The Community Health Needs Assessment (CHNA) provides valuable insights from parents, caregivers, and community leaders across our eight-county service region: Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant, and Wise Counties.

More than a hundred leaders from North Texas community organizations tuned in on May 6 for the first session of the two-part summit, during which Cook Children’s explained the methodology of the survey and outlined key findings. It is important to share these results because community organizations and leaders can use this data to inform their strategies for continuing to improve children’s health in their communities.

The key focuses of part one were overall health and well-being, asthma, and healthy lifestyles. The full assessment can be found here, and offers more detailed information on each data collection method used. See more tools for result breakdowns at the interactive data dashboard.

Additional findings specific to caregiver support, injury prevention, mental health, and oral health will be shared on June 3.

Main concerns

The assessment included 6,877 parents/caregivers' responses over the last three years and 239 survey responses from community leaders such as representatives from health departments, nonprofits, schools, and faith-based groups.

The most pressing concerns for many families in our area are related to financial stressors.

As costs have risen over the last few years, 45% of community leaders flagged inflation and poverty as a serious problem in their community.

These struggles directly impact kids’ and families’ physical and mental health. One caregiver said in a survey that they worry about paying for medical visits in addition to other household expenses. Community leaders noted that they help many working families with food, clothes, and other needs.

Housing affordability, food insecurity, and childcare costs are increasing problems for our communities. More than half of community leaders said access to affordable, nutritious food was a serious problem.

Overall health and well-being

Insurance coverage came up repeatedly in interviews with caregivers and parents. While the majority of children (88%) had continuous health insurance in the last year, 5% (about 54,700), had a coverage gap, and 7% (about 81,400) are currently uninsured. Children experiencing homelessness were three times more likely to be uninsured.

Caregivers shared that the lack of coverage was mostly due to affordability, respondents said. Families who did not speak English or Spanish said the language barrier was another obstacle to insurance coverage, and they did not always know how to renew or update their insurance.

Vaccination rates have decreased in our eight-county area - 89% of parents and caregivers reported their child had received all up-to-date vaccines, which is about an 8% decrease since the 2021 CHNA.

Asthma

One in ten children in the service area has asthma, and it is one of the most common health conditions in kids. While asthma is manageable, 19% of those children did not have an asthma action plan. This shows a need for more education, training, and support for caregivers of children with asthma, including daycare providers, schools, and aftercare programs.

Healthy lifestyles

A healthy lifestyle for children includes a healthy weight, physical activity, nutritious food, and adequate sleep. Only 35% of children in our area eat fresh fruits and veggies at the recommended amount, and the majority of children (94%) are spending more than two hours on entertainment screen time every day.

While living a healthy lifestyle benefits overall health, many children and families face obstacles to doing so. Not everyone can access nutritious food in their neighborhood, and 1 in 7 children do not live in an area that has sidewalks, parks, playgrounds, or recreation centers.

In the eight-county service area, approximately 34% of children (about 390,100) live in households that cannot always afford to eat good, nutritious meals and 21% of children (about 236,400) live in a household that reported receiving food stamps or SNAP benefits in the past year.

SNAP gives families financial help to buy nutritious food, but cuts in this program have made it harder for families to get those benefits. The reduction of SNAP emergency allotments also places additional strain on local food banks and community organizations to bridge the gap left by the reduced benefits.

Reduced benefits may lead to increased food insecurity, limiting access to nutritious meals and negatively affecting the health of families and children, ultimately exacerbating social and economic inequalities.

Calls to action

Based on the findings, Cook Children’s Center for Community Health identified crucial next steps to improving children’s health in our communities. One of those tactics is to foster more partnerships focused on non-medical drivers of health, such as food security, economic stability, and housing.

Cook Children’s also plans to strengthen collaborations to create more community outreach for families, advocate for strategies that benefit our communities, and improve access to community resources for children.

More detailed strategy plans can be found on Cook Children's community outreach page.

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Survey Highlights Health Concerns in the Community

It’s always nice to see future moms and dads come in with their list of recommendations they get online or from talking to other parents about what they should ask the pediatrician.

So when the parents come in for that initial visit, we first go over some basics. I introduce myself. We talk about the sex of the baby and the due date. Then I usually launch into my spiel.

