's office.

This service is for patients who have minor medical conditions, and not for emergencies.

• Animal and insect bites
• Burns or cuts
• Circumcision check
• Conjunctivitis (pink eye) without other symptoms
• Constipation advice
• Covid-19*
• Diaper rash
• Fever advice
• Flu-like symptoms*
• Ingrown toenail
• Lice
• Mouth ulcers, thrush
• Rashes or skin infections
• Sore throat/strep throat*
• Urinary tract infections*
• Vomiting/diarrhea
• Wound care advice

*Drive-through testing available at Cook Children's Urgent Care locations if medically necessary.

When to use the Cook Children’s Emergency Department

Cook Children’s Health Care System has two medical centers with an Emergency Department for our Fort Worth and Prosper little ones. Parents should take their child to the Emergency Department if their child is unconscious, not responding, a bone is sticking out, or the situation seems critical. Dial 911 immediately for an ambulance. When your child's condition is life-threatening or might cause permanent harm, it is safer for your child to be transported via ambulance.

• Severe bleeding that does not stop after 15 minutes of direct pressure
• Severe allergic reactions
• Difficulty breathing
• Coughing up or vomiting blood
• Sudden severe joint pain with swelling
• Insect stings accompanied by breathing difficulties
• Swallowing poison or choking
• Not being able to move or speak
• Severe or persistent vomiting or diarrhea
• Gaping wound (edges won’t come together)
• Head injury with loss of consciousness, vomiting or causing dizziness/confusion
• Visible broken bones or dislocated joints
• Fever in infants under 8 weeks old
• Diabetes/blood sugar issues

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

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

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

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

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

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

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

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

Tips to stop the spread:

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

RELATED STORY:

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

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

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

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

Symptoms for Mycoplasma pneumoniae Infection

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

Chest cold symptoms

Common symptoms include:

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

Younger children may have different symptoms

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

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

Pneumonia symptoms

Common symptoms include:

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

M. pneumoniae can cause "walking pneumonia"‎

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

The flu is an infection of the respiratory tract (nose, throat, and lungs) that is caused by a virus. It can spread easily from person to person. Usually during cold and flu season, most children will experience very mild symptoms that normally self-resolve within a few days, said Cook Children’s hospitalist Laura Romano, D.O.

Flu activity is considered widespread in Tarrant County, according to Tarrant County Public Health. This flu season, we are admitting larger numbers of older, previously healthy children with difficulty breathing and flu-related pneumonia at the Cook Children’s Medical Center - Fort Worth, Dr. Romano said.

Most are requiring supplemental oxygen and some require ICU admission. While this has not been uncommon during prior flu seasons, this is now becoming the norm for admissions rather than the exception, Dr. Romano said.

“Overall, it seems that the flu is not going away anytime soon this season,” Dr. Romano said.

From Feb. 4 to Feb.10, out of 1,593 tests conducted, 16% were positive for flu A and 21% were positive for flu B, according to lab data at Cook Children’s Medical Center - Fort Worth.

This is a decrease compared to the prior week (Jan. 28 to Feb. 3), which showed a 22% positivity rate for flu A and 24% positivity rate for flu B.

High Patient Volume

Cook Children’s Urgent Care Centers and the Emergency Department at Cook Children’s Medical Center - Fort Worth are experiencing high volumes from circulating viruses such as COVID, flu and respiratory syncytial virus (RSV).

From Jan. 9 to Feb. 5, Cook Children’s Urgent Care Centers saw 6,806 patients, and the Emergency Department in Fort Worth saw 3,437. These numbers are almost double what they were in early January and leading to crowded medical facilities and long wait times.

On Friday, Feb. 9, our UCCs saw 760 patients in 24 hours and the Emergency Department at Cook Children’s Medical Center – Fort Worth saw 435 patients.

“We are seeing tons of flu,” said Kara Starnes, D.O., medical director of Cook Children’s Urgent Care Centers. “I have three kids of my own, so I know having a sick child can bring some anxiety but, in many cases, children with upper respiratory illnesses like COVID, flu and RSV do just fine being cared for at home and do not require a visit to urgent care or the ER.”

Dr. Starnes says it is safe to manage your child’s symptoms at home as long as they are not displaying signs of respiratory distress or dehydration. Reserving visits to urgent care or the emergency department for truly urgent needs will help reduce wait times, conserve resources and limit your child’s exposure to other viruses.

Signs and Symptoms

COVID-19, flu and RSV are caused by different viruses, but all are upper respiratory illnesses that share similar symptoms such as:

• Fever
• Cough
• Fatigue
• Sore throat
• Runny or stuffy nose
• Muscle pain and body aches
• Headache
• Vomiting and diarrhea
• Loss of appetite, taste or smell
• Shortness of breath

Managing Symptoms

There are a few things you can do to keep your child comfortable while the illness runs its course.

Over-the-counter medications such as ibuprofen and acetaminophen can help reduce fever, aches and pains. Ibuprofen should not be given to infants younger than 6 months.

A fever is defined as a temperature of 100.4 or above. A temperature above 100.4 in babies less than 2 months old is a medical emergency and needs to be evaluated in the emergency room. Any fever lasting longer than four to five days, or one that continues to climb and does not break with fever reducers, should be evaluated by a physician. Otherwise, it’s safe to manage fever at home.

Keep your child hydrated by encouraging fluids every few hours. Electrolyte drinks can be helpful if you suspect your child is dehydrated or at risk of becoming dehydrated. If they aren’t interested in drinking, have them suck on a popsicle.

To help reduce congestion, keep the sinuses moist with saline drops and a cool-mist humidifier. This is especially helpful during sleep times.

If your child appears to be in respiratory distress or severely dehydrated, it’s time to go to urgent care or the emergency department.

●      Signs of respiratory distress:

• Increased number of breaths per minute
• Increased heart rate
• Bluish color around the mouth, on the lips or on the fingernails.
• Pale or grayish skin
• A grunting sound during exhale
• Nose flaring
• Chest appears to sink in with each breath
• Head bobbing when breathing in
• Change in alertness

●      Signs of dehydration:

• Urine output significantly below the child’s normal (Your child should be producing urine at least once every 8 hours.)
• Not producing tears when crying and eyes appear sunken
• In infants, the soft spot on top of their heads looks sunken
• Dried mucus membranes (lining within the nostrils, mouth, throat, ears, genitals and anus)
• Sleepy and unresponsive

If you’re a parent, you’ve said it to your child a thousand times. 

“Don’t run with that in your mouth!”

It could be a stick, a toy, a utensil or any other random object a child finds palatable.

While your little one may scoff at the command, it’s a fair warning. An ill-timed bump or fall could cause that object to crack a tooth or injure your child’s tongue, mouth or throat.

Data from Cook Children’s Medical Center suggests that palate injuries from an object in the mouth are on the rise. In 2021, there were two reported palate injuries, followed by eight in 2022. Already this year, there have been 14.

Six of the injuries since 2021 occurred while a child was using a straw, with some being a hard plastic or metal straw. Four of the injuries were the result of an accident while using a toothbrush. The others are from various objects, including a stick, curtain rod, spoon and plastic bat.

The activities leading to the injuries differ. They include everything from walking into a door while drinking from a straw, sneezing while using a straw, roughhousing with a sibling while brushing teeth and getting hit in the head with a ball while brushing teeth. These may sound random and far from the norm, but if you spend any time with children, you know the possibility of any one of these exists.

The key to preventing these types of injuries is to stay vigilant. Give kids a flexible, rubber straw rather than a hard plastic or metal one. Remind them not to play, roughhouse or throw or catch a ball while brushing their teeth or while holding anything in their mouths. And keep telling them not to run with objects in their mouths, even if it’s for the 1,000th time.

Jay Pearson, P.A., a physician assistant with Cook Children’s Trauma Services , says these injuries happen more than you would think.

“These soft palate injuries are considered penetrating injuries to the back of the throat and are at risk for significant complications,” Pearson said. “The risk is high enough that we activate the trauma team to do a thorough workup to make sure a significant injury is ruled out. We have seen an increase in these activations recently.”   

The most common injury from these incidents is a laceration of the palate that results in a hole in the mouth. These can be painful and interfere with a child’s eating and drinking, according to Michelle Marcincuk, M.D., Ear, Nose and Throat specialist at Cook Children’s. 

“They could potentially lead to an infection deep in the neck or even extending down into the chest around the heart area which can be very severe, and very dangerous. Sometimes they need surgery,” Dr. Marcincuk said. “But the most feared complication is for the object to go deeper and injure the big blood vessels in the neck. This can cause a stroke, a blood clot, an aneurysm, a catastrophic hemorrhage or even death.”

If your child sustains an injury from carrying something in their mouth, Pearson says they need to be evaluated by a medical professional. 

“The majority of the time these palate injuries are minor, but due to the potential risk of serious injury, an abundance of caution is taken,” Pearson said.

By Heather Duge

Cook Children’s Emergency Department nurse manager Kara Dorman has seen an alarming trend – a significant increase in patients coming in with a seemingly invisible problem. Patients may enter the ED for an injury or illness but have a mental health concern that also needs to be addressed.

“As we track suicide screening numbers, it has been horrifying and mind-blowing to see all these kids who visit the ED for medical problems and screen positive for suicide risk,” Dorman said. “These are kids we wouldn’t have known about if we didn’t ask.”

Many times asking the hard questions is the most challenging part of identifying those who need help. That’s when Team HOPE, a specially trained group of 25 employees at Cook Children’s, enters the picture.

Dorman and ED chaplain Cameron Brown lead the team, which includes patient care technicians, paramedics, nurses, security officers, chaplains and child life specialists. The team meets monthly, participates in education and shadows the inpatient psychiatry unit for eight-hour shifts.

Dorman and Brown proactively round on patients using Trust Based Relational Intervention (TBRI) to build early rapport. TBRI is an attachment-based, trauma-informed intervention that is designed to meet the complex needs of vulnerable children. The team uses the Ask Suicide Questions (ASQ) screening tool and TBRI training has been instrumental in the screening process.

The ED screens patients during intake to ask questions about their mental health. From January through July 2023, 405 patients ages 8 and older who came to the ED for medical conditions were positive for being at risk for suicide and 19 were suicidal at the time. In 2022, Team HOPE assessed 32,000 patients ages 8 and over who came to the ED for medical conditions – 640 were positive for being at risk for suicide and 22 were suicidal at the time.

Building Early Connections

If a nurse in the ED feels like they need help, they can call Team HOPE. An intake therapist will perform a behavioral health intake assessment and provide tailored resources for the patient to get help.

Oftentimes, patients come in and don’t want to speak to anyone.

“A huge factor in saving lives when treating mental health illness is connection,” Dorman said. “Good eye contact and modeling a calm demeanor when entering the room is the first thing. We share power and control with patients such as giving them choices of what drink they would like to take with their medicine and offering green scrubs instead of an open gown. We talk about transitions of care ahead of time and introduce their new nurse before shift change.”

Behavioral health carts filled with games, clay, stress balls, model magic and journals are other tools the team uses for distraction and to get rid of nervous energy. Brown not only provides patient families with support but also the ED staff. She checks in during each shift with team members.

“I ask how they are coping and assess how they are handling things,” Brown said. “I help them when patients are dysregulated and give them permission to ask for help.”

Sometimes that means walking through a scenario such as thinking through how to go in the patient’s room while maintaining a calm presence. 

Suicide Prevention Training

Dorman and Brown attended QPR training, which is an emergency response training for someone in crisis, hosted by the Jordan Elizabeth Harris Foundation. This training helped them learn how to ask difficult questions when concerned about someone having suicidal thoughts.

“This has been helpful in having conversations with friends, family, fellow coworkers and when checking in on each other in different units,” Dorman said. “Team HOPE members are a resource for not only our patients but for ED staff members as well. The QPR training helped our team gain knowledge and feel empowered to role model that having conversations matters.”

Ellen and Tom Harris established the Jordan Elizabeth Harris Foundation in 2014 after their daughter died by suicide. They know how unexpected depression and suicide can be after experiencing it with their daughter.

Jordan was valedictorian of her high school class, a National Merit Scholarship winner, a Stamps scholar at the University of Michigan, an athlete, musician and a friendly, compassionate young woman. The JEH Foundation honors Jordan’s life by raising money to support research on depression and offering training to help people recognize signs of depression.

"Jordan was the kind of person you would never expect to take her life,” Ellen said. “She was a wonderful, kind, funny and loving person with loads of friends and interests.”

After Jordan developed depression during her senior year of college, Ellen and Tom brought Jordan home until she felt ready to go back. Her upbeat personality hid the severity of the depression. Ellen said the confusing part of depression is that people who take their lives don’t want to die – they just don’t see any other way out of the dark hole.

“The night before Jordan passed away, she was on her computer searching for a therapist,” Ellen said. “She was trying to find a way out.”

Ellen and Tom’s goal through the foundation is to help people out of the dark hole. They offer free QPR training to the public.

During the 45-minute sessions focusing on Question, Persuade and Refer, people build confidence in asking the hard questions about suicide, learn how to persuade someone to seek help and understand referral options.

The sessions also include myths and facts about depression, nationwide statistics about the depression epidemic, ways to be aware of someone struggling and verbal versus nonverbal cues. Dorman had the desire to bring their training to Cook Children’s and four months ago 25 employees at the hospital participated in a session.

“If we can save one life, everything we’re doing has been worth it,” Ellen said. “I’m thrilled to provide training for employees at Cook Children’s. It is critical hospitals have this training because the earlier you can catch depression and start treating it the greater the outcome.”

Dorman said one interaction in the ED can be the moment that changes the trajectory of a patient’s life – bringing them hope in a dark time.

“We want to connect with these patients and empower them to seek help,” Dorman said.

