As visitors poured in from around the world, Cook Children’s Health Care System provided top-notch medical care not just for residents, but for traveling fans with children who may have needed unexpected care. Cook Children’s treated more than 200 visiting families in its Urgent Care centers over the course of the event.

Between the heat and the fandom, the summer games would bring the health system launched the "World Cup Wednesday" public health series. For nine weeks leading up to the tournament, this series provided families with essential resources on injury prevention, heat and water safety tips, and more.

While soccer matches in North Texas have come to an end, the impact of keeping global and local visitors safe will live long after the fans have gone home.

The Texas Department of State Health Services has not reported an outbreak.  

Cook Children’s pediatricians Devona Martin, M.D., and Jenica Rose-Stine, D.O., say they have seen a surge in cases at their primary care clinic in Willow Park, Texas.  

“Over the past few months, we have noticed a big increase in the number of cases of salmonella,” Dr. Martin said. “This usually presents as diarrhea that has blood or mucus and fever. Each case is reported to the Health Department to try to track down a cause, but a common source has not been identified.”  

Since July, the Emergency Department at Cook Children’s Medical Center – Fort Worth has also reported increased numbers of patients with salmonella.  

“In the ED, we usually see less than 20 patients per month with a diarrheal illness caused by salmonella,” said Stephanie Felton, D.O., associate medical director of the Cook Children’s Emergency Department. “In the month of July, we had 43 positive cases. We had 59 in August, 71 in September, and 74 in October.”  

Last week at Cook Children’s, 11 out of 229 patients tested for Salmonella were positive, resulting in a 5% positivity rate.  

Dr. Felton, Dr. Martin, and Dr. Rose-Stine provide answers to commonly asked questions about Salmonella.  

What is salmonella?  

Salmonella is a bacteria that can cause gastrointestinal illness and fever called salmonellosis. It is one of the most common causes of foodborne illness in the United States.  

What is the difference between salmonella and E. coli?  

Although salmonella and E. coli cause similar illnesses, they are different kinds of bacteria. E. coli more commonly produces a toxin that can lead to kidney damage, a condition called hemolytic uremic syndrome. This isn’t seen as often with salmonella.  

What are the symptoms of a salmonella infection?  

Symptoms of salmonellosis are diarrhea with blood and/or mucus, vomiting, abdominal cramps, and fever. 

How do children contract salmonellosis?  

Salmonella infection can be contracted by consuming contaminated food products, including poultry, eggs, produce, infant formula, and water. It can also be spread through contact with infected animals, like reptiles and birds, or other people who are infected if strict hand hygiene isn’t followed.  

Is salmonella contagious?  

Yes, salmonella is contagious and can be spread by person-to-person contact or by touching contaminated surfaces. The incubation period usually is between eight and 72 hours following exposure. You may be asymptomatic during this time.  

Salmonella is not as contagious as the viral stomach bugs we often see.  

How can parents and caregivers prevent infection?  

We can prevent infection with proper hand washing, especially before eating and after touching animals. Make sure that your counter spaces and sinks are clear of any bottles, sippy cups, or dishware before washing any fruits or vegetables. Cook and prepare all poultry and meat products appropriately. 

Only use FDA-approved formulas for your infants. Thoroughly clean all bottles, pacifiers, and toys before handing them to your children.  

How are salmonella infections treated?  

Treatment primarily involves rehydration and rest. Infants less than three months old or children with moderate to severe illness may receive antibiotics. These infections usually clear on their own.  

What should parents do if they think their child has a salmonella infection?  

If you are worried about your child having salmonella, please contact your primary care physician. He or she can run stool studies to confirm the diagnosis.  

Unless your child has blood, mucus, or fever with their diarrheal illness, it’s likely a stomach virus and not salmonella. Keep your child at home and make sure they hydrate!  

If your child is acutely ill or if you are concerned about dehydration or prolonged fevers (100.4 degrees Fahrenheit for five days or greater) please bring your child to the Emergency Department for an evaluation.  

For over 20 years, Cook Children's Health Plan (CCHP) has proudly served hundreds of thousands of families through the STAR/CHIP Managed Care Services Program. We were recently disappointed to learn that the Texas Health and Human Services Commission (HHSC) plans to exclude CCHP from the new STAR/CHIP contract starting in September 2025.

This decision has the potential to disrupt health care for nearly 125,000 CCHP Members, including low-income families and children with complex medical needs.

We strongly disagree with this decision, believe it will jeopardize access to health care and could harm vulnerable children and families. And that’s why we are appealing the decision.

Important Information for CCHP Members:

·       Your coverage is still active: Your health insurance with CCHP remains active for at least the next year and a half.

·       Keep seeing your current doctors and other providers. Nothing has changed. You can continue seeing all your favorite doctors and specialists both at Cook Children's hospitals and clinics as well as our other network providers, just like always. Absolutely nothing will be different for you.

·       If you are a STAR Kids Member, there have been no announced changes to that program.

·       Share your experience as a CCHP member or ask questions here: CommunityMarketing@cookchildrens.org.

·       Stay informed: Visit cookchildrens.org for updates.

Special thanks to The Texas Tribune for highlighting this important issue.

Respiratory illness is on the rise, causing a jam of patients at the Cook Children’s Emergency Department (ED) and Urgent Care locations.

In the last 24 hours, our Urgent Care sites across North Texas saw 731 patients, many with respiratory syncytial virus (RSV) and other seasonal illnesses. That compares to 684 visitors the previous day.  

At the same time, our ED was treating 524 patients, up from 448 one day earlier. That’s nearly a patient checking in every three minutes.

Swabs for the virus came back positive on 29% of the 834 patients who were tested at Cook Children’s Medical Center – Fort Worth during the week of Oct. 29-Nov. 4. That’s an increase from the 25% who tested positive for RSV one week earlier. Numbers for COVID-19 and influenza, meanwhile, are running much lower at the current time.

RSV is a common respiratory virus that usually causes mild, cold-like symptoms such as runny nose, cough and fever. But it can be serious when it turns into bronchiolitis and pneumonia. RSV sends anywhere from 58,000 to 80,000 children under 5 years old to the hospital each year, according to the Centers for Disease Control. Infants are particularly vulnerable if they were born premature or have weakened immunity or heart or lung conditions. 

Our ED and Urgent Care centers are crowded, and wait times are longer for non-emergency illnesses and injuries. How do you know if your baby with RSV needs medical attention – and where to go? The doctors at Cook Children’s have answers.

Your Pediatrician

Go to your primary care physician if your child is experiencing mild respiratory symptoms but is not having difficulty breathing. Your pediatrician can test for RSV, COVID or the flu.

Jonathan Nedrelow, M.D., associate chief medical officer for the Medical Center, said infants should be seen by a doctor if they’re struggling to breathe. Watch for faster breathing than normal, flared nostrils, airway congestion, wheezing or a rattle you can hear or feel in their chest. Other concerning signs are excessive sleepiness, lack of appetite and trouble feeding.

“If parents notice their infant’s breathing is hard or labored, they need to be evaluated,” Dr. Nedrelow said. “RSV is not the only virus that can cause these symptoms, so it’s good to be checked out.”

Urgent Care

If you can’t get in to see your child’s primary care physician for mild difficulty breathing or wheezing, then Urgent Care is the next best place to go, said Kara Starnes, D.O. medical director of Cook Children’s Urgent Care Services. Decreased fluid intake (not as many wet diapers) is another sign to watch for. 

“There is no medication to treat RSV,” Dr. Starnes said. “Treatment for mild to moderate RSV involves frequent saline and suction of the nose and supportive care for fever as well as increased fluids. Cough and cold medications are not recommended.”

Virtual Care Visits

Cook Children’s primary and urgent care locations both offer virtual visits that can be accessed from the comfort of your home. Cook Children’s Virtual Care appointments can help you avoid packed waiting rooms and allow you to see a physician at your convenience. This is also a great option if you need a doctor’s note for school. Visit our website to learn more.

Hospital Emergency Department

Call 911 if your child is having severe difficulty breathing, is turning blue or has become lethargic. Don’t seek RSV treatment at the ED unless you see signs of struggling to breathe, such as the muscles sucking in between the ribs, or if your child can’t stay hydrated.

“If your child has mild symptoms such as cough, congestion, or low-grade fevers, we recommend following up with your pediatrician or urgent care, please do not come to the emergency department,” said Taylor Louden, M.D., in pediatric emergency medicine at Cook Children’s.

Severe cases of RSV typically need supplemental oxygen until the virus runs its course. IV fluids may also be necessary.

