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.

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.

One of the first things I like to know when ascertaining the seriousness of a child’s condition is whether the child is playing, smiling eating or drinking. If a complaint is brought up regularly, interferes with play or a child really cries, parents should consult a physician.

High Fever

New parents might find the recommendations for when to seek treatment for a fever daunting, but it gets easier with time.

For infants 3 months and younger, any fever is serious and parents should see a physician’s help immediately.

For children older than 3 months, a high fever combined with symptoms such as lethargy, changes in fluid and/or difficulty breathing require prompt medical attention.

Children who are 3 months or older with fevers of 102 degrees Fahrenheit or higher that don’t respond to fever-reducing medicine should see a doctor.

Fevers up to 101 can often by managed with fever-reducing medicine, fluids and rest. However, if your child also has a harsh cough – which may indicate croup – you need to consult a doctor.

Stomach Hurts

If your child has a stomachache, there are three red flags that may warn parents of a serious illness such as appendicitis:

1. Your child has a tummy ache and a fever.
2. Your child can point with one finger to where it hurts.
3. Your child has been vomiting.

Children don’t need to have all three symptoms for parents to seek help because any one of these symptoms can indicate that appendicitis might be a possible diagnosis. Parents should also not wait too long. If symptoms worsen in six to eight hours, consult a doctor.

My Head Hurts

Headaches and even migraines can occur in children as young as 3 years of age. Parents can give their child a nonsteroidal anti-inflammatory medicine, such as ibuprofen, or eliminate headache pain caused by hunger, fatigue or dehydration with food, rest or fluids.

Talk to your pediatrician about his or her treatment recommendations, particularly if you’ve never treated your child’s headache before.

If headaches occur at the same time each day, parents should consult their pediatrician. Headaches can occur with the flu or fever, but we become concerned if a headache is serious enough to make a child cry, interferes with play or is so bad the child is vomiting.

Related Topics:

• Let's Learn About Fevers
• Is It Strep Throat or the Flu?
• Let's Learn About the Flu
• Probiotics for Tummy Bugs: Do They Help Your Chlid?
• My Child Poops Every Day. How Can They Be Constipated?
• Is Over-The-Counter Medication Causing Your Child's Headaches?
• When It Comes To Your Kids, It's Never Just a Virus

On Monday, Nov. 18, our staff saw 567 patients in the emergency room, which is equivalent to a patient checking in every 2.5 minutes for 24 hours straight. That’s nearly double the number of patients we typically see in the ED.

What’s causing the high census rate?

Hospitals across Dallas/Fort Worth and the state are experiencing similar situations right now due to a variety of bugs making their way around the region. Respiratory illnesses like RSV and croup are being seen in high numbers. We’re also seeing the first wave of flu cases, along with a range of gastrointestinal illnesses.

What does this mean for you?

If you’re planning to come to Cook Children’s Emergency Department with non-emergent issues, be prepared to wait.

“If your child is experiencing cough, fever or vomiting, you should contact your primary care physician first to make sure the ED is the right place to take your child,” said Corwin Warmink, M.D., medical director of Cook Children’s Emergency Department. “Wait times are going to be much higher than normal, and patients may have to wait several hours to be seen if they are not suffering from a life-threatening emergency.”

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

“The waiting room at the emergency department is so full that Cook Children’s staff have brought out folding chairs to accommodate as many people as possible,” said Dr. Warmink. “We are working as quickly as we can to get patients into rooms, while still providing quality medical care to each child. We know it’s frustrating for families to be stuck in the waiting room, but we ask for patience.”

Also, be aware that anyone who comes into the ED is at a high risk of being exposed to and contracting an illness. The following groups of people have the highest risk of infection:

• Pregnant women
• Infants and young children particularly under age 2
• People of any age with certain chronic health conditions (including asthma or lung disease, heart disease, diabetes, kidney disease or some neurological conditions).
• People with severely compromised immune systems.

What other options are there besides the Emergency Department?

Cook Children’s has a variety of options for care including 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.”

Cook Children’s has seven urgent care locations that provide services that are both convenient and comfortable for your child during the evenings and on the weekends, including two brand new locations in west Fort Worth and Prosper. Many of these locations are also experiencing a high number of patients, but not nearly as high as the emergency department.

If you’re not sure whether your child’s issue can be seen at an urgent care, click here to see a quick list of conditions and where to go for each.

What else should parents know?

The best way to keep yourself and your child out of the emergency room with seasonal illnesses is to wash your hands frequently. This means before, during and after preparing food, before eating, after using the restroom, after blowing your nose or sneezing. The Centers for Disease Control and Prevention suggests scrubbing your hands for 20 seconds, or hum the ‘Happy Birthday’ song from beginning to end twice. This will greatly reduce your chance of getting sick and spreading bugs to others.

And if you haven’t already done so, get your flu shot! It’s not too late, in fact, flu season is just beginning to ramp up. An annual seasonal flu vaccine is the best way to protect against the flu and reduce the risk of hospitalizations and deaths.

Learn more:

• State Confirms Rio Grande Valley Site of First Pediatric Flu-Related Death, 74 Cases of Flu Last Week at Cook Children's
• Let's Learn About Fevers
• https://www.checkupnewsroom.com/lets-learn-about-fevers/
• ER or Urgent Care? How to Decide Where to Go When Your Child Needs Immediate Medical Attention

Dan Guzman, M.D., a Cook Children’s emergency physician, called the day gut-wrenching for the victims, their families, and the medical staff that took care of the kids, ranging from ages 3 to 14.

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

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

Firearm-related fatalities are a top 3 cause of death among children in the United States.