September is National Suicide Prevention Month. If you are concerned about a child’s mental health, please reach out to one of these resources or your child’s pediatrician. It is important to get help early so that children can get the support they need.

Ahh, summer. It’s full of adventure. Or, if your kids are anything like mine — misadventure.

Barely two weeks into our summer break this year I made a visit to urgent care with my 14-year-old to have a fish hook removed from his hand. Totally worth it, he says, since he caught a bass. (Insert my motherly eyeroll and exasperated sigh.)

The summer months can be busy ones in pediatric emergency departments, urgent care centers and pediatrician offices. With kids out of school and looking for fun, they sometimes find trouble that results in injury. Tragically, some of those injuries can be serious, life-altering or even fatal.

“In the summer, kids have all day and night to be able to get into trouble, which is what kids are supposed to do. They're just learning,” said Daniel Guzman, M.D., a pediatric emergency medicine physician at Cook Children’s Medical Center. “As parents, we're just trying to manage the chaos so they don’t make any tragic mistakes.”

Drownings top the list of summertime injuries and causes of death at Cook Children’s, according to Sharon Evans, trauma injury prevention coordinator. In fact, it tops the list nationally. Drowning is the leading cause of accidental death in children ages 1 to 4. For teens, it is the second leading cause of death.

The Center for Community Health, led by Cook Children’s, offers parents and kids water safety and drowning prevention education guides and resources like water-watcher tags and life jackets through its Lifeguard Your Child program. Through this program, anyone can learn how to choose and properly fit a life jacket, how to build a water safety plan, what type of physical barriers should be in place to secure backyard pools and tips for a safe and fun swim time. 

After drownings, the top sources of summertime injuries sending kids to Cook Children’s Emergency Department include:

• Motor vehicle collisions
• All-terrain vehicle (ATV) accidents
• Dog bites
• Falls on playground equipment and trampolines

Dr. Guzman says car and ATV accident injuries are often the most tragic.

An estimated four kids are seen in U.S. emergency departments every hour for injuries related to ATV accidents, according to the American Academy of Pediatrics. From 2017 to 2022, more than 700 North Texas children, most between the ages of 10 to 14, were treated at Cook Children’s Medical Center for serious injuries involving accidents with off-road motorized vehicles.

“The most critical injuries we see from these vehicles are head injuries from kids not wearing a helmet and being ejected,” Dr. Guzman said.

Golf carts can be particularly dangerous.

“With individual ATVs, people tend to put more of the safety equipment on their children, but with a golf cart people feel more secure and protected and less threatened,” he said. “They usually are not wearing a helmet or a seatbelt, so we see these ejections. When you are riding on pavement and it’s head versus pavement, the pavement always wins.”

While common summertime injuries seen at Cook Children’s Urgent Care Centers are more minor in nature than those in the Emergency Department, the sources of injury are often similar.

“We see lots of trampoline and bicycle injuries," said Kara Starnes, D.O, medical director of Cook Children’s Urgent Care Services. “Kids get outside, they're more active and they're more likely to break things. Bicycles, hoverboards, skateboards and trampolines are a big source of fractures or sprains. Fish hooks are more common in the summer, as are lacerations because kids are playing outside more. They get more cuts and things that need to be sewn up in the summertime.”

The primary care pediatrician’s summer risk list looks a little different given their focus on non-emergency care. When temperatures rise, pediatricians see more:

• Infected bug bites
• Sunburn
• Dehydration
• Poison ivy
• Swimmer’s ear infections
• Leg fractures

“Believe it or not, I see lots of leg fractures in little kids from sliding down a slide while sitting in their parent’s lap, because their leg gets caught between the parent and the side of the slide,” said Diane Arnaout, M.D., a pediatrician at Cook Children’s Pediatric Forest Park. “It’s a really dangerous thing to do.”

Pediatricians and Their Own Kids

Given these common injuries, we asked a few Cook Children’s physicians to weigh in on what they never allow their own children to do, or never let their kids leave the house without in the summer. It’s important to note these physicians are not afraid of fun, they just see the negative outcomes of these thrill-seeking activities on a daily basis. For them, the dangers associated with some of these risky behaviors outweigh the entertainment.

Here’s what they had to say:

Dr. Guzman:

“Trampolines are a big thing that I despise. We see so many injuries from those. You get multiple kids on a trampoline and that really becomes a problem. Another thing for me is golf carts. Until kids can drive, they probably shouldn't be in the golf cart unless mom or dad is in there with them. You wouldn't let your kid drive your car. Why would you let them drive a golf cart, ATV or other off-road motorized vehicle at a young age without any experience? They just don't understand the gravity of the responsibility or have the physical dexterity to maintain a vehicle.”

Dr. Starnes:

“I would never let my kids ride their bikes without a helmet because we see some pretty severe head injuries from bike accidents. ATVs are an absolute hard no for me. Also, kids go barefoot a lot in the summer, so we'll see things get stuck in their feet more often, like glass or gravel. To avoid this, I would recommend they at least wear flip flops or some sort of shoe while playing outside.”

Dr. Arnaout:

“I never let my kids leave the house without a water bottle in the summer. We don’t do trampolines without safety nets or bikes without helmets. And ATVs are a no-go for me.”

Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Pediatrics Haslet

“Insect repellant, sunscreen and big hats for scalp protection are a must for my kiddos. Water safety is my No. 1 topic in the summer and must be the No. 1 focus of parents when their kids are in or near bodies of water.”

RELATED:

• Should My Child Ride ATVs? Cook Children's Experts Weigh In (checkupnewsroom.com)
• Sunburn Relief at Home, When to See a Pediatrician (checkupnewsroom.com)
• Pediatrician Shares Top Beach Vacation Health Tips (checkupnewsroom.com)
• Heads Up: Helmet Tips for Safer Bicycling (checkupnewsroom.com)
• Teen Driver? What to Know Before They Go This Summer (checkupnewsroom.com)

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

The number of babies and toddlers who screened positive for marijuana in the Emergency Department at Cook Children’s continued trending up in 2022.

Last year’s data show 33 patients between ages 0-3 whose urine tested positive for a molecule called tetrahydrocannabinol (THC), the main psychoactive ingredient in the cannabis plant. Back in 2019, there were just eight patients from the same age group with THC-positive urine. The number climbed to 13 patients in 2020, and to 29 patients in 2021.   

Doctors at Cook Children’s say the marijuana intoxication cases they see in babies and toddlers are caused by accidental ingestion of edibles. Edibles are marijuana-infused food items such as gummies or other candy, cookies, brownies, beverages and other products. They aren’t safe for children to consume.

The U.S. Centers for Disease Control and Prevention (CDC) cites the longer-lasting and unpredictable effects of edibles, in which the strength of the ingredients might not be known. Ingestion can cause altered mental status, extreme sleepiness, high heart rate and trouble breathing in young children.

“We’re not here to judge but to provide a warning that if you’re going to have these in your home, you really need to lock them up so that kids can’t access them,” said Daniel Guzman, M.D., who works in the Cook Children’s Emergency Department (ED).

Teenagers made up the majority of the 693 patients in the ED who tested positive for THC in the urine screenings last year. Even though there were far fewer younger patients affected overall, any ingestion by babies and toddlers raises concern. To a curious child, a candy or cookie edible looks like something good to eat.

Recreational marijuana use is illegal in Texas. But a product called delta-8, derived from legally grown hemp, is legal to buy and sell as long as THC levels are less than 0.3%. Delta-8 concentrated in a lab can produce a “high” similar to marijuana. Also, low-level THC medical marijuana can be prescribed in Texas for patients with conditions such as epilepsy and multiple sclerosis. 

Medical experts point out that any amount of drug will have a much greater impact on a child’s small body than on an adult. They urge precautions by all caregivers – parents, older siblings, grandparents and babysitters - to prevent the youngest and most vulnerable from swallowing any edibles they happen to find on a nightstand, in a purse, in a vehicle or in other locations. A preschool in Prosper made national headlines last Halloween after four children became ill following alleged exposure to THC.

What are the signs of marijuana intoxication? How is it treated?

Emergency Department

Abnormal behavior, extreme sleepiness and unresponsiveness are red flags for marijuana ingestion. When children come to the ED with those symptoms, doctors try to rule out other possible causes such as infection or traumatic brain injury.

“Unfortunately, we’ve seen an uptick in the number of kids who have had marijuana ingestion or use over the last couple of years,” Dr. Guzman said. If doctors suspect the child might have eaten a marijuana edible, they will ask the parents or caregivers about any drugs in the home.

“It’s a fair question to ask given the breadth of kids coming in with accidental ingestions. It’s not to judge anybody – we just want to know what we’re dealing with so that we can treat it quickly and know what to expect.”

It takes about three hours to get results from THC tests in the urine samples. Meanwhile, supportive care is provided while the intoxicating effects wear off, usually within about 12 hours. Dr. Guzman said the medical team will monitor the patient’s vital signs and fluids, protect the airway, and watch for worsening symptoms. If the patient’s breathing rate becomes short and shallow, he said, extra oxygen or a breathing tube could be needed.   

Children diagnosed with marijuana ingestion can typically be discharged to go home from the ED after they become alert, act playful, and resume eating and drinking, Dr. Guzman said. More serious cases require further care in the Medical Center.   

Admitted to the Hospital

Kyle Brady, D.O., a pediatric hospitalist at Cook Children’s, said sometimes it takes longer for young patients’ bodies to eliminate the drug. They remain extremely sleepy. The medical team waits and observes. An electrocardiogram (EKG) may be needed to measure the patient’s heart rhythm during recovery. 

“The big thing is doing neuro checks and making sure they’re arousable,” Dr. Brady said. “With the ingestive THC, your liver has to process that chemical, and it just takes time. The smaller you are with how strong some of these compounds are, it can be a few days that we see them in the hospital.” 

Severe cases of marijuana ingestion are linked to high concentrations of THC, he said. “It can be very scary and worrisome to both the parent and the provider,” Dr. Brady said.

Before he will discharge a patient from the hospital following marijuana ingestion, Dr. Brady wants to see that they’re completely awake, playing, eating and able to crawl or walk appropriately for their age. 

What safety tips do the experts at Cook Children’s recommend? Keep marijuana edibles locked up and stored out of reach. And make sure babysitters and grandparents understand those products are harmful to children, even though they look attractive.

“A little kid should not be ingesting THC, and if you as a parent are using it recreationally, you need to use it responsibly and you need to treat it as you would any kind of alcohol product or any kind of household chemical,” Dr. Brady said.

Dr. Guzman pointed out that parents and caregivers must take steps to keep their children safe around firearms and swimming pools. Safety measures apply to marijuana edibles too.

“It’s all about access,” he said. “If we can be responsible adults when it comes to any of these injury prevention areas, then we can keep our kids from getting hurt.”

If you think your child has ingested marijuana, get medical help or call the Texas Poison Control Center at 1-800-222-1222. For more information: Marijuana Edibles - Texas Poison Center Network (poisoncontrol.org)

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.

Larger than life-size digital displays, storybook murals, walking paths that invite exploration and play, and spaces bathed in every color of the rainbow — it’s what childhood daydreams and imaginations are made of. These are also a few of the moments of magic kids and their families will feel, see and experience when they walk through the doors of the new Cook Children’s Medical Center – Prosper.

The medical center opens to the community on Monday, Jan. 9, at 8 a.m., and is ready to serve those from Prosper and beyond seeking care under Cook Children’s signature blue peaks.

The 23-acre Cook Children’s campus in Prosper is the culmination of a multi-year expansion project into the rapidly growing northern region of the state. Cook Children’s began developing the health care landscape in the area in 2019 with the opening of an urgent care center and several area primary care offices, followed by a medical office building and outpatient surgery center in 2020. The medical center will support these existing services with an emergency department; a surgical and procedural floor; an infusion center; an outpatient imaging center; a retail pharmacy; an inpatient unit with medical-surgical and pediatric intensive care beds; and two floors of shell space that allow for growth to meet the future needs of the community.

“Cook Children’s Medical Center – Prosper is the next step in supporting those services and serving families in Prosper and the surrounding communities,” said Rick W. Merrill, president and CEO of Cook Children’s Health Care System. “It brings world-class medical care from Fort Worth closer to the homes of children living in the northern sector of the Metroplex. We’re very excited to be able to offer families the care they’ve come to expect and trust from Cook Children’s but in a location closer to their neighborhoods where they have the support structure of family, friends and community resources.”

A Leading Legacy

Those who know the heritage of Cook Children’s say that while construction of the Prosper campus took several years, it’s actually been generations in the making.

“Multiple generations have built Cook Children’s,” said Kevin Greene, vice president and administrator, Cook Children’s Medical Center – Prosper. “We have a nearly 105-year history of dedicated doctors, nurses and support staff caring for children. We are stewards of that history, and I believe that is one of the key components that differentiates Cook Children’s from other pediatric health care systems. Being able to provide top-tier pediatric care with a world-class experience is a product of our century old legacy and the generations that came before us.”

The patient and visitor experience was paramount when it came to creating the building’s blueprint. Each space of the facility is designed with everything for the child in mind.

In the main entrance, guests are welcomed by a Sistine Chapel-like painting of cartoonish flying cows — a nod to Cook Children’s Cowtown roots — a giant digital wall, and a tile motif of a tree whose color-coded falling leaves create a kid-friendly and interactive wayfinding trail to the emergency department in one direction and outpatient services in the other. At each stop in their journey through the facility, kids and their families are greeted with spaces that invite imagination, discovery, play and rest in a way that connects the dots between their ideal experience at Cook Children’s and the health care they receive along the way.