Preventing RSV

RSV season typically runs from October through early spring. These steps help avoid catching the virus or passing it along:

• Wash your hands frequently
• Cover your sneezes and coughs
• Stay home when you’re sick

And a new antibody-boosting injection, called nirsevimab, helps prevent severe RSV by providing a temporary boost to the immune system. The medication is in short supply nationwide, and available doses are reserved for patients at highest risk. Additional doses are on order at Cook Children’s, so check with your pediatrician for availability.

RELATED STORIES:

• CDC Recommends RSV Shot for Infants. Infectious Diseases Doctor Shares What Parents Need to Know 
• Clinic Watches out for Respiratory Trouble After Prior RSV Care

A new shot that helps prevent respiratory syncytial virus (RSV) is in short supply nationwide and Cook Children’s is following guidelines to prioritize infants at the highest risk of illness.  

Like other health care organizations across the country, Cook Children’s has limited doses of the new medication, called nirsevimab. Eligible patients are receiving the antibody injection as it arrives at Cook Children’s locations.

“While availability remains limited, patients may find their offices intermittently out of the product,” said Alice Phillips, M.D., at Cook Children’s Pediatrics Cityview. Additional doses are on order and Cook Children’s sites remain in contact with supply sources to maximize access for high-risk infants. 

Meanwhile, cases of RSV are on the rise at Cook Children’s, including at the Emergency Department (ED) and Urgent Care locations. At Cook Children’s Medical Center – Fort Worth during the week of Oct. 22-Oct. 28, tests for the virus came back positive on 25% of the 764 patients who were tested. That compares to a 6% positivity rate for COVID-19 tests and 1% positivity for influenza A.

Jonathan Nedrelow, M.D., associate chief medical officer for the Medical Center, said infants should be seen by a doctor if they’re struggling to breathe. Watch for faster breathing than normal, flared nostrils, airway congestion, wheezing or a rattle you can hear or feel in their chest. Other concerning signs are excessive sleepiness, lack of appetite and trouble feeding.

“If parents notice their infant’s breathing is hard or labored, they need to be evaluated,” Dr. Nedrelow said. “RSV is not the only virus that can cause these symptoms, so it’s good to be checked out.”

The Centers for Disease Control and Prevention on Oct. 23 advised health care providers to allot any available doses for patients most susceptible to severe RSV. That group includes:

• Premature infants
• Infants 6 months and younger
• Children younger than 2 years old with chronic lung disease or congenital heart disease
• Children with weakened immune systems
• Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

In July 2023, the Food and Drug Administration (FDA) approved nirsevimab, a monoclonal antibody to prevent severe respiratory disease due to RSV infections in infants and young children with underlying medical conditions. An injection provides a temporary boost to a child’s immunity to get them through the worst of the RSV season, typically the fall and winter months.

Cook Children’s pediatrician offices, neighborhood clinics, specialty clinics and Medical Center -- Fort Worth are navigating the shortfall by following the CDC advisory until the supply improves. At the Medical Center, supply is reserved for the highest risk patients such as infants admitted to the neonatal, cardiology and pulmonology units.

“All areas of Cook Children’s are working diligently to provide this product and to keep our families up to date with the most current information on supply and recommendations,” Dr. Phillips said. “Cook Children’s Health Care System remains actively engaged to provide this important preventative medication to our most vulnerable infants.”

The medication comes in single-dose syringes of 50mg and 100mg. The smaller dose is meant for infants weighing less than 5 kilograms (11 pounds). High-risk infants weighing more than 5 kilograms would receive the larger dose, which is especially scarce.

“Many infants pass this weight by 1-2 months of age, so careful consideration and early administration are key,” Dr. Phillips pointed out.

The CDC also recommended that doctors not give nirsevimab to children who are eligible for another medication, called palivizumab, instead. 

It’s important for parents to talk with their child’s health care provider to find out which medications are appropriate and available. And follow these key tips to prevent the spread of RSV: Wash your hands frequently, cover your sneezes and coughs, and stay home when you’re sick.

Background on RSV

RSV is a common respiratory virus that usually causes mild, cold-like symptoms such as runny nose, cough and fever. Virtually all children will be infected by RSV by the time they are 2 years old. Most recover in a week or two.

But RSV can be serious when it turns into bronchiolitis and pneumonia. RSV sends anywhere from 58,000 to 80,000 children under 5 years old to the hospital each year, according to the CDC. Dr. Nedrelow said those with severe cases typically need supplemental oxygen until the virus runs its course.

Taylor Louden, M.D., in pediatric emergency medicine at Cook Children’s said the recent increasing number of RSV patients has led to longer wait times in the ED. If your child has only mild symptoms -- including cough, congestion, or low fever -- please do not come to the ED, Dr. Louden said. 

“For milder symptoms we recommend frequent nasal suctioning at home, appropriate hydration, and follow up with your child’s pediatrician,” he said.

If you can’t get in to see your child’s primary care physician, then Urgent Care is the next best place to go, said Kara Starnes, D.O., medical director of Cook Children’s Urgent Care Services. Call 911 if your child is having severe difficulty breathing, is turning blue or has become lethargic, Dr. Starnes said.

Boosting Immunity

Clinical trials show that nirsevimab reduces the risk of hospitalization for RSV by 75%. Research and clinical trials show the medication is safe and causes only mild side effects. The injection is neither a vaccine nor a treatment.

This particular use of monoclonal antibodies for the prevention of severe RSV is new even though a similar type of RSV protection has been on the market for more than a decade. Nirsevimab needs just one injection to provide a period of protection that lasts about five months. The older medication requires an injection each month during the RSV season.

RELATED STORIES:

• CDC Recommends RSV Shot for Infants. Infectious Diseases Doctor Shares What Parents Need to Know 
• Cook Children’s | Medication to Prevent RSV 

The Centers for Disease Control and Prevention has recommended a new antibody shot to help prevent severe respiratory syncytial virus (RSV) disease in all infants.

RSV is a leading cause of hospitalization for infants. The use of nirsevimab (trade name Beyfortus) is a long-acting monoclonal antibody infusion, which has been shown to reduce the risk of both hospitalization and healthcare visits in infants by about 80%, according to the CDC.

The CDC recommends:

• One dose for all infants 8 months old and younger born during or entering the RSV season (fall through spring)
• One dose for children between 8 and 19 months old who are at an increased risk of severe RSV, including severely immunocompromised children

“This new antibody treatment, which has now received the Food and Drug Administration approval and CDC's Advisory Committee on Immunization Practices recommendation, will truly be a game-changer,” said Jason V. Terk, M.D. of Cook Children's Pediatrics Keller Parkway. “This will dramatically reduce the burden of this infection among infants in their 1st year of life and I am excited about that!”

What is RSV?

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Virtually all children will be infected by RSV by the time they are 2 years old. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults.

Every year, there are between 58,000 and 80,000 hospitalizations for RSV for children under 5 years old, according to the CDC.

RSV can also cause severe illnesses such as bronchiolitis and pneumonia. The risk is especially high for premature infants.

According to the CDC, those at greatest risk for severe illness from RSV include:

• Premature infants
• Infants, especially those 6 months and younger
• Children younger than 2 years old with chronic lung disease or congenital (present from birth) heart disease
• Children with weakened immune systems
• Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

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

Nicholas Rister, M.D., of the Cook Children's Infectious Disease team, shares what parents and caregivers need to know.

How severe can RSV be, if my baby is infected?

RSV is a very common infection for infants and young children. Most will only have a typical “cold” or “viral URI.” Although, given how many infants become infected, many children are admitted to the hospital and intensive care unit each year.

RSV infections can be very serious for some babies in particular. This includes very premature infants 36 weeks gestation or younger, but especially if younger than 32 weeks gestation. This also includes babies with congenital heart disease and babies who required several weeks of oxygen support after birth, such as ventilators or cannulas.

What is the difference between this antibody and a typical vaccine?

A vaccine is designed to trigger your body to produce its own antibodies to a disease. This provides both immediate protection and longer-term memory. An antibody infusion gives you protection immediately but has not trained your body to continue creating those antibodies. This leads to a quick but only temporary period of protection.

Many vaccines work well in older children but not infants. Providing antibody infusions can cover at-risk infants who would otherwise not create antibodies in response to a vaccine.

Can my baby show symptoms once they receive the antibody? Are there any side effects?

With any infusion of medication that was not created inside your baby’s body, there is always a chance their immune system will notice it and react. Thankfully young infants, due to their immune tolerance of recently living inside of another human body, develop these reactions less frequently. Your doctor will monitor for any signs of a reaction during the infusion and after with your assistance.

How long has this antibody been tested? How do I know it is safe for my child this fall?

The use of RSV antibody infusions has been present and tested for over a decade. While this newer treatment provides more widespread application, the core safety of the treatments is well established.