The main thing I go over at the interview is not to panic about breastfeeding right after the birth of your baby. I explain to moms to watch for certain interested cues and if the nurse makes you wake the baby up to feed the baby, it’s probably not going to work. And if it doesn’t work, don’t worry.

During those first couple of days, moms please get your rest. The nursing will happen. Your baby isn’t going to starve and only requires the colostrum (early milk rich in antibodies to help the baby’s immunity) in the first three or four days.

I let mom know I will be at the hospital every day that the baby is in the hospital. Usually it is two days for regular vaginal delivery and usually a C-section requires a little longer stay. We have everyone back in the office two days after you go home to check the baby for jaundice. Then when your baby is 2 weeks of age, you come back to make sure he or she has gained back the birth weight.

We go over the checkup schedule – 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months and then again when the child is 2 years old. From that point on, barring sickness or injury, I will see you once a year. Often times, I see the child through college.

I like to go over the behavioral aspects of raising kids and how much they change in that first two years because 2 year olds are very different than 18 month olds, 18 month olds are very different than 9 month olds and 9 month olds are very different than 4 month olds. Part of my job is to help prepare parents for those changes and one of the things is to prepare them for the behavioral things.

I then go over our office schedule. We are open from 8 a.m. to 5 p.m. during the week. We are closed on weekends, as well as Thanksgiving, Christmas, New Year’s Day, Easter Sunday, Memorial Day, Labor Day and Fourth of July.

Then we discuss when to call our office and our after-hours, nurse triage phone line.

If after hours, parents should call if it is a serious issue and you think there is cause for concern. If it’s something like cold symptoms or rash that’s not really bothering your child, I ask parents to wait. It’s Ok to call, just wait until the next day.

If parents think it’s important or even serious, they need to call and the triage nurses will call back. The nurse will then give you home care instructions or recommend that you call the office in the morning. However, if the child sounds like he or she is seriously dehydrated, the nurse will recommend going to the Cook Children’s Emergency Department.

Then it’s time for questions.

Usually, I’m asked about our waiting room situation. Do we have a room for the sick kids and one for the well kids? We usually separate our well ones and our sick ones by time. We see well ones early in the morning and early in the afternoon and sick ones later in the morning and later in the afternoon and that’s how we try to keep them separate.

But all bets are off when it comes to our toddlers. They are crawling on the floor and chewing everything.

Some people ask about antibiotic use. I treat bacterial infections with antibiotics. If the baby looks real sick, I get a blood count at our office. If I find a high white blood count and I can’t identify a source then sometimes I start them on antibiotics. I communicate with the parents what it is I’m treating. Really I’m treating the white blood cell count.

I’m often asked about immunizations. I can’t overstate the importance of immunizations and how passionate I am about taking care of your child. If I thought for a second that immunizations harmed your child, I would not recommend them. But I do believe in immunizations and believe they are crucial in keeping your child, and all other children, healthy.

We give a little booklet that goes over what the immunizations are for and how often they should be administered. Occasionally, a parent expresses concern about immunizations. I try to talk to them about how there is no evidence that immunizations do anything but save lives right and left, but if they are adamant that they aren’t ever going to give their baby immunizations I say, “you know what I may not be the doctor for you.” If I get someone that wants a different schedule or that sort of thing I’ll work with them. But if they don’t want to get any at all, I can’t in good conscience take care of your child. You are putting every other child in our clinic and at their school in danger.

I care about all of the kids I see and I want what’s best for every child. I don’t want to take responsibility for treating a child who has not been immunized. Plus, children who have not received their vaccinations place my other patients at risk for getting illnesses that are preventable with immunization.

I can’t in good faith do that for children. So it’s not out of arrogance, but out of caring that I expect parents to take my advice. Sometimes I have parents who don’t listen to me and they still come in for their visits. I wonder why. They may get their healthy kid stamp of approval, but they don’t get any of the other benefits I think I can give whether it’s behavioral issues, sleeping issues or eating issues. Parents should trust their pediatrician enough to take their advice, otherwise it’s frustrating and a waste of time for everyone involved.

You are paying for the advice. You might as well take it.

All the questions and information parents receive is important in choosing a pediatrician, but usually it comes down to the physician’s personality. It’s really important to take time to meet the person who, if chosen, will be taking care of your child into his or her teens.

More Resources For You

• Cook Children's Newborn Center
• Preparing For Parenthood
• Your Pregnancy
• Childbirth
• Newborn Care