“If I had to pick one of my favorite aspects of the medical center, it's the initial presentation our families experience when they walk in our front doors,” Greene said. “It’s so focused on that child’s experience, and everything has been designed with the child in mind. You feel like you're in a special place. We were very intentional with that. I can't wait for the community to experience and understand who we are in that first moment when they walk in.”

Critical Additions

The medical center's 10-bed emergency department adds much-needed emergency care beds to the area in a time when many pediatric emergency departments are overflowing from an unprecedented season of viral illnesses. Over the next several months, Cook Children’s anticipates opening an additional 10 emergency department beds to support the emergency care needs of children.

Anticipating future growth, a total of four operating rooms have been built and equipped to keep kids close to home when they need surgery. Two will open with the medical center on Jan. 9. The remaining two will open in the future as the community and its needs grow. Each operating room is equipped with technology that allows for real-time remote viewing and physician collaboration with colleagues at Cook Children’s Medical Center in Fort Worth if needed. This gives Cook Children’s Medical Center – Prosper patients and families the advantage of the health system’s full network of world-class physicians and surgeons.

“I’m really excited about the technology built into this campus, and I like the fact that physicians and providers were involved in the design process from day one,” said Tony Anani, M.D., MPH, MBA, gastroenterologist and Medical Director of Clinical Specialties at Cook Children’s Medical Center – Prosper. “There are some features that we’re really going to enjoy while practicing medicine. One of them is the ability for doctors to beam into our surgery and our endoscopy suites. So all our partners in Fort Worth have the ability to help us with their brain trust for difficult patients up here without us having to move the child downtown, and that would not have been possible without the technology and without it being designed into the building.”

Patients awaiting surgery are prepped in one of 12 private pre-operative exam rooms. A surgery waiting area provides private space for families to wait while a child undergoes a procedure.

Until now, children in Prosper and throughout the northern region needing intravenous infusion therapy would have to travel to Cook Children’s Medical Center in Fort Worth or to Dallas. A dedicated infusion center at Cook Children’s Medical Center – Prosper will now bring this critical service close to home for our families. In addition, a specialty procedure area, also referred to as the SPA, has three procedure rooms for gastroenterologists, pulmonologists and ear, nose and throat specialists. The SPA is designed so that physicians can easily work together on difficult cases.

Supporting each of these services is an imaging center equipped with all of the imaging and diagnostic technology needed to provide advanced care for pediatric patients.

Each inpatient room includes a 65-inch television that can integrate with the patient and family’s personal devices. The television serves as an interactive hub for anything the patient may need, from ordering food to entertainment to connecting and consulting with Cook Children’s specialty physicians at the medical center in Fort Worth if needed.

“We're not just Cook Children's – Prosper. We're part of the integrated health care system,” Greene said. “When a family is cared for on our campus or in one of our clinics, they will have the full weight of the entire Cook Children’s Health Care System behind them. From our home health division, to our health plan and physician network made up of more than 800 physicians and providers, our families can rest easy knowing they now have access to one of the nation’s largest integrated pediatric health care systems focused entirely on their child's care.”

Welcoming New Talent

In addition to its technology, infrastructure and patient experience, Cook Children’s Medical Center – Prosper is attracting trailblazing medical talent and bringing more than 500 jobs to the community. Trailblazers like Kanika Bowen-Jallow, M.D., a pediatric surgeon at Cook Children’s Medical Center – Prosper, and only the ninth Black female pediatric surgeon in the United States. Also, Dr. Anani, who was the first physician hired at Cook Children’s Medical Center – Prosper when all administrators had to show him was an empty parcel of land and a vision. Both Dr. Bowen-Jallow and Dr. Anani shared Cook Children’s vision and have been instrumental in the development of the Prosper campus and its services.

“Cook Children’s is hiring,” Dr. Anani said. “That’s an infusion into the economy of Prosper and the surrounding area. We're hiring people that truly care about providing care for the children in our community. I'm really excited about this because I live in Prosper. My kids go to the schools here in Prosper, and I'm happy that we'll have the care we need nearby. What’s good for kids is good for the community, including the local economy.”

Go here to view the open positions we're excited to fill in Prosper.

From Nov. 27 to Dec. 3, there were 533 flu A cases, a positivity rate of 33.8%. Protect yourself and your family by getting vaccinated against the flu and COVID. The flu vaccine works to prevent you from catching the flu or by reducing the severity if you do come down with the illness.

In addition to causing respiratory symptoms, the flu can also cause myositis, which results in significant muscle pain and requires admission for IV hydration and pain management. The best way to prevent influenza-associated pneumonia and influenza-induced myositis is to get your flu vaccine.

Respiratory syncytial virus (RSV) cases are declining compared to previous weeks, but remain high. We are also seeing positive cases of COVID and rhinovirus in our patients.

“There are not any current treatments for RSV,” said Laura Romano, D.O., Hospitalist at Cook Children’s Medical Center. “There is also currently not a vaccine available. We can use Synagis, a monoclonal antibody, to help prevent severe infections but that is reserved for certain patients such as our premature infants, our infants with congenital heart or lung disease, infants with compromised immune systems, or some infants with certain neurological conditions."

Cook Children’s has expedited our winter staffing plan in preparation for peak flu season. Our census is full, including beds, the Emergency Department and Urgent Care Centers. Wait times are extremely long. We ask parents and caregivers to contact their pediatrician unless their child has a moderate or severe illness or injury.

Patient Census

In the last 24 hours, 560 patients went to the Emergency Department, which is equivalent to one check in every 2 minutes. This is causing long wait times (8-10 hours) to transfer patients to the Pediatric Intensive Care Unit.

Across our seven Urgent Care Centers, we saw 654 patients on Friday, 653 patients on Saturday, 677 patients on Sunday and 528 patients in the last 24 hours.

There are steps families can take to avoid getting sick. Parents and caregivers can remind their children to continue the healthy habits learned in the pandemic, including hand hygiene, coughing into a tissue or your elbow and staying home if you or your child feel sick. Face masks add increased protection, especially in public spaces.

Last year, more people were wearing face masks and children were more likely to stay home while sick. This year, parents are sending their children to daycare and school for the first time following two years of the pandemic, Dr. Romano said. Children who haven’t been previously exposed to respiratory viruses are among the many children who are getting sick.

Positive Influenza A cases at Cook Children’s Health Care System:

Oct. 9 – Oct. 15: 47 cases

Oct. 16 – Oct. 22: 75 cases

Oct. 23 – Oct. 29: 170 cases (14.6% positivity rate)

Oct. 30- Nov. 5: 333 cases (22.6% positivity rate)

Nov. 6 - Nov. 12: 483 cases (27.5% positivity rate)

Nov. 13 - Nov. 19: 630 cases (35.4% positivity rate)

Nov. 20 - Nov. 26: 812 cases (42.3% positivity rate)

Nov. 27 - Dec. 3: 533 cases (33.8% positivity rate)

RSV cases at Cook Children’s Health Care System:

Oct. 2 – Oct 8: 210 cases (24% positivity rate)

Oct. 9 – Oct. 15: 288 cases (29% positivity rate)

Oct. 16 – Oct. 22: 246 cases (24% positivity rate)

Oct. 23 – Oct. 29: 263 cases (23% positivity rate)

Oct. 30 - Nov. 5: 337 cases (23% positivity rate)

Nov. 6 - Nov. 12: 342 cases (19% positivity rate)

Nov. 13 - Nov. 19: 267 cases (15% positivity rate)

Nov. 20 - Nov. 26: 222 cases (12% positivity rate)

Nov. 27 - Dec. 3: 174 cases(11% positivity rate)

Pediatrician Offices

Call your pediatrician first if children are experiencing mild symptoms or injuries (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.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

RELATED: Doctor's Note is Not Required for Excused Absence at Fort Worth ISD

Urgent Care Centers

If your child is ill, please contact your pediatrician's office first if it is not a moderate or severe illness or injury. If you cannot 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.

Understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. Staff are overwhelmed and they’re encountering a lot of frustrated parents. Please be nice to the people working – they need kindness!

Emergency Department

Bring your child to the emergency room if they have trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition.

Seek immediate medical care if your child is experiencing:

• Persistent fever for more than two or three days. However, any temperature greater than 100.4 in an infant under two months of age is considered a medical emergency.
• 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.
• Breathing faster than usual or 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.
• Please understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. 

Preparation/Prevention

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If you’re sick, wear a mask in public and stay home.

RELATED: 

• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

Cook Children’s has expedited our winter staffing plan in preparation for peak flu season. Our census is full, including beds, the Emergency Department and Urgent Care Centers. Wait times are extremely long. We ask parents and caregivers to contact their pediatrician unless their child has a moderate or severe illness or injury.

Be sure that you and your family are vaccinated against the flu and are updated on the latest COVID vaccines and booster shots. The flu vaccine works to prevent you from catching the flu – or, reduce the severity if you do come down with the illness.

“We are seeing increased cases of flu admissions, particularly influenza infections associated with pneumonias,” said Laura Romano, D.O., Hospitalist at Cook Children’s Medical Center. “In addition to causing respiratory symptoms, the flu can also cause myositis, which results in significant muscle pain and requires admission for IV hydration and pain management. The best way to prevent influenza-associated pneumonia and influenza-induced myositis is to get your flu vaccine.”

Respiratory illnesses, like flu and RSV, are typical for this time of year; RSV is a very common respiratory virus. Some children require hospitalization for RSV, but most do not. We are also seeing positive cases of COVID and rhinovirus in our patients.

There are limited treatments for RSV; most are available for premature infants, infants with other lung diseases, infants who are considered immunocompromised, or patients with a congenital heart disease.

“RSV cases continue to decline but we are still seeing children, particularly our most vulnerable patients, becoming significantly ill with symptoms,” Dr. Romano said. “Our most at-risk patients include those less than 12 weeks, any pre-term infant born at less than 34 weeks, or any baby with congenital lung disease or congenital heart disease.”

Patient Census

In the last 24 hours, 533 patients went to the Emergency Department, which is equivalent to one check in every 2 minutes. This is causing long wait times (8-10 hours) to transfer patients to the Pediatric Intensive Care Unit.

Across our seven Urgent Care Centers, there were 814 patients seen on Monday and 722 patients seen in the last 24 hours.

There are steps families can take to avoid getting sick. Parents and caregivers can remind their children to continue the healthy habits learned in the pandemic, including hand hygiene, coughing into a tissue or your elbow and staying home if you or your child feel sick. Face masks add increased protection, especially in public spaces.

Last year, more people were wearing face masks and children were more likely to stay home while sick. This year, parents are sending their children to daycare and school for the first time following two years of the pandemic, Dr. Romano said. Children who haven’t been previously exposed to respiratory viruses are among the many children who are getting sick.

RSV cases at Cook Children’s Health Care System:

Oct. 2 – Oct 8: 210 cases (24% positivity rate)

Oct. 9 – Oct. 15: 288 cases (29% positivity rate)

Oct. 16 – Oct. 22: 246 cases (24% positivity rate)

Oct. 23 – Oct. 29: 263 cases (23% positivity rate)

Oct. 30 - Nov. 5: 337 cases (23% positivity rate)

Nov. 6 - Nov. 12: 342 cases (19% positivity rate)

Nov. 13 - Nov. 19: 267 cases (15% positivity rate)

Nov. 20 - Nov. 26: 222 cases (12% positivity rate)

Positive Influenza A cases at Cook Children’s Health Care System:

Oct. 9 – Oct. 15: 47 cases

Oct. 16 – Oct. 22: 75 cases

Oct. 23 – Oct. 29: 170 cases (14.6% positivity rate)

Oct. 30- Nov. 5: 333 cases (22.6% positivity rate)

Nov. 6 - Nov. 12: 483 cases (27.5% positivity rate)

Nov. 13 - Nov. 19: 630 cases (35.4% positivity rate)

Nov. 20 - Nov. 26: 812 cases (42.3% positivity rate)

Pediatrician Offices

Call your pediatrician first if children are experiencing mild symptoms or injuries (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.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

RELATED: Doctor's Note is Not Required for Excused Absence at Fort Worth ISD

Urgent Care Centers

If your child is ill, please contact your pediatrician's office first if it is not a moderate or severe illness or injury. If you cannot 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.

Understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. Staff are overwhelmed and they’re encountering a lot of frustrated parents. Please be nice to the people working – they need kindness!

Emergency Department

Bring your child to the emergency room if they have trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition.

Seek immediate medical care if your child is experiencing:

• Persistent fever for more than two or three days. However, any temperature greater than 100.4 in an infant under two months of age is considered a medical emergency.
• 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.
• Breathing faster than usual or 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.
• Please understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. 

Preparation/Prevention

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If you’re sick, wear a mask in public and stay home.

RELATED

• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

The Cook Children's Health Care System census is full across the board, including beds, the Emergency Department and Urgent Care Centers. The sheer volume has made finding a bed for our patients a daily logistical puzzle.

In the last 24 hours, 487 patients went to the Emergency Department, which is equivalent to one check in every 2 minutes. This is causing long wait times (8-10 hours) for patients to be transferred to the Pediatric Intensive Care Unit and is putting unnecessary strain on the health care system.

Across our seven Urgent Care Centers, there were 763 patients on Friday, 668 patients on Saturday and 754 patients on Sunday. Cook Children’s has expedited our winter staffing plan in preparation for peak flu season.

We ask parents and caregivers to contact their pediatrician first if it’s not a moderate or severe illness or injury. Other hospitals and children's hospitals around the country are also experiencing high number of RSV and respiratory illnesses.