What is the most important takeaway for parents of infants?

RSV is a highly prevalent disease and every family should talk with their pediatrician about the potential benefit of this antibody infusion for their child. While some children will clearly benefit more than others, it is an important conversation to have for all families.

How soon will it be available at pediatrician offices?

The CDC expects nirsevimab to be available this fall. Expectant parents and parents of infants under the age of 8 months, as well as those with older babies, should talk with their pediatrician

1.     Baby Formula Recall: Here's What Parents Need to Know:

Starting in February, a nationwide recall affected the supply of infant formula. Parents and caregivers were searching for information to help during the shortage.

2.     Right Time, Right Place: Long-Lost Brother and Sister Brought Together at Cook Children’s

In August, we shared the heartwarming story of Cook Children’s very own Raymond Turner and how a Christmas present of a DNA kit led him to a sister who he never knew he had. His half-sister, Christina Sadberry, has been bringing her son to Cook Children’s for seven years. Go here to watch the reunion video.

3.     Does My Baby Need His Tongue-Tie Cut?

Dr. Diane received questions from parents about cutting their baby’s tongue ties, the thin band of skin underneath your tongue. She wrote this article after discussing the procedure with many different experts, including a dentist, lactation consultant, speech language pathologist, and an ear-nose-throat physician.

4.     Asking for Some Grace: Cook Children’s Emergency Department, Urgent Care Centers Overwhelmed

Cook Children’s Emergency Department and Urgent Care Centers were overwhelmed with patients starting with the back-to-school season.

5.     Accidental Ingestion of Marijuana in Babies and Toddlers More Than Doubled in 2021

The number of babies and toddlers who screened positive for marijuana in the Emergency Department (ED) at Cook Children’s more than doubled in 2021 from the previous year.

6.     Ongoing Issue: Cook Children’s Desperately Asking for Community’s Help

Cook Children’s continued to be overwhelmed with patients concerned with COVID-19 and upper respiratory infections, like colds.

7.     Cook Children’s Unveil New Medical Center in Prosper, Blending Technology with Moments of Magic

For the first time in 100 years, Cook Children’s cut the ribbon and debuted a new Medical Center. The state-of-the-art facility was built with everything for the child in mind, including what they'll see and experience as they make their way through the facility. Go here to look inside the new hospital.

8.     Emotional Reunion: Suicide-Attempt Survivor Returns to Cook Children’s to Thank Medical Team

Payton Singh survived a suicide attempt when she was 12 years old. In August, she reunited with members of the medical team at Cook Children’s who helped her on her journey back to health.

9.     Does My Child Have Allergies, COVID, a Cold or the Flu?

A runny nose and cough could point to a few things. We broke down how parents might get a better idea of what their child is suffering from.

10.  Uvalde School Shooting: Cook Children’s Doctors, Experts Share How Parents can Discuss Tragedy, Support Their Children

In the wake of the Uvalde school shooting, our doctors and pediatricians gathered to discuss how parents can help their children after a tragedy.

​We are deeply saddened by the senseless violence that took the lives of two people at Methodist Dallas Medical Center this weekend. We pray for unity, peace and healing.

We stand with you Methodist Dallas.

During routine yearly checkups, we ask about your child’s nutrition including soda consumption. When I ask this, parents often respond, “no doc, we don’t give him/her soda," but add that if they do drink soda, it's clear, such as Sprite, 7up, Sierra Mist), etc. But parents wonder, are clear sodas really healthier than dark sodas?  It looks clear, it’s not brown, it smells like lemon-lime…it must be OK, right? Not so much. Let’s look into this a little further.

So first let’s first start with the simple fact that clear sodas are still soda! We discourage sodas for several reasons but mainly for the sugar content. For example, a can of Sprite has 38 grams of sugar and a can of Coke has 39 g of sugar. So you can see there’s not much of a difference between the two. That’s about 9 teaspoons of sugar in one can!!

Studies show that kids who drink more than 10% of their daily calories from added sugar are more likely to have abnormal cholesterol levels and a higher chance of getting Type 2 diabetes.

The other main reason we discourage sodas is the caffeine content. It is true that clear sodas do not have caffeine. However, there are many other options for a hydrating drink without sugar such as good old-fashioned water. If your child does not like water, try adding fresh fruit or mint or from time to time try a zero-sugar sparkling water to satisfy that craving for “fizz.”

So what about diet sodas?  Most experts would recommend that children should avoid diet sodas in kids. Many diet sodas are sweetened with artificial sweeteners and long terms effects are still not clear.

There you have it! Clear soda is not a healthy choice for a drink. Opt for water!

Story by Eline deBruijn Wiggins. Video by Tom Riehm.

Hispanic Heritage Month creates an additional opportunity for us to celebrate the culture and contributions of people who are Hispanic or Latino/a. At Cook Children’s, we see the world through the eyes of children and families, of all races, ethnicities and languages. Let’s hear from a few Latino/a and Hispanic pediatricians and specialists at Cook Children's.

Celina Cepeda, M.D.; Ana Rios, M.D.; Javier Gelvez, M.D.; Roberto Caballero, M.D.; Victoria Talamo, M.D. and Bianka Soria-Olmos, D.O. sat down with us to share their journeys to becoming doctors and to hear their perspectives as Hispanic and Latino/a doctors and specialists.

Did you know?

• In the U.S., Hispanics and Latinos are an underrepresented population in medical and health care professions. Only 5.8% of active physicians are Hispanic or Latino/a in the United States.
• The Hispanic and Latino population is growing and currently makes up approximately 19% of the U.S. population.
• In Tarrant County, 30.2% of the population identified as Hispanic or Latino, according to the 2021 Census.
• National Latino/a Physician Day is Oct. 1, a day to raise awareness about the need for more Latino/a doctors.

Meet 6 of our doctors and specialists

Celina Cepeda, M.D., is a pediatric nephrologist at Cook Children's Prosper. She's from Brownsville, Texas and is bilingual in Spanish and English. She enjoys teaching her patients about the kidneys and staying healthy.

“It really makes me happy when patients are Spanish-speaking only and I can help take care of them and they are appreciative of that,” Dr. Cepeda said. “Because otherwise, it's difficult for them to communicate their needs and what they're hoping to achieve for their children health-wise.”

Ana Rios, M.D., of the Cook Children's Infectious Disease team, grew up in Colombia. She says both of her parents were physicians so she always grew up listening to them talking about how passionate they were about their jobs.

“My older brother was diagnosed with leukemia and my parents were the ones who made the diagnosis,” Dr. Rios said. “That made me feel more passionate about becoming a doctor and pediatrician and helping kids like my brother. Eventually, that's what I did.”

Bianka Soria-Olmos, D.O., serves as our Medical Advisor for Digital Health and a Cook Children's pediatrician in Haslet. She has lived in Fort Worth for most of her life and as a child, she went to Cook Children's as her brother received care here.

“I always said I wanted to become a doctor and that one day I wanted to work at Cook Children's,” Dr. Soria-Olmos said. “I love that I was able to fulfill my childhood dream here. I like that we continue to strive to serve this community in the way it has been changing and do the best for the children.”

Javier Gelvez, M.D., of the Cook Children's Pediatric Intensive Care Unit, is from Colombia and was the youngest of eight children. He has been at Cook Children's for 21 years.

“We can inspire other people to be physicians and as my kids grow up I say this is an opportunity to serve,” Dr. Gelvez said. “This is the beauty of a job where you can serve other people and make a living.”

Roberto Caballero, M.D., of the Cook Children's Pediatric Intensive Care Unit, grew up in Mercedes in the Rio Grande Valley of Texas. At the time, his father was the only doctor in town. People came to their house after hours and on weekends needing help. Dr. Caballero is bilingual and said not many days go by that he doesn't have to communicate with patients in Spanish.

“That inspired me to help others and to value what it means to be available to people in need,” Dr. Caballero said.

Victoria Talamo, M.D., of the Cook Children's Pulmonology team, is from Venezuela. She says she enjoys helping people and was inspired to become a physician just like her dad.

“He was like my hero and he was everything to me,” Dr. Talamo said. “I wanted to grow up and be like him. He would come home late at night and share these amazing stories about his day.”

In June 2018, Payton Singh arrived via ambulance to Cook Children’s Emergency Department in a barrage of flashing lights and sirens. She was just 12 years old and decided to end her short life while her parents were away from home.

Payton and her family returned to Cook Children’s this week to reunite with her medical care team who saved her on her darkest day.

