“It’s important to wash your hands before and after you eat, it’s important to wash your hands after you go to the bathroom,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. “Remember to do that with soap and water for 20 seconds. If you can’t use water, use hand gel.”

She adds handwashing is critical after you touch surfaces you share with other people.

“Handwashing with soap and water can prevent 1 in 3 people from getting sick with diarrhea and 1 in 5 people from getting a respiratory illness,” chief of the Waterborne Disease Prevention Branch of the US Centers for Disease Control and Prevention, Vincent Hill, said in an interview with CNN. "That is why handwashing is so important, especially at key times such as after using the bathroom, when preparing food, before eating, and after coughing, sneezing, or blowing your nose."

This year's theme of Global Handwashing Day, Hand Hygiene for All, calls for universal hand hygiene to beat the virus today and ensure better health outcomes beyond the pandemic.

"This day is an opportunity to design, test and replicate creative ways to encourage people to wash their hands with soap at critical times," the Global Handwashing Partnership noted. "After all, this simple behavior can save lives. For children, handwashing can cut diarrhea by almost one-half and acute respiratory infections by nearly one-quarter."

An easy way to help your children wash their hands properly is to pick a song to sing, like happy birthday, while they scrub.

“Keep yourselves safe. Help us prevent the spread of coronavirus that causes COVID disease and help us prevent the spread of influenza,” said Dr. Whitworth.

As of Oct. 12, the number of patients who have tested positive reached 1,657, with four of those patients currently in the hospital.

Pediatric cases of COVID-19 have been climbing along with overall cases in Tarrant County. On Sunday, Tarrant County Public Health reported an ‘uptick’ with 794 new cases.

“I’ve been asked frequently about the number of infected children, as well as the number of infected adults locally and throughout the state. We’ve noticed over the last couple of weeks that we’ve had more positive cases here,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. “Part of the reason we have more cases here is because we are doing more testing. If you double the amount of testing you do, you would expect to double your number of positive results. If you more than double your number of positive results, that means there’s more disease in the community.”

Cook Children’s COVID-19 positivity rate was near 2.5% in August. Today, our overall positivity rate is 5.3%. Dr. Whitworth says that rate is in line with statewide and national data for children. She says throughout the pandemic, less than 10% of all COVID-19 cases occurred in children under 15 years old.

“It is disturbing that our percent positivity rate is going up, and we also see that in Tarrant County,” she said. “Tarrant County is hovering around 10% positivity rate, while the state has dropped to around 7%.”

There are a number of reasons why this may be occurring, including people going out more and becoming tired of wearing masks and social distancing. She also says there are some cases at schools, but those haven’t been tremendous numbers.

So what can you do to protect yourself and your family?

• Wash your hands often, for 20 seconds with soap and water, or use hand sanitizer.
• Keep at least six feet away from others.
• Wear a mask.
• When around others, remember being outdoors is safer than indoors.

“As the holidays approach, I have wrestled with how to handle this and I know everyone else is wrestling with it too,” she said. “It’s going to be difficult to not be involved in crowded gatherings, but they’re not going to be very safe this year. Those are some of the things I think we can do.”

She says another important way to protect yourself and your family is to get a flu shot.

“There are decades of safety data with flu shots. They are safe. You can’t get the flu from a flu shot. You might be a little achy afterwards, but that beats having the flu where you might be in bed for a week with high fever and miss work or miss school.”

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.

Along with vaccinations, hand-washing is one of the most effective ways to prevent flu. Alcohol based hand sanitizers are not effective against enterovirus 68, only good, old fashioned hand-washing.

Hand hygiene is especially important while children are attending school, where nearly every interaction carries the possibility of transmitting viruses.

“Children should wash their hands before and after going to the bathroom, as well as before eating or drinking,” Frank McGehee, M.D., a Cook Children's pediatrician in Fort Worth, said. “They should work the soap into a good lather and scrub for at least 20 seconds—the amount of time it takes to hum ‘Twinkle, Twinkle, Little Star.’ Have them scrub especially well around fingernails and jewelry.”

It’s also a good idea to have children wash their faces frequently during flu season.

Sometimes it's difficult to make your child take the time to wash his or her hands. How do you get your children to wash their hands? We would love to hear from you.