RSV cases at Cook Children’s Health Care System:

Oct. 2 – Oct 8: 210 cases (24% positivity rate)

Oct. 9 – Oct. 15: 288 cases (29% positivity rate)

Oct. 16 – Oct. 22: 246 cases (24% positivity rate)

Oct. 23 – Oct. 29: 263 cases (23% positivity rate)

Oct. 30 - Nov. 5: 337 cases (23% positivity rate)

Nov. 6 - Nov. 12: 342 cases (19% positivity rate)

Nov. 13 - Nov. 19: 267 cases (15% positivity rate)

Positive Influenza A cases at Cook Children’s Health Care System:

Oct. 9 – Oct. 15: 47 cases

Oct. 16 – Oct. 22: 75 cases

Oct. 23 – Oct. 29: 170 cases (14.6% positivity rate)

Oct. 30- Nov. 5: 333 cases (22.6% positivity rate)

Nov. 6 - Nov. 12: 483 cases (27.5% positivity rate)

Nov. 13 - Nov. 19: 630 cases (35.4% positivity rate)

Urgent Care Centers

If your child is ill, please contact your pediatrician's office first if it’s not a moderate or severe illness or injury. 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.

Understand that kids with more severe issues will be seen first and that means long wait times for those with minor illness. Staff are overwhelmed and they’re encountering a lot of frustrated parents. Please be nice to the people working – they need kindness!

Emergency Department

Bring your child to the emergency room if they have trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition. Please understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. 

Pediatrician Offices

Call your pediatrician first if children are experiencing mild symptoms or injuries (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.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

Preparation/Prevention

The increase in RSV and influenza began much earlier than usual this year, but we have yet to reach peak flu season. With Thanksgiving approaching, we want to help parents understand what they can do to prevent the spread of illnesses.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization. Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

Remind your children to continue the healthy habits learned in the pandemic, including hand hygiene, coughing into a tissue or your elbow and staying home if you or your child feel sick. 

There is a nationwide shortage of RSV tests. RSV testing doesn’t change the way in which most children are treated/managed.

RELATED: 

• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

Cook Children's is currently experiencing a surge in patients diagnosed with RSV, flu and other respiratory illnesses – this is impacting our ability to care for our patients in a timely manner. Other hospitals and children's hospitals around the country are also experiencing high number of RSV and respiratory illnesses.

The Cook Children's Health Care System census is full across the board, including beds, the Emergency Department and Urgent Care Centers. The sheer volume has made finding a bed for our patients a daily logistical puzzle.

In the last 24 hours, 568 patients went to the Emergency Department, which is equivalent to one check in every 2 minutes. There were 740 patients across our seven Urgent Care Center locations.

This is causing long wait times (8-10 hours) for patients to be transferred to the Pediatric Intensive Care Unit. This is putting unnecessary strain on the health care system.

Cook Children’s has expedited our winter staffing plan in preparation for peak flu season.

We ask parents and caregivers to contact their pediatrician first if it’s not a moderate or severe illness or injury. Other hospitals and children's hospitals around the country are also experiencing high number of RSV and respiratory illnesses.

RSV cases at Cook Children’s Health Care System:

• Oct. 2 – Oct 8: 
  • 210 cases (24% positivity rate)
• Oct. 9 – Oct. 15: 
  • 288 cases (29% positivity rate)
• Oct. 16 – Oct. 22: 
  • 246 cases (24% positivity rate)
• Oct. 23 – Oct. 29: 
  • 263 cases (23% positivity rate)
• Oct. 30 - Nov. 5:
  • 337 cases (23% positivity rate)

Positive Influenza A cases at Cook Children’s Health Care System:

• Oct. 9 – Oct. 15: 
  • 47 cases
• Oct. 16 – Oct. 22: 
  • 75 cases
• Oct. 23 – Oct. 29: 
  • 170 cases (positivity rate of 14.6%)
• Oct. 30- Nov. 5: 
  • 333 cases (positivity rate of 22.6%)

Urgent Care Centers

If your child is ill, please contact your pediatrician's office first if it’s not a moderate or severe illness or injury. 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.

Understand that kids with more severe issues will be seen first and that means long wait times for those with minor illness. Staff are overwhelmed and they’re encountering a lot of frustrated parents. Please be nice to the people working – they need kindness!

Emergency Department

The influx of patients to the Emergency Department is causing long wait times (8-10 hours) to be transferred to the Pediatric Intensive Care Unit. This is putting unnecessary strain on the health care system.

Cook Children’s has expedited our winter staffing plan in preparation for peak flu season.

We ask parents and caregivers to contact their pediatrician first if it’s not a moderate or severe illness or injury.

Bring your child to the emergency room if he/she has trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition. Please understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. 

Pediatrician Offices

Call your pediatrician first if children are experiencing mild symptoms or injuries (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.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

Preparation/Prevention

The increase in RSV and influenza began much earlier than usual this year, but we have yet to reach peak flu season. With Thanksgiving approaching, we want to help parents understand what they can do to prevent the spread of illnesses.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization. Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

Remind your children to continue the healthy habits learned in the pandemic, including hand hygiene, coughing into a tissue or your elbow and staying home if you or your child feel sick. 

There is a nationwide shortage of RSV tests. RSV testing doesn’t change the way in which most children are treated/managed.

RELATED: 

• State of the System: High Census of Patients With RSV & Respiratory Illness (checkupnewsroom.com)
• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

The Cook Children's Health Care System census is full across the board, including beds,  the Emergency Department and Urgent Care Centers. The sheer volume has made finding a bed for our patients a daily logistical puzzle. According to the Texas Hospital Association, pediatric hospital beds across the state are currently 88% occupied. 

Urgent Care Centers

We had 728 visits across our seven Urgent Care Center locations on Wednesday. If your child is ill, please contact your pediatrician's office first if it’s not a moderate or severe illness or injury.

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.

Understand that kids with more severe issues will be seen first and that means long wait times for those with minor illness.

Staff are overwhelmed and they’re encountering a lot of frustrated parents. Please be nice to the people working – they need kindness!

Emergency Department

We saw 623 patients in the ED yesterday, which is equivalent to one check in every 2 minutes. The influx of patients is causing long wait times (8-10 hours) to be transferred to the Pediatric Intensive Care Unit. This is putting unnecessary strain on the health care system.

Cook Children’s has expedited our winter staffing plan in preparation for peak flu season.

We ask parents and caregivers to contact their pediatrician first if it’s not a moderate or severe illness or injury.

Bring your child to the emergency room if he/she has trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition. Please understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. 

Pediatrician Offices

Call your pediatrician first if children are experiencing mild symptoms or injuries (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.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

Preparation/Prevention

The increase in RSV and influenza began much earlier than usual this year, but we have yet to reach peak flu season. With Thanksgiving approaching, we want to help parents understand what they can do to prevent the spread of illnesses.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization. Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

Remind your children to continue the healthy habits learned in the pandemic, including hand hygiene, coughing into a tissue or your elbow and staying home if you or your child feel sick. 

There is a nationwide shortage of RSV tests. RSV testing doesn’t change the way in which most children are treated/managed.

RSV cases at Cook Children’s Health Care System:

• Oct. 2 – Oct 8: 210 cases
  • (24% positivity rate)
• Oct. 9 – Oct. 15: 288 cases
  • (29% positivity rate)
• Oct. 16 – Oct. 22: 246 cases
  • (24% positivity rate)
• Oct. 23 – Oct. 29: 263 cases
  • o   (23% positivity rate)

Positive Influenza A cases at Cook Children’s Health Care System:

• Oct. 9 – Oct. 15: 
  • 47 cases
• Oct. 16 – Oct. 22: 
  • 75 cases
• Oct. 23 – Oct. 29: 
  • 170 cases (positivity rate of 14.6%)

RELATED: 

• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

A surge in flu cases is often correlated with Thanksgiving and the approaching holiday season, so it’s important that everyone 6 months and older get the flu vaccine now. Along with a spike in RSV cases, North Texas is currently a hotspot for flu activity.

“The influenza vaccine is a very safe and effective way to avoid getting sick with the flu,” said Mary Suzanne Whitworth, M.D. “One quick shot can potentially prevent a week of fever and feeling miserable. This is a no brainer.”

Parents and caregivers can remind their children to continue the healthy habits learned in the pandemic, including hand hygiene, coughing into a tissue or your elbow and staying home if you or your child feel sick. Face masks add increased protection, especially in public spaces. 

Be sure that you and your family are updated on your COVID vaccines. As flu cases increase due to the holidays and travel, COVID cases often go up as well. Patients are still experiencing COVID. On Oct. 18, the rolling 7-day average was 2.3% positivity rate.

Why should I get the flu vaccine in response to the spike in RSV cases?

Our goal is for our community, our patients and our patient families to stay as healthy as possible. Our Emergency Department and Urgent Care Centers are currently overwhelmed with patients and resulting in extremely long wait times.

Vaccination against the flu helps prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccine reduces the risk of hospitalization.

Our emergency department is seeing more than 500 children each day. Our Urgent Cares are seeing nearly 800 children each day. This is the equivalent of a child being checked in to see a provider every 2 minutes and is resulting in extraordinarily long wait times for those who are not severely ill.

Additionally, Cook Children’s pediatric ICU remains near capacity with about half of patients diagnosed with RSV.

Parents should not go to Cook Children’s Urgent Care Centers or Emergency Department for only a flu or a COVID test. See your pediatrician, who can test for flu, RSV, strep throat and COVID. You can also use at-home COVID tests or tests from a pharmacy.

What are flu cases like now?

At Cook Children’s, flu cases are increasing earlier this year; the flu numbers we are currently seeing are equal to what we saw near the end of November 2021. There were 47 cases of Influenza A and one case of Influenza B at Cook Children’s Health Care System during the week of Oct. 9 – Oct 15.

RSV cases at Cook Children’s Health Care System:

• Oct. 2 – Oct 8: 210 cases
  • (24% positivity rate)
• Oct. 9 – Oct. 15: 288 cases
  • (29% positivity rate)
• Oct. 16 – Oct. 22: 246 cases
  • (24% positivity rate)

Influenza A cases at Cook Children’s Health Care System:

• Oct. 9 – Oct. 15: 47 cases
• Oct. 16 – Oct. 22: 75 cases

Most of the United States is seeing an early increase in seasonal flu activity, according to the Centers for Disease Control and Prevention. The southeast region and south-central region, which includes Texas, are reporting the highest levels of flu activity, the CDC said.

Everyone ages 6 months and older should get a flu vaccine. The flu vaccine is the best way to protect your child and family from potentially serious complications from flu.

Texas is at a high activity level for respiratory illness, including fever plus a cough or sore throat. The map shows ILI (influenza-like illness), which includes patient visits due to other pathogens that cause similar symptoms. The cases reflected in the map are not all confirmed flu cases.

RELATED: 

• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

Since Aug. 30, our ED and UCC have hit record levels. In the last 24 hours, 580 patients were seen at the emergency department and 705 patients were seen at our Urgent Care Centers. This has resulted in extremely long wait times.

Many parents are bringing in children who have been exposed to COVID-19 but show mild to no symptoms. This is putting unnecessary strain on the health care system. It’s also important to note that an average of 5.5% of COVID-19 tests at Cook Children’s are coming back positive at this time.

Parents and caregivers, please call or visit your pediatrician first if your child is experiencing mild symptoms or a minor injury. View the chart below to see when you should bring your child to the ED or UCC.

As you can imagine, long wait times have led to frustration for those seeking care. Our exhausted staff has heard an abundance of complaints and mean comments that are discouraging when they are working so hard to serve our patients and families. Unfortunately, they are outmatched by the demand.  

Here’s what we know:

1. The vast majority of patients in our UCCs and ED have upper respiratory infections like colds.
2.  The vast majority of COVID-19 tests are coming back negative.
3.  All of our pediatrician offices offer COVID testing and it’s safe to wait for one to two days for COVID testing if you plan to keep your child at home.
4. If your pediatrician does not have available appointments for your child’s cold symptoms, there are at-home COVID-19 tests available in stores currently.
5. Minor concerns like sore throat, cough, low-grade fever, diarrhea and other stomach problems are issues your pediatrician can help with.
6. The ED should only be used for severe symptoms and injuries.
7. The UCC should be used for moderate symptoms and injuries.

Media partners: If you are interested in telling this story, please contact Public Relations Manager Kim Brown at Kim.Brown3@cookchildrens.org or at 682-885-1080, 817-266-3728

For information about some common questions we hear, take a look at these articles:

• My Child's Fever Isn't Going Away. Should I Be Worried? (checkupnewsroom.com)
• Fever, Headaches and Stomach Pain. When Should You Be Concerned? (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)
• 5 Reasons Why Your Child's Coughing Is A Good Thing (checkupnewsroom.com)
• Let's Learn About Fevers (checkupnewsroom.com)
• How Much Sickness Is Too Much? (checkupnewsroom.com)

From Aug. 22 to Aug. 28, Cook Children’s treated five patients who were struck by vehicles in separate incidents.

As the new school year gets underway for many districts across North Texas, it’s crucial that drivers look out for children, especially in school zones.

Injuries treated:

• 3 patients (pedestrians) struck by vehicles
• 1 patient (pedestrian) struck by an ATV
• 1 patient (bicyclist) struck by a vehicle

Drivers should eliminate distractions and pay attention to their speed, especially in school zones. Always look out for pedestrians and don’t text and drive.

Dan Guzman, M.D., pediatric emergency medicine physician with Cook Children’s Medical Center, says that it’s important that parents also teach their children safety precautions for walking near a road, including paying attention, using sidewalks and crosswalks, and always looking both ways before crossing a street.

“It’s really important to teach your kids and make sure they understand that we need to pay attention because this is your life, there’s only one you and there’s no way to get this back if something bad were to happen,” Dr. Guzman said.

Dr. Guzman says the emergency department sees more children this time of year as kids walk or ride bikes to school and are, unfortunately, struck by vehicles.