“I can’t even explain the emotion and the panic that sets in as a parent,” said Brandy Lumbert, Payton’s mother. “After getting the call, I remember running into the emergency room - they knew exactly who I was. And then she flat-lined right in front of me. As a parent, you want to jump in and tell the doctors and nurses to move faster, but you’re just standing there, helpless.”

Payton and the Lumberts also shared their story on the latest episode of our Raising Joy podcast.

Payton’s brother, Kegan, found her unconscious in her room and took action well beyond his years. Though he was just 8 years old, he had the wherewithal to call 911, put the family’s dogs outside and notify his parents that help was on the way.

 When officers arrived at the Lumbert’s home in Keller, Texas, they believed Payton had been without oxygen for 12 minutes.

 “Doctors told us, ‘She’s alive but she’s not showing any brain activity,” said Nick Lumbert, Payton’s stepfather.

 The medical team was able to stabilize Payton and moved her to the pediatric intensive care unit (PICU).

 “Every day in the ICU, we’d stare at the breathing machine to see how many breaths she was taking on her own,” said Nick. “It was very hard to go through that.”

Soon after being admitted to the hospital, Payton’s neurologist pulled the Lumberts aside to show them the scans of her brain. They revealed four small spots, an encouraging sign that the damage wasn’t as dire as it could have been. Still, it was unknown if she’d ever walk or talk again.  

On day five in the PICU, something unexpected happened.

“I remember walking through the doors and we hear all of the alarms going off and we take off running to her room,” said Brandy. “She had stood up next to the bed and was ripping everything off. She looked right at us and I was flabbergasted!”

And just like that, hope began to shine on the Lumbert family.

Soon after, Payton was transferred to Cook Children’s rehabilitation unit where she embarked on the long road to recovery. Over the next six months, she underwent treatment at three different hospitals across Texas.

Now, four years later, she is returning to Cook Children’s to say ‘thank you’ to the people who saved her life.

 On Thursday, September 1, 2022, Payton and her family were reunited with the doctors, nurses, and care team members who cared for her at Cook Children’s. This emotional reunion was requested by Payton, who is now a 17-year-old high school senior. She has a job, drives a car and is planning to pursue a career as a veterinarian.

The Lumberts recently shared their story on the Raising Joy podcast in hopes of encouraging other families who may find themselves in a similar situation.

 When asked what message she has for kids and teens who are struggling with their mental health, Payton said “Get help.”

 Their episode is now available on all major podcast platforms including Apple, Google and Spotify.

 September is Suicide Prevention Awareness Month.

 Here are some signs to be aware of – though not every suicide attempt will display signs. This is why it’s important to talk to children and teens about suicide, whether you suspect they are suicidal or not. 

1. Preoccupied with death (writing, drawings)
2. Talking about feelings of hopelessness
3. Talking about being a burden to others
4. Telling loved ones goodbye
5. Decline in performance
6. Giving prized possessions away
7. Isolating and withdrawing
8. Acting highly anxious or agitated
9. Acting reckless and taking risks
10. Rages
11. Changes in sleeping and/or eating
12. Use of alcohol/drugs
13. Dramatic changes in personality and/or appearance

If you feel your child needs help, please click here to find a Cook Children's Behavioral Health location near you. You can also address your concerns with your child’s pediatrician, psychologist or therapist.

The 988 Suicide & Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) offers 24/7 call, text and chat access to trained crisis counselors who can help people experiencing suicidal, substance use, and/or mental health crisis, or any other kind of emotional distress. People can also dial 988 if they are worried about a loved one who may need crisis support.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Editor's note: This story was originally published on Nov. 4, 2021.

Results are in for the 2021 Community Health Needs Assessment parent survey conducted by Cook Children’s Center for Children’s Health and one thing is clear—the mental health of children is top-of-mind for parents, particularly during the pandemic.

Half of all children ages 6 to 17 living in Cook Children’s eight-county service area have a parent who is concerned that the pandemic will have a negative impact on both their child’s education and mental health, according to the survey. The impact of COVID-19 was also noted by parents and guardians as one of the top three barriers to children receiving necessary health services, along with a lack of insurance coverage and the scarcity of needed services available in the area they live.

These barriers played a role in 137,000 children not getting needed medical care, more than 180,000 kids being deprived of needed dental care, and 63,120 kids going without needed mental health care. When compared to the same demographics from the 2015 and 2018 parent surveys, all of these numbers represent an increase in children not getting the health care they need.

The survey revealed that parents need support, too. More than 30,000 children have a caregiver not coping “very well” or not “well at all” with the day-to-day demands of parenting, and 24% of children live with someone who has a mental illness, or is suicidal or depressed.

“Parents of teens score lower when it comes to coping well with the demands of parenting than those with kids ages 6 to 11,” said Blair Williams, community health analyst at the Center for Children’s Health. “So the question becomes what do we do for parents to help them grapple with those daily parenting demands and the really tough topics that they face with their teens that are relatively new to us adults and changing almost every day.”

These results, along with many other survey data points, were shared Tuesday at the Virtual Children’s Health Summit presented by the Center for Children’s Health. Nearly 300 community members representing a number of area schools, health agencies and community organizations attended the summit.

“We recognize and acknowledge that Cook Children's isn't the only one working to improve the health of children and families in our communities,” said Becki Hale, director of Child Health Evaluation within the Center for Children’s Health. “We have such strong community partnerships and these issues around children's health are so complex that it can't just be one entity. It has to be all of us working together. We're so grateful that we have such a strong community that comes together to support one another to help families.”

Every three years the Center for Children’s Health surveys parents and guardians within its service area, including Denton, Hood, Johnson, Parker, Tarrant and Wise counties. This year the Center added Grayson and Collin counties into the surveyed region in preparation of meeting the needs of children served by the new Cook Children’s-Prosper, slated to open in late 2022. It also increased the child age range from 0 to 14 to 0 to 17.

A total of 5,715 surveys were collected from a sample of households across the surveyed region at large, not just Cook Children’s patients. Surveys were also collected from parents of special underserved populations via partners within community shelters and other local aid agencies. The results are weighted to represent the actual population of children living in the service area. That means data percentages are translated into the actual number of children within the population the percentage represents.

“We use this data to see how we might need to adjust our current programs to best address the needs we already know exist within our community because of what we see within Cook Children’s Health Care System,” Hale said. “Mental health is a good example. Because of what we are seeing in our health system data around self-harm and suicide, we’re particularly looking a little closer at what the survey reveals about mental health knowing that there may be some opportunity to adjust our programming to address that issue, especially within the adolescent and teen population. It’s another piece of the puzzle to help us figure out how to best support families and children.”

Parents reported that 19% of children ages 6 to 17 have been told by a health care provider they have anxiety, and 10% have been told they have depression. That’s higher than the national numbers of 13% and 6% respectively. In addition, Cook Children’s has recorded a record number of suicide attempts by children within the last 12 months.

“The survey reinforces what we have seen over the past year with skyrocketing numbers within our mental and behavioral health services,” said Rick W. Merrill, President and CEO of Cook Children’s Health Care System. “In 2022, we’ll dive deep into mental health access and behavioral health services. We owe it to the hurting children in our community to continue to make this a top priority.”

In addition to addressing mental health, the Center for Children’s Health will work with its community partners to explore new and innovative approaches for increasing access to food, personal health care providers, insurance, oral health care, parent support networks, injury prevention education, and opportunities for physical activity.

“The information we shared at the summit was just the tip of the iceberg,” said Chris Pedigo, senior vice president of system planning, health analytics and the Center for Children’s Health. “We’ll continue to dig deep into these issues to understand how to join with our community partners to best address these needs.”

Other notable findings include:

• 55,570 children are living in households that “sometimes” or “often” can not afford enough to eat.
• 57% of children ages 3 to 5 have a caregiver who is coping “very well” with daily parenting demands, which is lower than the national percentage of 63%; and 51% of children ages 6 to 17 have a caregiver who is coping “very well” with daily parenting demands, also lower than the national percentage of 61%.
• 70% of children ages 3 to 5 are ready for school according to their caregiver, which is slightly lower than the national percentage of 75%.
• 8 in 10 children have “excellent” or “very good” health.
• 9 in 10 children had continuous insurance coverage for 12 consecutive months prior to completing the survey.

In February, the Center for Children’s Health will release part two of its Community Health Needs Assessment, which will include a report of the “why” behind many of the survey results learned from parent focus groups and community leader interviews. That information will be combined with the parent survey results as well as the results of a community leaders survey to complete the Community Health Needs Assessment, which will be released in spring 2022.

Let’s start with a story. 

As I began the introduction of solid foods to my first child, I was by the book! One food at a time. Slow introduction to make sure it was safe.  That kid was pretty picky but as an adult eats just about everything.