Dr. Guzman said before the weekend, the medical center staff sees about one child per week. Already in 2019, three gunshot wounds treated at the medical center have been fatal.

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

As part of the program, Dr. Guzman offers these safety tips to follow:

The 3 Ts of firearm safety and children

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

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

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

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

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

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

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

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. 

Imagine you are 5 years old. It’s a beautiful day and you are stuck in the house with a fever. Your wonderful mother gives you little orange tablets that taste like oranges. You think taking these little tablets that look a lot like M&M’s will make you feel better really soon. What a wonderful Mom! Then she leaves the bottle with the little orange flavored tablets on the table just a few feet away. What would you do?

I was the child that decided if a couple of little orange things would make me feel better than the bottle of little orange things would get me well quicker and I could get back to playing with my friends. What I didn’t know was that there were enough tablets in that bottle to cause a very large overdose. After I took the pills, my mom noticed that I wasn’t responding to my name. I was nearly unconscious. So I was given a trip to the emergency room at our local hospital. I was fortunate that someone noticed and that it wasn’t something worse. 

A recent study in Pediatrics found that 640,000 emergency department visits were made in the U.S. from 2004 to 2013 because children were able to to get medication without adult supervision.

When I became a mother myself, I was very diligent in keeping medications away from little hands by keeping the medications in a high or locked cabinet. We can protect our children from an accidental poisoning at home by looking at things from their eyes. Everything that looks like candy is interesting to them.

Every year Cook Children’s receives more than 600 children due to poisonings. Seventy-five percent are medication related. Children can be accidentally poisoned by finding medication belonging to a friend or family member at their house or in their purse or bag. Or by getting into a cabinet that contains household cleansers like bleach or window spray. Remind your friends or family members to keep medication and household cleaners out of the reach of your children. Often Grandmother’s medication looks like candy, just like my little orange pills, or the cleanser bottle looks like lemon/lime drink.

Sometimes it’s as simple as not measuring a liquid medication correctly. Ask your pharmacist for a medication measuring spoon or oral syringe so you give the correct amount of medicine to your child. The spoons in your kitchen will not always measure the same amount as a medication spoon.

Also, make sure to keep the poison control number (1-800-222-1222) near your phone in case you need it.

Rosanne Thurman is director of Pharmacy at Cook Children's. Cook Children's pediatric pharmacists are available at the medical center to make sure your child's medicines are safe and effective.That includes helping parents understand what their child's medicine is for, the best times to take the medicine, the right dose, side-effects and any possible drug interaction with other medications that their children may be taking, such as other prescriptions, over-the-counter medications like cough syrup or antihistamines and herbals. They can even tell parents what food and drinks might cause an interaction.

While the increase in self-injuries may not seem that extreme, Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Behavioral Health for Cook Children’s in Denton, said the study does not tell the entire story. Sometimes the degree of cutting, for example, may not be severe enough to receive medical attention.

Elliott presents to schools, churches and community organizations on the issue of teens and self-harm injuries. She also treats patients in her practice.

“It can be difficult to determine the prevalence of these types of injuries accurately due to the secretive nature of self-harm prevalence,” Elliott said.

Elliott says that the most accurate numbers show that 20 to 23 percent of teens engage in some type of self-injury. The age of self-harm abuse typically begins between the ages of 12 to 14 years old.

Research shows that gender differences appear only to be associated with method of self-injury. Females are more likely to use cutting. Both genders use burning and self-battery. Caucasians are significantly more likely to engage in self-injury than non-Caucasians.

Methods of self-harm include:

• Cutting (70 percent of self-injuries)
• Carving
• Scratching/biting
• Burning/abrasions/branding
• Hitting themselves
• Picking/pulling skin and hair
• Head banging
• Tattooing
• Excessive body piercing

Injuries are most commonly found on arms, hands, wrists, thighs and stomach.

"This is something we see quite often, mainly in female teenagers, and it has increased dramatically in the last several years once it became a 'thing' that teenagers do and have seen or heard about," said Corwin Warmink, assistant medical director in the Emergency Department at Cook Children's. "It is a response to stress and anxiety and gives the performer a sense of control and eases their anxiety. It is not a suicidal behavior, but some studies have shown people who perform self-injury are more likely to commit suicide than people who do not. It also can be indicative of a more serious mental disorder."

So why do kids harm themselves?

“Kids who repeat self-harm injuries are often trying to ease some type of intense, overwhelming negative emotion such as anger, pain, anxiety or frustration,” Elliott said. “That’s the most common reason, but the second most common reason is self-punishment. They are expressing anger at themselves. This is strongly connected to self-derogation and criticism.”

Other reasons for self-harm include:

• Interpersonal influence – as a means to garner affection/caring from others, to identify/connect with others who have self-injured, to “belong” or fit in with a peer group.
• Stress management.
• To feel a sense of control over their own body, feelings or life situations.
• To provide a distraction from painful emotions through physical pain.

Kids who engage in self-harm behavior are more likely to tell and seek help from a peer their own age than tell a parent. Usually, adults only become involved if that peer tells a grownup and asks for help for his or her friend. Other times, a teacher or coach hears talk among other teens and steps in to help.

Elliott offers these tips to identify if your child is involved in self-harming behavior:

• Dressing in long sleeve shirts/hoodies even in hot weather.
• Wearing concealing outfits.
• Avoiding activities such as sports and swimming.
• Making excuses for having cuts, marks, wounds on body.
• Finding razors, scissors, lighters, knives in unusual places such as under the bed.
• Spending long periods of time locked up in bedroom or bathroom.

For more information

To schedule an appointment or refer a patient to Behavioral Health Services, please call 682-885-3917. To have Lisa Elliott speak more on this topic at your school, church or community organization, click here.

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