“We want our children to be safe and no one wants to hurt a child,” Dr. Guzman said. “We all need to slow down close to school zones and neighborhoods. Make sure we take care of our kids.”

Elementary school children are very active and impulsive. Although they’re learning and growing, school-age children 10 and younger still need guidance and supervision when playing and walking near traffic, according to the National Highway Traffic Safety Administration.

Pedestrian tips:

1. Children less than 10 years old should not be crossing the street without an adult.  All kids are different, but developmentally until they are about 10 years old they don’t have the cognitive ability to judge the speed of an oncoming car.
2. Don’t be distracted while walking.  Stay off your phone and if you HAVE to use headphones, only use one. You have to be aware of your surroundings!
3. Look left, right and back left again before crossing the street. 
4. Only cross at the light, corner or crosswalk. Never cross the street between parked cars.
5. Walk on the sidewalk. If there isn’t a sidewalk walk FACING traffic.
6. Be alert for cars pulling into parking lots and driveways as well as cars backing up.
7. When there is a car approaching or even stopping, make eye contact with the driver and wait for them to motion for you to cross the street. Often times you may think the driver is looking at you but they may be in a “daze” and not truly see you.
8. More than 80% of pedestrians die when hit by a car going 40 mph or faster, and less than 20% die when hit at 20 mph or less. As a driver, SLOW DOWN.

School Zone tips:

1. Slow down and follow all speed limits.
2. Pay attention and look out for pedestrians.
3. Cell phone use is prohibited.
4. Obey crossing guards.
5. Stop for school buses.

Tips for Drivers:

1.  Always stop for pedestrians.
2.  Yield to pedestrians in crosswalks and stop well back from the crosswalk to give other vehicles an opportunity to see the crossing pedestrians so they can stop too.
3. Yield to pedestrians in crosswalks and stop well back from the crosswalk to give other vehicles an opportunity to see the crossing pedestrians so they can stop too.
4. Never pass vehicles stopped at a crosswalk. There may be people crossing where you can’t see.

Media partners: If you are interested in telling this story, please contact Public Relations Manager Kim Brown at Kim.Brown3@cookchildrens.org or at 682-885-1080, 817-266-3728

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.”

“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.”

Carpenter said many parents have come to Cook Children’s ED in a panic because their child was exposed to a classmate at school who tested positive for COVID-19. The parents often bring younger siblings too, so that the whole family can be tested in the ED. High volumes of non-emergency patients puts unnecessary strain on the department.

“It pulls away staffing from the critically-injured and ill and it takes away bed space,” she said. 

As an example, Carpenter said, of the 361 patients seen in the ED on Tuesday, almost half were considered less urgent or non-emergent. Many of the patients could have been seen at a pediatrician’s office or clinic.

 The U.S. Centers for Disease Control and Prevention (CDC) lists these COVID-19 symptoms requiring emergency care:

• 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

With schools reopening and COVID-19 cases on the rise, parents should encourage their children and teens to wear masks, social distance, wash their hands frequently, and follow guidance for quarantining. Carpenter encouraged parents who suspect their child might have COVID-19, and are not exhibiting symptoms, to get tested at drive-thru centers or other designated testing facilities. 

It’s important to know that Cook Children’s urgent care clinics are unable to perform rapid COVID-19 testing on a child who doesn’t show symptoms. Cook Children’s does have drive-thru testing sites, but those appointments are scheduled only through a Cook Children’s pediatrician and for specific times and locations.

Kara Starnes, D.O., medical director of Cook Children’s Urgent Care, said patient numbers and wait times have dramatically increased recently. Dr. Starnes said 737 patients came to urgent care on Tuesday – compared to a previous maximum of about 650 patients.

“The usual surge that comes when school starts is usually about two to four weeks post back-to-school,” she said. “We’re seeing strep infections, common colds and pink eye as well as the expected substantial increase in COVID cases as kids are now congregating together at school, often without masks.”

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.

For more information, visit www.cookchildrens.org/coronavirus.

Along with the physical illnesses and injuries treated at the Cook Children’s emergency department (ED), a standard part of care includes a questionnaire that flags possible suicide risk.

Every patient ages 8 and older in Cook Children’s ED gets screened in a process that aims to proactively identify kids and teens who might be inclined to harm themselves. Much like more familiar vital signs -- temperature or heart rate, for example -- the screening for suicide takes a pulse on the patient’s emotional well-being.

“If a child arrived to the emergency room with a fever or a blood pressure problem, we would do lab work or various tests to search for the cause of these symptoms,” said psychiatry nurse case manager Melody Hackfeld, “With mental health issues, screening for suicide and asking about sadness and worries is how you determine there is a concern that needs to be addressed.” 

Numbers reveal an alarming trend: through July of this year, 261 patients required hospitalized medical stabilization at Cook Children’s due to suicide attempts. That compares to 143 patients hospitalized following suicide attempts in the first seven months of 2020. These statistics don’t include the attempted suicides in which the patient goes straight from the emergency room into psychiatric inpatient care.

Vigilance to prevent youth suicide takes on even greater urgency given the reported rise in anxiety and depression during the COVID-19 pandemic. In response, Cook Children’s has launched the Joy Campaign communications initiative as a way to spotlight areas of help and reasons for hope. The good news in this story? More kids who speak up. Earlier detection of suicidal tendencies. A quicker path to treatment.

A child or teen who arrives in the emergency department with a broken arm, for instance, or a severe case of the flu might also suffer from unexpressed suicidal ideas. By routinely asking a few brief questions in the ED, Cook Children’s works to detect any patients experiencing thoughts about harming themselves. The preemptive strategy uses two key components… screening and assessment.

“The emergency room staff lets them know that in addition to being worried about your physical health, we want to know more about your emotional health, and if you’re having any sadness or worries,” Hackfeld said. “You’d be surprised with how many kids just open the floodgates” with honest answers and relief.

The National Institute of Mental Health developed the Ask Suicide-Screening Questions (ASQ) tool, which Cook Children’s uses. Nurses are trained to administer a five-part questionnaire:

1. In the past few weeks, have you wished you were dead?
2. In the past few weeks, have you felt that you or your family would be better off if you were dead?
3. In the past week, have you been having thoughts about killing yourself?
4. Have you ever tried to kill yourself?
5. Are you having thoughts of killing yourself right now?

A “yes” answer to any of the five parts results in what’s called a positive ASQ, which leads to a closer assessment by the behavioral intake staff at Cook Children’s. After assessment, the range of recommendations can span from counseling to hospitalization, depending on the warning signs that surface when more in-depth questions are asked.

Experts describe the ASQ as a short, simple, valid and evidence-based method for identifying a suicidal inclination. Let’s take a closer look at how and why it fits into Cook Children’s delivery of emergency medical care.

Step 1: Screening

Patients fall into two categories. Those arriving with behavioral complaints (such as anxiety, self-harm, aggression, intentional ingestions, suicidal/homicidal ideation) are screened in the triage bay. Patients with nonbehavioral complaints (physical ailments) go through triage to be medically stabilized first. Later, during their secondary triage in the patient care rooms, the nurses screen the nonbehavioral patients. 

When Cook Children’s ED implemented suicide screening in 2017, Hackfeld and others worked to develop an educational video and computer-based training that incorporate scripts and scenarios to make the nurses more comfortable raising the topic.

“Some nurses thought if you asked about suicide it would give the child the thought, but research shows that that’s not true,” she said.

Nurses at Cook Children’s preface the conversation by asking “Do you struggle with sadness or worry?” An affirmative answer to that segue question doesn’t necessarily indicate suicide risk. But the discharge staff can provide those patients with take-home resources to help manage the sadness and worry.

ED nurse manager Kara Dorman tracks the number of nonbehavioral patients who answer at least one “yes” on the ASQ, requiring further evaluation. That number climbed from 18 patients (1.1% of the total screened) in March 2020, to 64 patients (3.4% of the total screened) in March 2021. Meanwhile, the patients who reported feeling sad or worried rose from 9.8% to 16.8%.

“Had ED staff not utilized the screening tool, then it is highly likely that no one would have known these children were struggling mentally or having suicidal thoughts,” Dorman said.

She points out that the nurses are trained to make eye contact, pay attention to facial expressions, and listen to tone of voice so they don’t miss any nonverbal cues during the screening. One challenge, she said, is establishing a good nurse-patient rapport in the ED within a short amount of time.

Step 2: Assessment

When a patient answers “yes” to one or more of the ASQ questions, the Cook Children’s intake team gets called in. The goal is to determine the degree of suicide risk, and the right course to follow next.

Phillip Breedlove, intake manager, explained that the assessment process dives deeper into the patient’s mental state. Breedlove and his team need more information in order to recommend either outpatient referral, immediate inpatient care, or something in between. The assessment typically starts with easy-to-answer questions.

‘’’So tell me, you're 10 years old, right? OK, good. I had to check that. And tell me what school do you go to and what grade are you in and how do you like school? What's your favorite subject? How are you doing in school?’ You start with that,” Breedlove said. “And then like, ‘How's your appetite? Have you been eating OK lately?’ You get progressively more personal.”  

One tool used is the Columbia-Suicide Severity Rating Scale, a checklist that covers various behaviors and the intensity/duration of suicidal thinking. Responses help the intake staff to weigh the risk factors versus the protective factors when assessing what type of treatment is needed, and how soon. Risk factors include feelings of hopelessness, agitation, previous self-injury, or a specific intent to attempt suicide. Protective factors include supportive friends and family, engagement in school, and strong religious beliefs.

Breedlove said patients with suicidal tendencies have become increasingly younger during his 22 years working at Cook Children’s. The cutoff for suicide screening in the ED used to be age 10. Breedlove said age 8 isn’t too young now, especially during the COVID-19 pandemic.

“The younger ones tend to be more in that angry, upset and impulsive category, and the older ones maybe tend to be thinking it out. They're pondering it. They're mulling over ways to harm themselves. It can be an impulsive act with them as well, but a lot of times you see the impulsivity more clearly with those younger kids,” he said. “I know anecdotally that a growing number of those sad, morose children with suicidal thinking is driven by a greater degree of hopelessness than in past years.”

Breedlove predicted an uptick in positive ASQ screens when school returns to in-person learning in the fall. He advocates for more frequent dialogue about suicide -- in homes and in every medical setting. The emergency department can be an especially opportune venue for preventing suicide in kids who don’t see a pediatrician regularly. Just a few questions and follow-up assessment can uncover a potential problem that might otherwise go unnoticed, Breedlove said.

Assessment can be a therapeutic process for the children or teens and their parents when the outcome leads to resources for help. Patients frequently thank the intake staff for taking the time to gather more background that clarifies the status of their mental health, he said.

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’re in an unprecedented time of low temperatures across the entire state. Because of that, we've had rolling power outages,” Dr. Selby explained. “Several families, including my own, don’t have enough gas to power their heaters. With families struggling to keep warm, I've seen a lot of families go to extreme measures, meaning they're putting things in their home that aren’t safe.”

Dr. Selby has seen families use propane or diesel-burning engines that are meant for outside use with adequate ventilation. Families are also using generators inside or too close to their homes or garages, which emits fumes and can cause carbon monoxide poisoning. While generators can help keep you warm and keep your lights on, using them inside your home does more harm than good.

During a press conference hosted by Cook Children’s Wednesday, Phillip Scott, M.D., pediatric hospitalist, said one patient was treated after inhaling fumes from a charcoal grill that the family was using too close to the home. "To treat this patients, what we do is put them on 100% oxygen," Dr. Scott said. "That helps flush the toxin out of their system and replace it with oxygen." 

Those at a higher risk for carbon monoxide poisoning include infants, children, pregnant women, the elderly and people with heart or breathing problems.

“Carbon monoxide poisoning prevents your blood from being able to bind to or carry oxygen. You suffocate while you are still breathing,” Dr. Selby explained. 

Families need to be aware of what type of heat source they are using and make sure it is safe for indoors. “If you are using anything that burns propane, like a camper stove, it needs to be used exclusively outside and away from the home,” Dr. Selby said. 

Signs of carbon monoxide poisoning can include:

• Headache
• Nausea
• Dizziness
• Vomiting
• Upset Stomach
• Chest Pain
• Confusion
• Flu-like symptoms

Here are some additional ways to keep your family safe during this time:

• Don’t use anything such as a BBQ grill or propane tank to heat your home.
• Don’t run a vehicle inside of a garage attached to your home.
• Don’t heat your home with a gas oven or stovetop.
• Don’t burn charcoal inside of your home. 
• Do seek medical attention if you suspect carbon monoxide poisoning.
• Do ensure the carbon monoxide detectors in your home are properly functioning and installed in areas that will wake you if it alarms.
• Do check for local resources, such as warming shelters, to keep your family safe. 

Another winter storm could bring several more inches of snow in the coming days. While trying to stay warm, remember safety is your top priority! 

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.”

I have had the privilege of working in the Emergency Department at Cook Children’s for 10 years, with three of those years as a nurse. I often have people ask me, “How do you do it every day?” or “What is the hardest part of your job?”

It’s hard to describe to an outsider just what happens inside our walls. One thing is certain, dear patients and families, I want you to know that we see you. Every Christmas I work, I remember my first one here. I walked in to find out we had already had two children die. To those families who lost their children, I want you to know that I see you and I think of you at Christmastime.

There are times when I drive home from work in complete silence and don’t even realize I forgot to turn on the radio. There are days when I have to sit in the driveway a few extra minutes before I go in to see my family, and they wonder when I am coming in.

To the mother who I sat with after she received news that her daughter’s cancer was back and metastatic, I see you and I remember you. I remember you when I walk in the door to see my daughter, who is the same age as yours. I see you when I don’t want to get up early to rush through the crazy morning. I see you when I’m lucky enough to drop my child off at school, knowing you would give anything to trade places with me.