Then came my second.  At 7 months, we were out to dinner with family and enjoying some crab dip.  She was begging for it so…. she ate a bunch.  That kid was never picky but as an adult eats just about everything.

Different paths to the same ending

Flash forward to now, as I took on a challenge to dig into baby led weaning (BLW) I learned a lot.  I also learned that we have a ways to go in understanding this subject completely.

The name Baby Led Weaning (BLW) was coined as far back as 2005 by author Gill Rapley who completed some of the early studies on BLW as part of her master’s thesis.

So, what is weaning?  This is best described as the time that infants transition from breast milk or formula to the consumption of solid foods.  Traditionally, this has been recommended to begin at 6 months of age through the gradual introduction of foods via spoon feeding of purees.  As babies mature developmentally, this then transitions to finger foods and use of a spoon and fork.

Baby led weaning (BLW) differs from this classic model because spoon feeding of purees is skipped. Its basic model includes:

• Feeding of complimentary foods begins at age 6 months as infants attain the developmental ability to sit securely in a highchair, SAFETY POINT!
• The baby sits with the family during mealtime.
• An adult is always with the child while eating, SUPER SAFETY POINT
• Food is offered in pieces of shape and size which are developmentally able to be explored by the infant.  At 6 months, this is strips or fingers of foods with transition to bite sized pieces as cutlery is introduced.
• The infant self feeds from day 1.
• It is up to the baby how much and how quickly she eats.

Parents and health care providers seem to agree on the potential but unproven good parts of BLW:

• Self-feeding promotes fine motor skills
• Shared family mealtimes
• Infants develop good recognition and response to hunger and safety cues
• Prevents picky eating (no data to support)

What are the disadvantages of BLW?

It’s messy and time consuming.  When babies are given the freedom to explore food with their hands….man do they explore.  They will squeeze and squish the food with maybe a little bit ending up in their mouth.  More lands on their face, in their hair, in their ears and on the floor.

Time is not a luxury all moms have.  BLW requires giving the infants time for this exploration and when you’re trying to get the crew fed, dressed and out the door, this can be difficult to manage.

The book at first read sounds great.  However, as a pediatrician, I need to dig in on what science we have to support the safety and health benefits to kids.

The more I read and researched, the more I began to see phrases such as:

• Insufficient evidence
• More research is needed  
• Current studies inadequate to support a general recommendation

Even the reference section for the book itself only lists 10 references for the main content of the book and two of those are the author’s own studies.

The greatest concerns from health care providers surrounding BLW include the risk of choking and potential inadequate calorie/energy intake and inadequate nutrients mostly focusing on iron.

Several studies have attempted to dig in on these topics and the results are a mixed bag.

One impressive study, Baby-Led Introduction to Solids (BLISS), did a randomized control study on this topic.  These fancy words mean infants were randomly divided into two groups.  One group received standard well child information on introduction of foods at 6 months while the other had additional education provided for BLW but with something extra.

BLISS provided caretakers with focused advice on minimizing choking! This included both general advice as well as specific foods to avoid such as raw apple slices, grapes, whole nuts, popcorn, and foods such as sausages, which can be sliced into coins. With this education, there was no measurable difference in choking between the two groups.

BLISS also targeted education of the specific types of foods to offer kids for balanced nutrition.

That is a lot of information.  You're probably asking, “Yeah it sounds like a good idea if done safely, but should I do it?”

Here’s what I think.  Most parents I see in my office who try BLW tend to adopt a healthy mix of both old and new - both purees and table food when they are introducing foods to their infant.

Dr. Diane Arnaout at Cook Children's Forest Park seems to see a similar pattern.  She states, “BLW certainly seems to be growing in popularity thanks to social media and the online sharing of experiences. As a pediatrician, I don’t really mind what feeding method parents choose, as long as it seems appropriate to the infant’s developmental abilities. Parents know their baby best - if BLW seems to not be going well, I encourage them to take a few steps back and trial softer, smoother foods. If they try BLW and it just doesn’t fit for their family, no big deal. Purees are totally fine, too. I sometimes tease that this isn’t the difference between Ivy League and community college - all kids will learn to eat eventually.”

These words seem to mirror my story from the beginning.

Different paths to the same ending.

References:

• Rapley, G., Murkett, T. (2008, 2019) Baby-Led Weaning, the Essential Guide. The Experiment, LLC
• Brown, A., Jones, S., Rowan, H. ( April, 2017) Baby-Led Weaning: The Evidence to Date.  Curr Nutr Rep 6:148-156
• Azuria, E. et. Al. ( 2018) Baby-Led Weaning: What a systematic review of the literature adds on. Italian Journal of Pediatrics. 44:48
• D’Andrea, E. et. Al. (2016) Baby-led Weaning: A Preliminary Investigation. Canadian Journal of Dietetic Practice and Research. Vol. 77
• Fangupo, L. Et. Al. (2016) A Baby-led Approach to Eating Solids and Risk of Choking. Pediatrics.

Many expectant moms avoid seeing a dentist out of fear that dental treatment could be harmful to their pregnancy or their baby. That’s not true, says Tonya Fuqua, D.D.S., director of Child Oral Health at the Center for Children’s Health, led by Cook Children’s Health Care System.

“It is 100% safe to treat a pregnant female during the whole nine-month time frame of her pregnancy,” Dr. Fuqua said. “The second trimester is ideal because that can be the safest and most comfortable time for mom, but if you need treatment during the first or third trimester, you should absolutely get it.”

The American Congress of Obstetricians and Gynecologists (ACOG) agrees, saying that women should and can safely maintain their oral health during pregnancy, be it through prevention, diagnosis or treatment with procedures such as fillings, extractions and even root canals.

Not only is it safe, but it’s crucial that women see the dentist during pregnancy for their health, the health of the pregnancy and the future health of their baby.

“Women still need regular dental care when they’re pregnant,” said Shanna Combs, M.D., an obstetrician and gynecologist at Cook Children’s who has experience treating both adults and adolescents. “It’s okay to go see a dentist when you are pregnant. It’s safe and it’s actually good for you and your baby to get good dental care.”

Myths that pregnant women should not get X-rays or have numbing medication for treatments have scared many away from getting help for painful oral issues. In 2007-2009, 56% of women in the United States reported that they did not visit a dentist during pregnancy, according to ACOG.

On top of their concern for safety, lots of pregnant women struggle with a sensitive gag reflex, nausea and sensitivity to tastes and smells, turning a simple teeth cleaning visit into an uncomfortable ordeal.

“Most of the things that dentists use, like antibiotics and topical anesthetics are all things that are fine and safe to use in pregnancy,” Dr. Combs said. “More than anything, as pregnant women get bigger, just being in the dental chair and laying back might make them dizzy, weak and lightheaded, so definitely take that into consideration and ask your dentist to tilt you to the side. 

"Bring a pillow to your appointment if you need to put it behind your back, under your knees or between your legs when you’re in the dental chair. But, please, don’t run from the dentist when you are pregnant. You need good dental care.”

Cost can be a barrier, too. Dental treatment is expensive, but financial resources are available, especially during pregnancy.

“For young uninsured women in Texas, pregnancy gets them insurance coverage through Medicaid that will pay for their dental care,” said Andrea Palmer, M.D., an obstetrician and gynecologist in Fort Worth.

Healthy Teeth Help Mom and Baby

Taking care of your oral health contributes to your overall good health, and a healthy momma has a much better chance at a healthy pregnancy. Ignoring issues could be dangerous for both mom and baby.

“If an expectant mom is in pain of any kind and may be hurting every time she eats or drinks then she might not be eating and drinking enough because of it, and that’s a big problem for mom and baby,” Dr. Fuqua said. “If mom is not getting the nutrition she needs to care for that baby, then the baby isn’t getting the nutrition it needs to grow and develop properly.”

A toothache could be the result of a cavity. If left untreated, that cavity can turn into an abscess, which is an infection-filled pocket at the base of the tooth. That infection can get into the bloodstream and spread to other parts of the body resulting in a life-threatening condition called sepsis. Tooth pain can also lead to increased inflammation and blood pressure, which can be especially dangerous during pregnancy.

All of these issues create risk factors that could cause a baby to be born before their due date. Some studies show a link between diseased teeth and gums and preterm labor, according to Dr. Combs. Babies born prematurely may require admission to the neonatal intensive care unit (NICU) and are at risk of having underdeveloped lungs and neurological complications.

“We don’t want to let things fester and a cavity is not going to naturally fill itself without intervention,” Dr. Palmer said. “I’ve had patients who were admitted to the hospital with an abscess and were on sepsis watch, and that’s definitely not good for baby. So doing all that we can for outpatient preventative dental treatment is the best idea for mom and baby always.”

Pregnancy Impacts Oral Health

As much as poor oral health can impact pregnancy, being pregnant can wreak havoc on a woman’s teeth and gums. Increased levels of hormones during pregnancy can cause gingivitis, or gum disease, and can fan the flames of cavity growth. 

Some women who have never had cavities before could potentially be at risk for the development of multiple cavities during pregnancy, according to Dr. Fuqua.

Hormones aren’t the only culprit. Sugary cravings and changes in appetite and eating habits give bacteria ample feeding grounds. Acid reflux and vomiting due to morning sickness increase the acidity within the mouth, and acid to teeth is like rust to metal. Sensitivity to certain tastes and smells and an overactive gag reflex are also common during pregnancy and can deter moms from brushing thoroughly.

“These things create a domino effect,” Dr. Fuqua said. “So it’s much safer to do prevention, meaning dental checkups, cleanings, exams and even X-rays when necessary, than to ignore an issue or try to wait it out until after birth. Prevention is key and your oral health is a part of your overall health.”

Prevention Is The Best Medicine

Women should make dental care a part of their regular health checkups, especially if they are pregnant or thinking about getting pregnant. Dr. Fuqua says to think of a cleaning as no different in terms of risk to you or your baby than brushing your teeth in your own bathroom. 

Some women may need to increase their cleaning visits during pregnancy from every six months to every three or four months to help prevent pregnancy-induced gingivitis or other dental issues.

Moms who take good care of their teeth set their babies up for good oral health after birth, too. A mom with a healthy mouth reduces the number of bacteria transmitted to baby through common mom activities. 

What mother doesn’t shower her baby with kisses, or taste baby's food to make sure it isn’t too hot before feeding, or “clean” the pacifier that fell on the ground by sticking it in her mouth first? If done with a mouth full of cavities, these activities can transmit disease-causing bacteria to baby that will target their oral health as they grow.

Beyond regular check-ups and cleaning, pregnant women should see their dentist at the first sign something has changed in their mouth or something feels different. Bleeding gums, bad breath, a dark spot on a tooth, and discomfort when eating or drinking something hot, cold or sweet are all indications that something may be wrong.

Dr. Fuqua encourages pregnant women to communicate with their hygienist and dentist about their needs prior to and during their appointments. Don’t be afraid to tell them you need to elevate your head a little or take breaks during treatment. 

If certain smells bother you, let them know and they can help minimize any discomfort. If you’re really nervous or have a significant gag reflex, nitrous oxide will help you relax and is safe for use during pregnancy, according to Dr. Fuqua.

Don’t neglect those pearly whites when you have a little one on the way. Taking care of your teeth before, during and after pregnancy is not only safe for you and your baby, but good for your overall health and the health of your child. Healthy moms make healthy babies.

Kaden was born with a lymphatic malformation, the medical term for an abnormal growth of lymph vessels in his head and neck. His enlarged tongue makes it difficult to get to all the areas a toothbrush should effectively reach. Due to this condition, Kaden’s mother and his nurses use Toothette swabs in conjunction with a squirt bottle to clear out his mouth six times each day.

“We can’t get to his teeth really well because the tongue just kind of fills the whole space,” mom Kimberlee Lee said. “We realized we can’t leave food in his mouth at all, ever. He gets food stuck on the roof of his mouth because he can’t move his tongue around.”

Dental care for Kaden’s sister, Joslynn Lee, also requires a degree of finesse and patience. A rare genetic disorder caused strokes that left 7-year-old Joslynn autistic and developmentally delayed with behaviors more aligned with a 3-year-old child. She bites, squirms and resists whenever it’s time to brush her teeth.

Kimberlee says Joslynn responds better when she can watch her reflection in the mirror. And their routine involves music; Kimberlee sings a special toothbrushing song to both distract and calm her wiggly daughter. Singing also helps Joslynn make a connection to the purpose of the toothbrush.       

February is National Children’s Dental Health Month, an occasion to promote awareness of the importance of oral health to overall health. This includes the best oral care practices at home and while at the dentist office. Routine dentistry can be challenging for many children, and even more so for children like Joslynn and Kaden who face extra medical hurdles.

The various sensations that even a routine dental procedure entails – sounds, tastes, tickly tools and bright lights – can be overwhelming for a child with developmental or mental disorders. Patients with autism might need additional patience and care to mediate the sheer amount of sensory immersion they are experiencing all at once. Or a patient with muscular dystrophy might need specialized tools to keep her mouth open during the treatment. Or a patient with epilepsy might have chipped front teeth because of his seizures.

“Patients who have mental, developmental or physical disabilities have a harder time with communication or have difficulty cooperating for oral health practices at home. This all leads to a higher risk of dental problems,” according to Sheela Patel, D.D.S., a pediatric dentist at the Cook Children’s Renaissance Neighborhood Clinic.

“We often encounter families who put off seeing a dentist because they are fearful their child may not be able to cooperate. But it is very important -- especially for the special needs population -- for children to visit the dentist early on so prevention strategies can be created in order to address oral health issues before they cause pain or even infections,” she added.

Dr. Patel and Shawne Barron, D.D.S., M.S., both practice at the Cook Children’s Renaissance location, the only Cook Children’s neighborhood clinic that offers dentistry services in addition to general pediatric care. Dr. Patel estimates that out of the more than 50 patients treated in the dental clinic each day, typically 20%-30% of those patients have underlying medical conditions or special health care needs. The Lee family makes the drive from their home in Justin for dental services at Cook Children’s Renaissance Dental Clinic in Fort Worth.

The American Academy of Pediatric Dentistry (AAPD) reports that children with special needs tend to run a higher risk for tartar buildup, cavities, gum disease, overcrowding and tooth fractures. The AAPD cites various reasons to explain why these children often face a greater likelihood of oral health problems. Examples of complications include behavioral issues (attention deficit hyperactivity disorder, for instance); intellectual disabilities; and facial birth defects such as cleft lip or cleft palate.

“The more severe their health conditions, the more likely they are to have unmet dental needs,” according to the AAPD.

But the experts at Cook Children’s have some advice regarding strategies to ensure healthy oral care and treatment: Go to a pediatric dentist.  Communicate your child’s likes and dislikes to the clinic staff. Establish a daily brushing routine that fits your child’s needs and sensitivities. The guidance and encouragement can ultimately help keep every child’s smile as healthy as it can be.    

Children should make their first trip to the dentist between 6 months and 1 year of age, said Tonya Fuqua, D.D.S., director of Child Oral Health at the Center for Children’s Health, led by Cook Children’s. The first visit lays the foundation for a good relationship with the dentist and for healthy dental practices at home.

“I can’t tell you how to best help your child unless I meet them, I see them, I ask you questions and learn about your child and their special needs,” Dr. Fuqua said. “We as dentists want to help make toothbrushing the least invasive part of the day. We can give tips and tricks to help support a good dental routine at home with different gadgets, tools and ideas. There’s so much to offer, but a parent won’t know unless they take their child to the dentist and start early.”

 She calls the initial appointment the “happy visit” – a chance for the patient to meet the clinic staff, explore the surroundings, and maybe ride up and down in the exam chair. “The first visit should establish a positive experience for that child so that each time they come back they know that this is a safe and possibly fun place to go,” Dr. Fuqua said.

 To acquaint her patients with a few common dental items, Dr. Fuqua might send them home with mouth mirrors, gloves and masks, encouraging the family to play “going to the dentist.” Create a pretend scenario looking into each other’s mouths and using a flashlight to mimic the dental light on the swing arm above the dental chair. Having that play experience can help decrease anxiety when it’s time for an actual cleaning or checkup, she said.  

 Parents of children with special needs should be sure to update the dentist each time their child’s medication and health history change. The office will need to know any accommodations that might help the appointment go smoother, such as headphones or dimmed lighting. Dr. Fuqua recalled a patient with autism who requested a Taylor Swift playlist. “It made a huge difference,” she said.

Dr. Fuqua welcomes any favorite toy or blanket that helps soothe a child in the dentist chair. Parents may also hold their child’s hand and give words of reassurance during the dental procedures. “You have to find what makes them tick, what makes them engaged and smile, what makes that child happy,” she said.

 Alert the staff to any aversions, such as loud noises or a crowded room that could be upsetting. “You know your child best. Let the dentist know those things that trigger your child to get nervous or worked up, in order to help us know what to avoid.”

 Modifications and role playing at home can help a child with special needs warm up to going to the dentist and receiving dental care. For those with extreme sensitivity to taste and touch, Dr. Fuqua recommends limiting the stimulation. Start with a small toothbrush without toothpaste. Eventually, you can apply the toothpaste when the child is ready. Let the child brush a stuffed animal’s mouth. Read books and watch animated videos. All of these steps can start the process of making oral hygiene both fun and familiar.