As a nurse, I love nothing more than to send your child out the door feeling better and in good spirits. I will drop anything at a moment’s notice to have a bubble party or dance party. I’m never afraid to look silly in the name of making your child smile. I think most of us keep coming back to pediatrics because the good truly outweighs the bad. To the sweet sparkly princess who colored me a picture, told me thank you, and gave me a hug, you gave me the push to get through the rest of my day on a high note.

As an ER nurse, expectations and demands placed on me are high. I experience difficult situations every day. There are always more patients waiting who need care. I try to take a moment if I can to process what happened.

I am lucky to work with truly the best team of people who understand and who support me when I need it. It’s easy to feel lost and overwhelmed at times in our world. If you find yourself here with your child, I want you to know that each of your children impacts my life. They are the reason I come to work every day.

Megan Cole has worked at Cook Children's for 12 years, 10 of which have been in the Emergency Department. Outside of work, Megan enjoys baking, music and spending time with her family. To learn more about Cook Children's Emergency Services, click here.

For most of us, a snake bite of any type would send us directly into a panic. However, when Ray was bitten while working in his lawn, he was hesitant to go to the doctor. He didn’t want to overreact. He wasn’t even sure he’d been bitten because of the heavy gloves he wore outside.

“Initially I knew it wasn’t good, the numbness and tingling. I told my wife that I thought I got bit by a snake but I never saw it because I was trimming the shrubs,” Ray said. “I actually called the Emergency Department at Cook Children’s and talked to one of the physicians I work with, and he advised that I go into my local ER to get some labs.”

While Ray was on the phone with the doctor, his wife went to the front yard where he was bit, found the snake and killed it. Later, poison control confirmed the snake hiding in their shrubs was, in fact, a venomous copperhead.

Ray went to Texas Health Resources for testing and bloodwork, and eventually started Crofab (an anti-venom) in the following hours. He spent the next four days in the hospital, receiving additional doses of antivenom while waiting to regain use of his left hand.

Providers aren’t immune to the fear of the unknown that patients often experience. It was in that same unease that he began to sympathize with his own patients.

“Going from a caregiver and being placed into the role of a patient is something I’m going to take away from this,” Ray said. ”I was really anxious in the waiting room because of the swelling, I even knew the science behind it all, but it was still a source of anxiety for me so for children to be a patient, it’s even harder on them.”

Now fully recovered, Ray’s experience has given him a deeper level of empathy for his patients and has made him a better provider for children with anxiety.

“Seeing the compassion of the other physicians and the nurses is something that is going to make me a better provider going forward,” Ray said. “This experience is going to make me more compassionate. I think whenever a provider is forced into the role of a patient it can create more empathy for their future patients.”

Related Topic:

• After the Bite: When and Why Antivenom is Used at Cook Children's
• 1 Year Old Bitten By Rattlesnake Recovering At Cook Children's
• Patients Bitten By Snakes
• What Are The 4 Venomous Snakes Found in Texas?

I spend a good portion of my day asking my daughter to give my son a little space; sister loves hard!

Recently, my son was playing in the kitchen (right next to me) when my daughter suddenly came in, sat behind him and looked like she was doing the Heimlich on him. As I was telling her to back away slowly, I noticed he was trying to put something in his mouth and wasn’t able to due to her pestering... and then I wanted to throw up. It was a button battery. A tiny battery that he could have swallowed without difficulty, and without me ever knowing it.

Last year, more than 470 children visited the Cook Children's Emergency Department after swallowing a "foreign body." Most objects that children ingest can be passed without much concern, but a battery is not one of those things. A battery lodged in the esophagus is a medical emergency. Essentially it can erode the lining of the esophagus. They are very dangerous and can be deadly without treatment.

As a previous pediatric ICU nurse and currently a primary care nurse practitioner at the Willow Park office, I knew this. I warn others of this danger. So how did it almost happen 2 feet from me?

I suddenly remembered my daughter was wearing a headband that lit up the day before, and she accidentally pulled the back off spilling the batteries. I thought I had picked up all the batteries, but one was hiding under the kitchen mat.

After thanking my daughter for her brother obsession, I went on a mission to locate all the button batteries in the house.

Keeping these babies safe is a hard job, for ALL of us! Doing a quick scan of the house to make sure no batteries they could easily swallow are in their reach is a good step towards safety.

-Sperry, NP

For more on this topic, read:

• Number of Kids Seen in ER for Swallowing Small Objects Doubles Over Past Two Decades
• Button Battery Injury Prevention Safe Kids
• Choosing Safe Baby Products
• Is Your Home Safe for Baby?
• Is This an Emergency?

Corwin Warmink, M.D., medical director of Emergency Services at Cook Children’s, said not a day goes by that a child doesn’t visit the ER after ingesting a foreign body.

“The vast majority of swallowed objects pass without incident or treatment,” Dr. Warmink said. “The most common objects that must be removed are large coins (quarter or larger) because they won’t pass through the stomach and then button batteries and magnets due to the risk of intestinal injury when they are ingested.”

Dr. Warmink wasn’t surprised to see findings from a new study in the latest edition of the journal Pediatrics. Researchers from Nationwide Children’s Hospital in Ohio looked at data from the National Electronic Injury Surveillance System about foreign body ingestions in children between 1995 and 2015.

The research found that over the 20-year period, ingestions doubled.

Seventy-five percent of ingestions were under 5 and coins (61.7%) were the most ingested items.

“It’s the same at Cook Children’s. Coins are far and away number one, along with beads, toys, buttons, nails/tacks, batteries and magnets,” Dr. Warmink said.

Button/disc batteries are the extremely dangerous due to the risk of corrosion. High powered small magnets are also a risk due to entrapment and erosion of the intestines. But many of the objects have the potential for harm.

“The initial danger is if the object gets stuck in the upper airway and causes the inability to breath or if it’s inhaled instead of swallowed and trapped in the lung,” Dr. Warmink said. “Once swallowed, an object may get trapped in the esophagus, which would cause the inability to swallow items. Swallowed objects very rarely cause obstruction in the intestines, but that is also a concern.”

Dr. Warmink adds any object that can fit through a toilet paper tube opening is a high risk item for swallowing. Children under school age should be monitored closely and never allowed to play with coins or toys with small pieces. Children from 6 months to 4 years are at most risk.

Warning signs to bring your child to the Emergency Department are wheezing, coughing, drooling, difficulty swallowing or sensation of object in the chest.

Last year, 35 children were treated for snake bites at Cook Children's, up from 21 bites in 2017 and 20 in 2016. Earlier in the week, a 19-month-old girl became the first child to be treated for a venomous snake bite at the medical center. She was admitted to the ICU and given three vials of anti-venom over the course of two days, according to Fox4News. The child is now recovering at home.

When children are taken to Cook Children’s Emergency Department, a careful snake bite protocol begins that can result in antivenom given to the patient.

"We have advance practice providers with years of experience and expertise in caring for snakebite victims as part of the Trauma Team," said Melinda Weaver, Trauma Program Manager at Cook Children's. 

The Trauma Team uses an evidenced based clinical guideline along with a scoring system, lab results and other indicators to decide if the antivenom is needed or not. If it's determined the antivenom is needed, the Cook Children's Pharmacy team is notified.

Cook Children’s Pharmacy carries one of the largest stocks of Crofab®, a snakebite antivenom treatment, in the area for rattlesnake, copperhead and water moccasin (cottonmouth) bites at all times.

Once the patient is brought to Cook Children’s, he or she is watched carefully for signs and symptoms to a venomous bite.

The initial evaluation of the patient includes the “A-B-Cs” (airway, breathing, circulation) and vital signs. The wound is then examined for swelling, discoloration and bleeding. Signs that the antivenom is needed include:

• Respiratory distress
• Nausea
• Vomiting
• Abdominal pain
• Bleeding from nose, skin or gums
• Tingling or prickling sensations
• Abnormally low blood pressure
• Faster than normal heart rate.

Ean Miller, a manager in the Pharmacy Clinic and a pediatric clinical specialist in the Emergency Department at Cook Children’s, said the signs that Crofab will be needed usually occurs within the first couple of hours.

“Once we know it’s a snake bite, we are immediately drawing the labs,” Miller said. “We will then assess the bite wound. One of the things that we watch for is if the redness and swelling around the bite starts to expand rapidly. If it’s not a venomous snake, usually there will be a little bit of redness and swelling but it doesn’t spread."

The initial care is administered by the Emergency Department and then the Trauma team at Cook Children’s takes over for treatment. An order is given if it’s determined the child needs the antivenom. The mixing takes 15 to 20 minutes by the pharmacist to get the antivenom ready.

The most important factors to giving CroFab are evidence of coagulopathy (blood clotting factors out of normal range) and evidence of respiratory distress, low blood pressure and fast heart rate.

If the patient responds to the initial dose and no allergic reaction occurs then an additional two vials will be given every six hours for three more doses.

Miller said 90 percent of patients start to improve after that first four to six vials of Crofab. Most of remaining 10 percent show improvement after an additional four to six for an almost 100-percent rate.

On rare occasions, a patient will develop an allergic reaction to the antivenom. If that happens, the patient cannot receive any more antivenom and treatment consists of symptomatic and supportive care.

Antivenom is not effective for the other venomous snakes in this country. Coral snakes, which also are in Texas, and other exotic species make up the remaining 1 percent of venomous snake bites in this country. Crofab® antivenom is not used to treat these bites. Patients are admitted to the hospital for 24-hour observation and supportive care.

“For us, in the Emergency Department, it’s just sad because this is something that’s totally preventable,” Dr. Warmink said. “It was an unusual summer because of the number of kids who came here because of drowning, but it’s something we see all the time. It’s not a freak occurrence. We live in Texas. There are a lot of pools here. It’s just water and children don’t mix without supervision.”

Dr. Warmink understands that people focus on the number of fatal drownings that occur during a given year. But he says that a near drowning can be devastating for a child.

“Kids come in here and they don’t die, but we know that their outcome is not going to be a good one,” Dr. Warmink said. “People think, ‘He didn’t die, so everything will be great.' But often times, that’s not true. There is a large subset of children who survive, but end up with catastrophic outcomes.”

Time under water = brain

Dr. Warmink describes drowning as the inability to breathe, normally due to submersion in a liquid, usually water.

The outcome, including death, of the person who drowned depends on how long he or she was under water.

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

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

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

Once a child arrives to the Cook Children’s ER, treatment begins that may include oxygen, X-rays, intubation or medication.

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

Adult supervision – the hallmark

As a parent, Dr. Warmink stresses supervision of his own children in the pool. He calls it a hallmark of making sure children are safe. Half of all drownings occur within 25 feet of an adult.

“Children should never be in water without adults watching them,” he said. “If you have a toddler, that child shouldn't be in water without what we call touch supervision. You need to be in hand's length and it's not just pools. That includes bathtubs or any other container with water. I've seen kids drown in buckets. A child can drown in any water, even a few inches deep.

“Supervision isn't, Hey there’s six of us cooking hamburgers and text messaging. It means there’s someone who has the designated job to watch the children in the water.”

Other layers of protection Dr .Warmink stresses include:

• Fencing around the pool. A fence on all sides of the pool has been shown to reduce fatalities by more than 80 percent.
• Swim lessons for everyone who will be in the pool, including adults.
• Coast-guard approved floating devices. Water wings and “floaties” do not constitute a floatation device.
• Drowning doesn’t look like drowning. Drowning is a silent killer. Kids aren’t kicking and flailing. Dr. Warmink says it’s usually someone looking for their child and they see them at the bottom of a pool.

“As the adult, you have to be actively watching at all times, counting even. OK, there are five kids in this pool. How many heads do i see? Kids will drown right in front of you,” Dr. Warmink said. “It's not a long process of them screaming and crying. It's just one second they are fine and the next second they are under.”

Take it from Dr. Warmink. Unfortunately, he’s had plenty of experience.

Related articles:

• Cook Children's drowning prevention page
• Drowning prevention - 9 ways to protect your kids
• Drowning prevention - watch your kids
• Drownings double from a year ago 
• Be a water watcher. Adult supervisions saves lives.
• Is your baby ready for swim lessons?
• Drowning tragedy - 'I can't believe this happened to me.'
• Swimming with Type 1 diabetes
• The life-saving reason for Water Watchers

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."

So Collin never expected a national correspondent from CBS News to be on a helicopter with him during the rescue of a 93-year-old woman from the perils of Hurricane Harvey in Port Arthur, Texas.

Omar Villafranca was on that helicopter and captured the rescue, naming Main in one of his tweets and showing him in his evening news report on the dangerous flooding.

“My cousin texted me and said, “I just watched the CBS Evening News and you were on it,” Main said while laughing. “I saw him (Villafranca), but I didn’t realize he was a reporter at first until we started talking. I never thought much about it.”

Main, who is a registered nurse in the Emergency Department at Cook Children’s, never thought much about helping people either after he saw the devastation of the hurricane.

“I feel like we did a lot of good, but I don’t necessarily feel like we did anything special,” Main said. “We were just doing what we were called to do. You don’t go into the medical field without having the call to help people.”

That call tugged at Main as he listened to Zello, a Walkie Talkie App, where he could hear the need for medical help and people with boats.

“I listened all day and it was just pulling at my heart,” he said. “They were pulling out babies and old people. I had to do something.”

Main called his fishing buddy Trent Palmer, who is a dispatcher at Cook Children’s Teddy Bear Transport and a paramedic. Main asked Palmer if they could take his aluminum flat water boat and head to Houston to help with the hurricane.

At first Palmer said no. After all, it was his expensive fishing boat that they would take to South Texas. But like Main, that calling to help tugged at him too.

"I said, 'Man, I don't want to run over a fire hydrant and sink. We would have to be the first ones rescued,'" Palmer said. "Collin told me to download this walkie-talkie rescue channel. I kept hearing call after call. People stranded in their attics or up on a roof. It just didn't sit well with me. I called Collin back and said, "The boat is hooked up to the truck, get here as soon as you can. Let’s go.”

They took another friend who is a physical therapist and headed toward Houston at 10:30 p.m. on Tuesday, Aug. 29.

They listened to the app the whole trip. After a couple of hours, they realized that Houston was covered and it was Port Arthur that needed help the most. The three friends called until they reached a dispatcher in Port Arthur who gave them directions to a local mall, a place high enough that they could dock their boat and begin their rescue mission.

When they reached Port Arthur at around 5 a.m. Wednesday, they were shocked at what they saw, or to be more accurate – what they didn’t see.

Other than the Coast Guard, they were the first boat on the scene. They talked to a dispatcher to prioritize medical calls and headed out on the water. Within 5 minutes, they brought 15 people on their boat to safety.

For the next 12 hours, the three men lived the adventure of a lifetime:

They rescued a woman that Main estimated to be in her 80s. She was using a walker to help her stand in water up to her knees. She had been standing for 12 hours. When she saw Main, she sobbed from relief.

One family proved to be especially meaningful to Main. He volunteers at Camp Sanguinity, a camp for patients with cancer and blood disorders. The dispatcher said a child in the family had cancer and had a port. When Main and his physical therapist friend reached the house, they found six kids and a couple of adults. Main put one child on his back and carried the young child with cancer. Main wrapped his poncho on the child to protect the port.

At times, Main walked in waist-deep water to go to a house, while Palmer drove people to land in his boat. In most of the houses, the electricity was still on and power lines were on the ground. Main even commandeered a Jon Boat he saw floating by to carry someone to safety.

But for all the people helped, none were more dramatic than the one captured by CBS Evening News.

The trio received a call about a 93-year old woman who had suffered a seizure and was experiencing chest pains. Palmer drove the boat as far as he could, but the water became too shallow and Main jumped out to walk.

He saw a young boy riding by on a Jet Ski. Main asked him for help. He hopped on the back of the Jet Ski and used his phone for directions. When Main arrived, he found the woman with water up to the mattress on her bed. She couldn’t walk or stand and was not physically able to ride back on the Jet Ski. She was in immediate need of help and beyond what Main could offer her with limited supplies.

Main walked out and saw Navy rescue helicopters hovering above like bees. He took off his white hat and waved it frantically to get the crew’s attention.

The lady was carried out, placed on a basket and lifted up to the helicopter. They asked Main what he did for a living and since he was a nurse, they brought him along for medical support.

But the adventure didn’t stop there. Once the woman was safe, Main still had to get back to his friends who were about six miles away.

He walked out of the airport where the helicopter landed and hitchhiked to the highway. From there he flagged down a dump truck that was headed to the mall.

“It was the wildest day of my life,” Main said.

From sunrise to about 8 p.m. that evening, the three men from North Texas made multiple trips and were involved in rescuing more than 100 people. By the end of the day, dozens of boats had arrived. The Army and Coast Guard took over by the evening and it was time to go home.

"It was a real humbling experience," Palmer said. "Everybody was so grateful. I saw stuff I never wanted to see and I saw stuff that was really amazing. We did have some pretty scary moments, but it was nothing compared to what was going on around us. We weren't worried about ourselves."

They drove back and went nearly 48 hours without sleep. Palmer returned to work, with someone else who needed to be rescued -- Harvey, a dog they saw that was wandering around without an owner.

"He's as skinny as could be," Palmer said. "But we brought him home. He's sitting right next to me. I have him now."

Thursday night and Main was up after only 5 hours of sleep to take care of the animals that live on the farm.

“It was such a terrible situation. I’ve never seen anything like it and hope I never do again,” Main said. “The look of loss and despair on people’s faces… it will stay with me forever. People were crying. Some did not want to leave their house. Everything was a total loss. We tried to be encouraging. We told them they were safe. You can replace this stuff. But, it was hard on people. They would be in waist-deep water and they didn’t want to leave.”

And yet through it all, the three friends found moments of joy.

“We were able to laugh. We had a boat full of people and we were going by a Dairy Queen,” Main said. “It looked open except for all the water around it. The lights were on and the Drive Through sign was lit up. I said, “Palmer, pull over and get us all some Blizzards. We all started laughing. All of these people who had gone through so much started laughing. This was without question, one of the craziest things I’ve ever been through in my life. But I never felt like I was in danger. I’m sure I was. I’m sure we all were. But my granddad, he was always my hero. He taught me to help people. We all feel fortunate that we were able to help. I know this. I would do it all again and wouldn’t think twice about it.”

His grandfather would be proud.

*Top photo, credited to Omar Villafranca/CBS News

**All other photos, video credited to Trent Palmer

But are they ready for the hottest part of the year?

Locally, the National Weather Service has issued a heat advisory that remains in effect until 8 p.m. Saturday. Daily temperatures will range between 94 to 102 degrees, with a heat index between 105 to 109 degrees.

So while you don't want your children to waste their summer vacation away playing video games inside, warm summer temperatures can lead to more than just a sunburn. Being outdoors in the heat for too long can pose a heat-safety risk.

Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children's, says eight kids have been treated in the ED this summer with a chief complain of heat related illness.

"As the outside temperature rises, your family's risk of heat stroke rises right along with it," Dr. Warmink 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. One study of nearly 9,000 U.S. children, ages 3 to 5 years old, found that only half were taken outside by their parents on a daily basis to walk or play.

"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."

Staying safe

Symptoms of heat exhaustion include flu-like symptoms such as paleness, sweating, nausea and vomiting. Signs of heatstroke include hot, red and dry skin, as well as confusion, vomiting, rapid heart rate, decreased sweating, shortness of breath, decreased urination, increased body temperature (104 to 106 degress Farenheight), or convulsions.

MedStar reminds us that heatstroke and heat exhaustion are common this time of year, but they can be easily prevented:

• Hydrate: Drink plenty of water during the day, especially if you are engaged in any strenuous activity. Sports drinks are a good choice if you're exercising or working in hot conditions, but water is a good way to hydrate as well.
• Ventilate: Stay in a place where there is plenty of air circulating to keep your body cool. If you are indoors and don't have access to air conditioning, open windows and use a fan.
• Cover Up: Wear light-colored and loose-fitting clothing to avoid absorbing the sun's light and trapping heat. Wear a hat to shield yourself from the sun, but once you feel yourself getting warm, remove any items covering your head which can trap heat close to your body.
• Limit Activity: Heatstroke can occur in less than an hour when you are participating in strenuous activity during a hot day. If you feel yourself getting hot or light-headed, stop your activity and rest in a cool place out of the sun. Be sure to drink water or a sports drink before, during, and after any strenuous activity.
• Check on Loved One’s: MedStar reminds families to make sure that your child's grandparents are OK. The elderly are especially vulnerable to heat related emergencies. Many elderly residents are not aware of how hot it may get in their residence. Call on older friends and family members regularly to assure they are doing OK.

About the source

Corwin Warmink, M.D., is the medical director of Emergency Services at Cook Children's. Cook Children's Emergency services are available 24 hours a day, seven days a week. Cook Children's Emergency Department (ED) treats more than 105,000 patients every year. Our ED is the only EMS-designated pediatric trauma center in Tarrant County. 

Wheezing, coughing and the struggle to catch a single breath.

Sounds like asthma, right?

But there may be another cause for respiratory distress in your child: vocal cord dysfunction.

Asthma and vocal cord dysfunction (VCD) seemingly show the same symptoms, especially in adolescents. But what’s the difference between them?

Cook Children’s Emergency Department sees an average of 13,000 children each year exhibiting wheezing and difficulty breathing. The similarity of symptoms between asthma and vocal cord dysfunction may be difficult to differentiate to the eye so it’s important to note the small distinctions.

“Asthma and VCD are quite different even though some of the symptoms can overlap,” Corwin Warmink, M.D., medical director of Emergency Services at Cook Children’s said. “VCD causes difficulty breathing in compared to asthma, which makes it more difficult to breathe out. They also sound different when using a stethoscope to examine a patient.”

Unlike vocal cord dysfunction, asthma is an immune response when the body is exposed to various “triggers,” such as air pollutants, physical activity and airborne particles like pollen and pet dander. When triggered, the bronchial muscles in the airways constrict and the sudden obstruction causes the reaction of an asthma attack.

You may be experiencing an asthma attack if your symptoms include:

• Tightness in the chest

• Difficulty breathing

• Shortness of breath

• Coughing and wheezing

• Excess mucus

Vocal cord dysfunction is the abnormal closing-together of the vocal cords, resulting in the loss of airflow. Unlike asthma, VCD does not involve an immune response or a reaction from the airways. Vocal cord dysfunction makes it more difficult to breathe in than breathe out when symptoms occur.

Children who are active, vocal and use their vocal cords more than usual may have higher tendencies to experience VCD.

“We see VCD most common in female teenage athletes although it does occur in males,” Karen Schultz, M.D., pulmonologist at Cook Children’s said. “Type “A” personalities are at higher risk.”

You may be experiencing vocal cord dysfunction if your symptoms include:

• Tightness in the throat

• Difficulty breathing

• Coughing and wheezing

• Hoarse voice

Asthma and VCD are regularly confused as the symptoms and triggers are similar. Many patients with VCD are originally treated for asthma.

“Patients are diagnosed by history, exam and lung function testing,” Dr. Schultz said. “Lung function testing can be completely normal in both conditions when no symptoms are present. Frequently history alone can differentiate the two. Occasionally lung function testing after exercise can be diagnostic or laryngoscopy after exercise”

Signs you may be experiencing VCD instead of asthma:

• It is more difficult to breathe in than it is to breathe out

• Asthma medications and inhalers do not ease symptoms

The diagnoses for VCD and asthma are different. Asthma requires pulmonary function tests, such as a peak flow and a spirometry test. While a diagnosis for vocal cord dysfunction typically entails results from other pulmonary function tests, such as a laryngoscopy or a spirometry test.

Many children who are diagnosed with vocal cord dysfunction are referred to see a speech pathologist who can assess the degree of dysfunction, and begin a plan of action with different types of breathing and stretching exercises for the vocal cords.

“There are a number of ways we treat different diagnoses, but we will usually start with breathing exercises to make sure air flow is unhindered and the vocal cords can be well supported,” Melanie Van Noy, speech pathologist at Cook Children’s said. “Then we may do simple exercises to lengthen and stretch the vocal cords or exercises to reduce pressure. It depends on the diagnosis and the dysfunction.”

While VCD does not have specific medications to ease symptoms, speech therapy is tailored to allow children and their families learn triggers and how to cope when an attack does occur.

“For kiddos, a large part of our job is helping our young patients to become more aware of their vocal habits and educating not only them but their parents and siblings on how they can help change those habits, Van Noy said. “We also have some sophisticated software programs that help give our kiddos the feedback they need so they can not only hear the difference, but see the difference and the changes they are making as well.”

Speech therapy typically teaches and treats children for three to five sessions. If the child is still showing symptoms, a team of Cook Children’s doctors will begin to assess all the different aspects to their case.

“Our ENTs and pulmonologists work closely together to ensure that if our treatment plateaus or the patient is still showing symptoms despite treatment, we can collaborate on what to do next,” Van Noy said. “That may look like a discussion with the physician regarding compliance and progress of treatment, what other medical intervention strategies are available or maybe just another episode of care, which is what we refer to as our plans of care.”

You walk through the door of the ER to see no one else signing in. You breathe a sigh of relief. This doesn’t look so bad. You get checked in, and it’s not long before they call you back to a room - triage. Your child gets their vitals taken, the nurse asks you a slew of questions and the doctor sees you. Then you are back in another waiting room...WAITING. You think it’s not going to be long, but 45 minutes turns into a couple of hours and you are still waiting.

The ER is just that - an emergency room. Most people try to avoid it completely, while for others, it’s their go-to for health care. No matter where you land in that mix, there is more going on behind the scenes than what you see in the waiting room. 

This is your first tip from an ED Child Life Specialist and mom. Every time I walk through the waiting room on my shift, I think like a mom for those few seconds. I don’t know about you, but as a mom I avoid waiting with my children for everything. This is why drive-thrus were invented! If I can’t avoid it, I come armed with everything possible to make it more bearable. Usually there is a bribe attached to this option.

As a mom with behind-the-scenes experience, there are a few things I think you should know before you sit and wait or, unfortunately, experience a really scary emergency.

The emergency room is a necessary place, and we know how much you don’t want to be there. Trust me, I’ve debated going at midnight with the screaming baby whose ear infection came on within a matter of hours on a Friday night. Confession: I let my oldest go two days with a broken arm and had no idea. The second time, I had her x-rayed the day of. Being a caregiver comes with so many decisions, and I know that deciding whether or not to go the emergency room is one of the hardest ones. Remember that we are here to help you and your child through these hard moments and illnesses that come with childhood. Our motto is: It’s all about the kids! And we mean it!

About the Author

Ashley Pagenkopf is a Child Life Specialist in the Emergency Department at Cook Children's Medical Center. The Child Life program at Cook Children's offers a variety of services, all designed to make your experience at Cook Children's the best it can be. Our services include educating, preparing and supporting your child through tests and procedures, as well as coping with any life challenges you and your child may face. 

Related articles:

• 6 Ways To Prepare Your Kids For Their Next Doctor's Appointment
• Urgent Care or Emergency Room?
• New ED opens just in time for back-to-school injuries

Urgent care or emergency room?