 For children with dexterity impairments, a tool can be created by inserting a toothbrush into a tennis ball, making it easier to grasp. This modification not only teaches a level of independence, but also gives those children the confidence that they are capable of doing it on their own. 

 Dr. Patel and Dr. Fuqua understand that families juggling with stress and time constraints. possibly due to their child’s health challenges, might be tempted to make dental care a low priority. “It’s definitely one of those things that parents let slide because it’s just one more thing to deal with,” Dr. Fuqua said. The intense combination of medications and frequent doctor visits for the underlying health condition can be overwhelming. Even with these struggles. families should aim for brushing teeth at least two times a day (morning and before bed). Oral health impacts overall health, so it’s not something to ignore.

 The two dentists at Cook Children’s Renaissance Dental Clinic stay busy but are always accepting new patients. The clinic has seen an annual average of 5,434 dental patient visits since 2019. Depending on the medical issues, the safest way to perform dental procedures for some children is under anesthesia in the operating room. Annual dental surgeries at Cook Children’s averaged almost 1,100 in the past three years.

 Dr. Patel recommends finding a pediatric dentist who is comfortable with your child’s unique and individual needs, and can speak at his or her cognitive level. She attributes the resistant behaviors in some patients to a lack of understanding or an inability to express themselves. For a patient who is nonverbal like Joslynn Lee, the care must be extremely customized.

Kimberlee Lee says her daughter has a sensory processing disorder along with her autism. Joslynn’s desire for control makes brushing her teeth a battle. She won’t allow flossing or pulling a loose tooth.

During a dental appointment, Joslynn doesn’t understand why she has to sit still and can’t bite. As a result, she must be sedated for cleanings or other dental work, Kimberlee said.

At home, keeping little brother Kaden’s teeth clean involves the team of nurses who tend to his tracheotomy and restricted airway. The nurses collaborate with Kimberlee to sponge off his teeth and gums every time he eats. 

Unfortunately, a medication Kaden takes to control his lymphatic malformation makes him prone to mouth sores and tooth decay. At just 4 years old, Kaden has already needed several extractions and caps due to the damage to his enamel. Through all of this, he maintains high spirits at the dental office.  

“He loves the attention,” Kimberlee said. “So for the most part, he really is very cooperative. He’s happy to open his mouth. He’s excited about the little bag with the toothbrush and the new toothpaste and all the little things inside and to get the stickers at the end of the appointment.”

For parents with children who have similar needs, Kimberlee shared a few points that help dental visits go smoother for her family:

Plan ahead and bring whatever makes your child relax. Kaden prefers the iPad, and Joslynn likes fidget toys to keep her hands busy.

Offer a reward afterward as encouragement.  

Stay calm and positive. “Check your own energy and be able to show up and love and comfort for your child rather than feeding on their fear,” Kimberlee said. “When you’re scared, it ends up making everything worse.”

 Kimberlee advises parents to do their best to implement dental care at home, and be OK if it isn’t perfect.  The key is progress, not perfection.

“In the beginning of having special needs kids, I always felt like if they got a cavity or something was wrong, that it was my fault that I haven’t been taking good care enough of their mouth,” Kimberlee said. “I’m just going to have some grace, and if we have a problem, we have Dr. Patel to help us through it.”

Anxiety and depression drive some teens to recreational marijuana as a way to self-medicate. But that coping strategy can backfire.

Health advocacy groups indicate a link between marijuana use and an increased chance for mental health problems. The National Institute on Drug Abuse and the American Academy of Child Adolescent Psychiatry, for instance, both list a correlation to schizophrenia, depression and anxiety. The Centers for Disease Control and Prevention cites those risks plus temporary psychosis – “not knowing what is real, hallucinations and paranoia” – on its list of mental health implications for dope users.

Lisa Elliott, Ph.D., psychologist/neuropsychologist and manager of the Behavioral Health Clinic at Cook Children’s in Denton, estimated that at least half of her adolescent patients report having tried or using marijuana. For those already struggling with their emotional well-being, is this something to avoid? “Yes. Put that in all capital letters: YES. We have too much evidence to show how harmful it is,” Dr. Elliott said. “There is a significant amount of research that supports the negative impact marijuana/THC use has, especially on the developing brain, so much so that it scares me for our kids’ future.”

Read more about the link between suicidality and young adults here.

Those harmful effects go beyond anxiety and depression to include impairment to intellectual functioning, memory, learning, attention, problem-solving skills and coordination, according to Dr. Elliott. Marijuana use also can cause coughing and wheezing, damage to the immune system and addiction for some people, she said. And when it comes to suicide, some studies show a relationship.    

“There’s been a significant increase in suicides as well as mental health disorders in states that have legalized marijuana,” Dr. Elliott said. “Can we say that marijuana causes suicides? We can’t really say that, but there’s a direct correlation. However, we also know that whenever you’re more depressed and also if you’re coming out of depression, you’re more likely to feel suicidal.”

Just breathe. Open up. You matter. That’s the truth behind the Joy Campaign, an ongoing rollout of articles, videos and other resources aimed to prevent youth suicide. Cook Children’s initiated the Joy Campaign in response to rising numbers of suicide attempts in our region and nationally. While raising awareness, the Joy Campaign delivers help and hope for children and teens who struggle with mental health. This article looks at the ways marijuana use complicates the picture.

How common is recreational marijuana among adolescents? The National Institute on Drug Abuse reports that 11.4% of eighth graders and 35.2% of 12th graders surveyed in 2020 said they had used marijuana in the past year. The Substance Abuse and Mental Health Services Administration calls marijuana the most common illegal drug in the United States, with particular risks for young users and pregnant women.

At Cook Children’s in 2019, there were 830 patients who acknowledged recent use of marijuana when they came to the Emergency Department (ED) for various complaints. That statistic increased to 986 patients in 2020 and 1,105 patients in 2021.  Patients as young as 10 years old were among that group who indicated “yes” to marijuana use on their ED intake paperwork.

In that three-year span at Cook Children’s, most of those who admitted using marijuana were discharged from the ED to home or self-care. Records show some of those patients left the ED against medical advice or were discharged to court or law enforcement. And there were 207 self-reporting marijuana users who were discharged from the Cook Children’s ED to psychiatric hospitals during 2019-2021.

 Dr. Elliott and others say marijuana products have become more potent in recent years. The cannabis plant’s main psychoactive ingredient, a molecule called tetrahydrocannabinol (THC), causes the “high” feeling. Marijuana can be smoked, vaped in an electronic cigarette, eaten in candy or baked edibles, or inhaled in dabs that contain especially high THC concentration.  

Recreational marijuana remains illegal in Texas. In states where it’s legal, consumers must be 21 or older to buy marijuana for non-medical use. Recreational use differs from approved medical use of cannabidiol oil (CBD). Doctors may prescribe CBD in children to help manage epileptic seizures and some other illnesses. But many young people mistakenly confuse THC with the medicinal value of CBD, Dr. Elliott said.  

To set the record straight in therapy sessions, she provides her patients with facts about the documented negative impacts of marijuana, including exacerbated problems with mental health, impaired driving, difficulty in school, diminished IQ scores, aggression, anger and legal consequences. Adolescents who admit to marijuana use tell Dr. Elliott that the drug is easy to come by, even at home or school. She asks them why they started and how it impacts them.

“They’ll say that they will smoke marijuana because it helps them deal with the stress and the trauma and as well as the conflict and unrest in our world. Some of them report that it helps them feel happier, relaxed. Several report that they use it to help them sleep. And several of them report that they used it because they were bored (during the pandemic lockdown) and couldn’t go do things.”

Depending on the reason they’re using the drug, Dr. Elliott works with her patients to treat any contributing factors such as anxiety or depression, peer pressure and low self-esteem. “I try to encourage them and lead them toward healthy coping tools,” she said. “There have been times when I have discharged patients and referred them to therapists who specialize in drugs and addiction because they’re unwilling to stop smoking. Therapy is not productive if they’re high.”  

The Child Mind Institute, a nonprofit organization promoting mental health, sponsored a virtual symposium in October 2021 that featured new research and a panel of experts on the topic “Marijuana and the Teenage Brain.” Among the symposium’s highlights: 

THC exposure in animal models has shown repeated association with increased risk for developing anxiety, depression, substance abuse disorders and psychosis. Exposure to THC changes the cells in the brain and restructures how the gene networks talk to each other.

Adolescence is a critical period for brain development. The adolescent brain is primed to take risks, satisfy immediate wants and be easily swayed by social influences.