Every parent knows there are a plethora of reasons their child might need doctor this time of the year. They could catch a cold, come down with the flu or injure themselves on the playground.

When it comes time to make that call, be prepared by knowing when to use Cook Children’s Urgent Care and when to rush to the Emergency Department.

Urgent care situations are illnesses or injuries that need medical attention.

When to use Cook Children’s Urgent Care

• Ear infections/pain
• Strep/sore throats
• Cold symptoms
• Flu
• Mild dehydration
• Respiratory illnesses – including respiratory syncytial virus (RSV), bronchitis, bronchiolitis, pneumonia and asthma without severe breathing difficulty
• Sprains and possibly broken bones
• Minor cuts
• Vomiting
• Diarrhea
• Infected bug bites
• Foreign body removal (marbles, beans and other interesting things)
• Urinary infection symptoms
• Pinworms, ringworm, rashes and pink eye
• Painful muscle strains
• Head injuries without loss of consciousness or vomiting

Cook Children’s is home to a brand new and expanded Emergency Department (ED). However, you only want to visit the ED in case of a medical problem that could cause death or permanent injury if not treated right away.

When to use the Cook Children’s Emergency Department

• Severe bleeding that does not stop after 15 minutes of direct pressure
• Severe allergic reactions and/or breathing problems
• Coughing up or vomiting blood
• Sudden severe joint pain with swelling
• Insect stings accompanied by breathing difficulties
• Swallowing poison or choking
• Not being able to move or speak
• Severe or persistent vomiting or diarrhea
• Gaping wound (edges won’t come together)
• Head injury with loss of consciousness, vomiting or causing dizziness/confusion
• Obviously broken bones or dislocated joints
• Fever in infants under 8 weeks old and under
• Diabetes/blood sugar issues

“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.”

If your child is sick, know this:

• If during the day, call your Cook Children’s primary care physician first to schedule an appointment. Cook Children's is also home to six Neighborhood Clinics in Arlington, Fort Worth, Berry Street, Fort Worth, 8th Street, Fort Worth, McCart Avenue, Fort Worth Miller Avenue and Fort Worth, Northside.
• After hours, consider one of Cook Children’s Urgent Care Centers. Cook Children's has four Urgent Care Centers to treat your children in Fort Worth, Mansfield,Southlake and Northeast Hospital.

If your child doesn’t have life-threatening symptoms, an urgent care center can be more convenient and the right choice for your family.

Cook Children's has several urgent care clinics across Tarrant County. The newest clinic opened in Sept. 2016 in the Alliance area of North Fort Worth. It also includes a specialty clinic. 

“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.”

Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children’s, knows that guns will be a popular gift this holiday season for not only children, but for adults too.

According to the journal Injury Prevention more than one-third of American adults own a gun. Last year, Cook Children’s saw 10 total injuries related to shootings of a gun (ranging from a BB to rifle). Since 2009, Cook Children’s has seen 104 shootings and three deaths.

Dr. Warmink asks parents to explain to children that BB guns can be dangerous, with harm ranging from severe eye damage to liver and kidney injuries.

Dr. Warmink says it’s important that parents educate their children about gun safety and make sure kids know to leave the area if another child, or someone other than their parent, has a gun.

“We live in Texas and I know many kids are raised hunting and have guns in the home,” Dr. Warmink said. “But if you give your child a gun for the holidays or if the adult in the house is given a gun, it’s important to take the proper precautions. The thing we want parents to remember is to keep guns locked, unloaded and separate from ammunition”

1. Lock the gun and keep it out of reach of kids. Hiding the gun is not enough.

2. Unload your gun. Take all ammunition out of the firearm.

3. Store the keys for the gun in a cabinet or safe different from your household keys. Keep the keys out of the reach of children.

Along with guns and replica firearms, such as airsoft guns that use hydraulics to shoot pellets, Dr. Warmink lists these gifts as dangerous and even life threatening:

• Ripstik Casterboard, Skateboards, roller skates …
• Pull toys with strings over 12 inches
• Trampolines
• Backyard playground equipment
• Hard plastic swords

Sharon Evans, Trauma/Injury Prevention coordinator at Cook Children’s, knows that owning a bike or scooter is part of growing up. But she encourages parents to take the proper precautions before placing wheeled gifts under the tree.

“Parents, please don’t forget a helmet for all riding toys,” Evans said. “Make sure the helmet is on properly and read the instructions.”

For younger children, Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coalition, warns parents to be aware of any small parts or potential choking hazards from their own toys or perhaps older siblings.

“The holidays can be an especially dangerous time for the little ones,” Walraven said. “Pick out toys and activities that will be appropriate for their age. On Christmas, designate an adult to supervise the children. It’s surprisingly easy to lose track of small children and with just a little planning we can keep choking hazards away from them. When it comes to young children, preparation is key.”

"If it can accelerate your body, it can injure you," said Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children's. "Vehicular accidents, including boats, ATVs, cars, scooters and bikes are all too common on holiday weekends during the summer."

Another danger Dr. Warmink is concerned about this weekend: broken bones. No one wants to spend Labor Day weekend in the hospital. But Dr. Warmink says many families do, thanks to trampolines and monkey bars.

One of the scariest threats we see all too often is drowning. And yes, it can happen to you. In August alone, 14 children were admitted to Cook Children's Medical Center for drowning-related injuries. Two of those children died.

"We've seen many cases where children took their life preservers off and jumped back into the water," said Magdalena Santillan, Trauma Injury Prevention specialist at Cook Children’s. "Often, parents are getting ready to leave the pool and don't realize their kids have jumped back in."

One of the best ways to protect your child around the pool or lake is to become a Water Watcher. This means adults take turns supervising the water with undistracted attention. You can find more information about the program here, including 5 seldom used tips that could save a child's life.

And Labor Day may mark the unofficial end of summer, but that does not mean an end to the heat. According to Dr. Warmink, heat-related illness also tops the list of Labor Day dangers. "Heat exhaustion, heat stroke, hot cars and sunburns are among the common injuries we see over the Labor Day weekend," said Dr. Warmink. "Parents should make sure their kids drink plenty of water and wear sunscreen, and of course, never leave a child alone in a car."

With your help, we can cut the number of Emergency Department admissions this holiday weekend and ensure a safe celebration for everyone.

My wife nudges me. It’s 2 a.m.

“Hey babe, did you hear that? Who is coughing? Can you go check on them? Take your stethoscope.”

That’s what an Emergency Room visit looks like in our house in the middle of the night. This time of year, many of you might wish you were married to a pediatrician … but, alas, Mrs. Doc Smitty is one of the few with that privilege.

We at Cook Children’s, and hospitals around the nation, have seen a significant rise in the use of our Emergency Departments and Urgent Care Centers over the past few weeks. Not only are we seeing more kids, many of those kids are more complex and more sick than we have seen in previous years. We are seeing RSV, flu, vomiting/diarrhea and just about every other pediatric illness you can imagine. It’s all going around.

Not only do we find ourselves servicing our local area, we are accepting transfers from most of North Texas in an effort to provide service to very ill patients who need the level of care that Cook Children’s can provide. This responsibility is based on Cook Children’s promise that every child’s life is sacred.

But that important commitment to helping so many children means helping a lot of kids. Here’s what we know that means to you.

We know that wait times are longer than usual right now.

We follow the trends in wait time closely – both at our medical center and in our region. All across Dallas-Fort Worth, hospitals are experiencing this surge in visits and we are hearing about increased wait times at emergency rooms throughout the area.

We are working to address this issue. We are increasing the number of providers ready to work in the ED. These are not our regular ED physicians but physicians who will be available to help out with patient surges after their “day jobs.” We are working to educate our families about other locations where they can receive care. Unfortunately, once a patient is checked in at the ED, we cannot ask that they leave to receive care elsewhere. Asking them to leave would be a violation of a law known as EMTALA.

Another issue we are facing is limited space. Hospital beds are filled with sick children that are not ready for discharge. This requires that children who need admission remain in our ED as they wait for a room in the hospital.

Space in the ED is already limited based on the fact that it was built to accommodate 45,000 visits per year but is currently seeing more than 120,000. Much of this problem will be addressed when our new Emergency Department opens, but, for now, we have to work to maximize the use of the space that we have.

Therefore, increasing providers will not cut your wait time down to zero but we will do our best to shorten it as much as possible.

You can help by utilizing our various other ways to care for your child’s medical issues addressed. Do not hear this as a lecture to not go to the ER; that is not the point of this post. We are working hard to provide other means that might help you by addressing the problem more quickly. Consider calling your Cook Children’s pediatrician. Even if they are not open, you can get advice from our outstanding pediatric nurses who can take your phone calls overnight. If your issue requires a visit but the ER seems like too much, check out one of the four Cook Children’s Urgent Care Centers throughout the Fort Worth area.

We know that waiting is terrible.

Doctors are some of the most impatient people I know. I don’t like to wait for anything. I get antsy and frustrated and become very difficult to deal with. If the radiology report or the lab result takes longer than expected, our anxiety level goes up. When we know our patients are suffering and we need those results to relieve suffering, we become even more frustrated. We hope you don’t sense our frustrations as frustrations with you. We just hate to see kids sick and to see more of them sick than usual makes us all sad.

You can hear the frustration in this brief interview with Corwin Wormink, M.D., Cook Children's Assistant Medical Director of Emergency Services.

We are working to address this issue. We are working to speed up all the processes associated with caring for your children so that our providers can be as efficient as possible. We are working to support providers (doctors, nurses and all other staff) so that they can be energized (physically and emotionally) to continue to provide excellent care for your child.

We know that waiting with a sick child is even worse.

We hate it that you are waiting hours to be seen in our ER. When our providers walk into the room and see that you’ve been waiting, our heart hurts about the time you’ve spent sitting in an uncomfortable chair trying to corral your sick child (often with their siblings). We know that you are worried about your child because he or she is sick. You’ve been scared to go to the bathroom, afraid you might miss your name being called out and that you are hungry and tired.

We are working to address this issue. We are looking to staff volunteers in the waiting rooms to help you get to where you need to be, to provide distractions for your children and to do anything they can to help you while you wait. We also are looking to increase our use of text and other notifications to update you on the status of your wait times, need for vital sign checks and other issues. Even when you are waiting, unable to be seen by a doctor, our triage nurses are checking and re-checking your child’s vital signs to make sure that your child’s medical condition is not changing, requiring them to be moved up in line to be seen sooner.

Your child is important to us.

Despite the fact that the numbers of children in the ED are high, we want to continue to provide the best care for your child. No matter how long your wait, we want you to feel like your concerns and questions have been addressed and that you have received the personal care your child deserves. If at any point, you do not feel like you have received that level of care, feel free to reach out to us at 682-885-6698.

You may not have a pediatrician lying next to you in bed for a quick ER check in the middle of the night but we do want you to know that we are here for your child in many other ways. Start by picking up the phone and calling your pediatrician or nurse triage line. If you decide your child needs to be seen, think about trying one of our Urgent Care Centers or in an emergency, our Emergency Department.

Our providers in each area are ready to provide the best care for your child.

Previous articles, related to this topic:

• Sicker kids means longer wait time in ED
• 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

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

Dr. Aaron spent her morning on Thursday, July 24, doing interviews with newspaper, radio and three local TV stations.

“I’ve never been one to reach out to the media or certainly get in front of the camera,” Dr. Aaron said. “I’ve had those times where I’ve been asked to be on camera and needed to do that. This is the first time where I’ve ever picked up the phone and called our team and said, ‘Guys, we need to do something. We need to reach out because three in one week … that’s just too many.’”

The mother of a 2-year-old son, the swimming deaths hit way too close for Dr. Aaron. All three children who died were between the ages of 2 to 4 years old. The teams at Cook Children’s involved in the three drowning events met with Cameron Brown, a member of Cook Children’s Pastoral Care and a firefighter, who is specially trained to lead caregivers through a critical incident stress debriefing. To put it simply, they were heart broken.

“This is what we do. This is our profession, but it impacts us,” Dr. Aaron said. “We’ve had great sorrow. That is minimal to what we sense must be happening with these families and close friends. It’s unusual for us to have three cases in one week ... and we still have many weeks of summer left.”

What makes the deaths even more tragic is the fact that most drownings are preventable. Dana Walraven, Cook Children’s Community Health Outreach manager and Safe Kids Tarrant County coordinator, also spent the day with media to discuss drowning prevention steps. Texas has the highest incidence of swimming pool- and spa-related childhood drownings in the United States. All three children who died were pool related incidents.

Drowning is the leading cause of unintentional deaths for children 1 to 4 years of age. The common myth of children splashing, waving their arms around and yelling is simply not true.

“In many drowning situations, an adult was just a few feet away from the pool and didn’t realize anything was wrong because he or she didn’t hear any sounds of distress, such as splashing or yelling,” Walraven said. “Drowning is a silent event that can occur in the time it takes to send a text message. Should supervision fail for any reason, having multiple layers in place helps protect your child.”

Walraven offers these drowning prevention basics:

• Have your children take swim lessons.
• Have the entire family taking swim and safety lessons.
• Learn CPR.
• Provide 100 percent supervision without distractions.
• Use pool and child alarms to alert you if your child gets in the water without you.
• Isolate your pool from the rest of your backyards with a permanent, four-sided fence with self-latching gates to prevent kids from accessing the pool area without adult supervision.

“We realize that it could happen to anyone,” Dr. Aaron said. “It happens very, very quickly. We’re not being judgmental. We feel so strongly about this and knowing how it impacts us we wanted to reach out and raise awareness to the community.”

For more information:

• Drowning prevention
• Water safety
• Vento family story
• Cookchildrens.org/safety
• Backyard and Pool: Household Safety Checklist
• Household Safety: Preventing Drowning