Parents should have frequent conversations with their children about the facts that marijuana can be addictive, there’s no such thing as a safe amount, and there’s no way to predict how it will impact a person. Factors such as age, genetics and amount/concentration of the drug play a role. 

 Dr. Elliott cited the statistic that about 1 in 10 people who use marijuana will become addicted. For those who start using before age 18, the addiction risk rises to 1 in 6. Warning signs of Cannabis Use Disorder include cravings, unsuccessful efforts to quit, and increased tolerance to the drug.

“One of the most frightening concerns with marijuana use is the increase in psychotic episodes, especially in those who have a family history of mental illness,” she said. “We also know the recent research really shows that for kids and teens who smoke that higher potency of marijuana, it will increase their chances of developing psychosis nearly five times more than those who have never used.”

Parents should stay alert to behavior changes -- such as secrecy, a sudden decline in grades, less motivation – that might point to a cause for concern in teens. Dr. Elliott recommended that parents speak to their children early and often about the dangers of marijuana. Her encouragement to parents? Keep an ongoing dialogue, stay calm, and set clear expectations and boundaries. And if their teens do start using marijuana, find out why.  

“If they’re feeling stressed, let’s get them into therapy. If they need help sleeping, let’s go talk to our pediatrician and get the sleep addressed,” Dr. Elliott said. She pointed to the good news of hope for families who stay vigilant regarding drug use, social media and mental health in general.

“Parents need to increase their awareness and be hyper alert to this as being an issue. And to create that dialogue and open communication and to be willing to seek help, because if you’re willing to seek help, it teaches your child healthy coping tools.”

About Cook Children's Behavioral Health Program 

Growing up in today's world is hard, and many children or teens may go through life experiences that cause them to feel anxious, depressed or even suicidal. It can be hard for parents and caregivers to know when to ask for help. The Behavioral Health Center at Cook Children’s brings all services together in an expanded space to provide a dedicated team of physicians and professionals with the facilities, resources, tools and programs that deliver the high-quality treatment these vulnerable children need and deserve.

Cook Children's Behavioral Health (cookchildrens.org)

But when you are plagued with mental illness or poor oral health—or a combination of both—it can be hard to turn a frown upside down, and that can have a profound impact on a child’s overall well-being.

“Our children don’t smile if they are hurting,” said Tonya Fuqua, DDS, director of child oral health at Cook Children’s. “If they have oral health disease and pain, or they are embarrassed by their smile, they don’t eat, or talk, or socialize, and they have trouble learning in school or being the best they can be as a kid. It’s the same with their mental health. If they are not in a good state of mind kids disconnect and aren’t the best kid they can be, and a domino effect happens.”

When people think about health, they rarely consider mental and oral health as part of the equation, but the two can be as taxing on the body as any other ailment. In Cook Children’s 2021 Community Health Needs Assessment (CHNA) survey of parents and guardians in the North Texas region, more than 180,000 children ages 0 to 17 went without needed dental care, and more than 63,000 without needed mental health care.

“People don’t realize the importance of oral and mental health to their overall health,” Dr. Fuqua said. “But dental disease is connected to heart health, and if you have cancer and are using certain medications, or you’re an asthmatic and using inhalers, that is going to impact your oral health. It’s the same with mental health. If you have to cope with one of these chronic illnesses, it’s going to impact your mental health, and poor mental health can stress other body systems and lead to other health issues.”

Oral and mental health also have a direct impact on each other. People with severe mental illness often neglect good oral hygiene practices and are 2.7 times more likely to lose their teeth, according to an article published in the Canadian Journal of Psychiatry. Add in an unhealthy coping strategy and your mouth and teeth are at even greater risk of disease.

“There is a clear connection between your emotions and how you handle stress,” said Kim Cox, a clinical therapist and manager of Cook Children’s Save a Smile program. “Sometimes kids handle stress in non-productive ways, like smoking and vaping, for example. That all affects your oral health as well.”

The risk is present in reverse, too. Poor oral health often leads to worsening mental health as people grapple with chronic pain and self-consciousness from an imperfect smile.

Add the stress of the pandemic on top of all of this and it’s easy to understand the recent decline in both mental and dental health among children. Cook Children’s has recorded a record number of suicide attempts in the past 12 months and, according to the CHNA parent survey, more than 170,000 children have had dental problems in the past 12 months. Parents identified the impact of COVID-19 as one of the top three barriers to their children getting the care they needed.

“There has been a marked increase in dental disease since the pandemic,” Dr. Fuqua said. “There is no surprise that when kids are stressed, disconnected or depressed, they eat. This leads to bad habits that can result in increased cavities. Also, when kids are off their routine, like during the pandemic, things go by the wayside, such as brushing and good oral health habits. Then, when kids get lots of cavities, they will not smile or even talk as much because they are embarrassed by the way their teeth look. This is a huge social inconvenience and causes kids to be even more distant and traumatized emotionally.”

Connecting the Dots

More often than not, mental illness and dental disease are treated in a silo. There is little recognition of their ties to and impact on other health issues and body systems, and little coordination between specialties in their treatment, according to Cox.

“If you have heart disease and go see a cardiologist, just because you are going to see a specialist for a specific issue doesn’t mean that part of your body is disconnected from other parts of your body and its function,” Cox said. “But for some reason, oral and mental health are seen that way. Dentists and therapists are seen as treating systems completely disconnected from a person’s overall physical health.”

Both share a similar stigma, too. Embarrassment leads many to suffer in silence.

“I call it the silent epidemic,” Dr. Fuqua said. “Nobody talks about mental health because there’s a stigma attached to it. Nobody wants to admit their child is going through a difficult time or kids don’t speak up about it. We see the same in dentistry. Many are embarrassed to admit they have issues with their teeth.”

A lack of insurance keeps many from getting the dental and mental health care they need, according to the CHNA parent survey. Insurance companies don’t cover services for mental and oral health as robustly as they do for other issues, making treatment unaffordable for many families. Dental insurance, for example, usually provides a capped maximum payout for treatment per year, but many dental procedures and treatments cost well above the typical yearly maximum.

The first step to breaking these shared barriers is for physicians and parents to talk about oral and mental health as much as they talk about diabetes, obesity, asthma, nutrition, childhood vaccinations and viruses.

“We need all of us—dentists, pediatricians and parents—talking about mental and oral health and looking at kids as a whole,” Dr. Fuqua said. “We need to always be in tune and watching for signs and symptoms. Doctors can take a quick look at a child’s teeth at their well-child check and ask them if they are seeing a dentist. Parents can talk to their kids about how their mind and mouth are feeling, and help them understand that their mental and oral health and hygiene are as important as any other part of their body.”

After all, a healthy mouth and mind help make a healthy body, not to mention a big, beautiful and bright smile.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cook Children’s Medical Center has something to smile about these days.

Despite the toll of a lengthy pandemic, the hospital system hit two milestones since the inception of its Save a Smile program—it reached a 100,000-oral-screenings mark at the end of the 2020-21 school year in August, as well as tallied more than $10 million in value dentistry completed by private practice dentists who volunteered their services.

“It’s huge! I’m so proud we hit these milestones in such a difficult year,” says Tonya Fuqua, DDS, director of Child Oral Health at Cook Children’s. “And then to know that we were the only ones who went the extra mile to make things really happen (in oral screenings) and we didn’t give up.”

Instead of shutting down during the pandemic, the team suited up in personal protective equipment (PPE), created new safety protocol and procedures with the help of Cook Children’s infectious disease specialists, and took every precaution to safely enter schools, conduct screenings and treat children in need of oral health care.

“We were going to be at dental screenings where kids’ mouths would be open, so all of a sudden, it was like, ‘We have to rethink how we do this and do it safely,’” Dr. Fuqua says.

Other similar programs within the state paused operations during the pandemic, Dr. Fuqua says, but Save a Smile was boosted by “the generosity and quick thinking of a lot of people within our system,” including Cook Children’s leadership, infectious disease team, Children’s Oral Health Coalition, The Center for Children’s Health and legal department. The program also received funding for two new vans, which allowed the Save a Smile community health workers to offer free and safe transport for patients (and their accompanying parents) to dentists’ offices when needed for treatment.

“It took all of us together to make this happen…knowing we were going to do this effectively and safely for all—not just for our team, but for the kids and families and the schools’ staff, as well,” Dr. Fuqua says.

And our volunteer dentists didn’t say no either, she says. About 100 area dentists participate in Save a Smile, including Dr. Fuqua, who is in private practice while overseeing the program on a part-time basis.

“The dentists could have said, ‘It’s too scary out there right now…we’re not going into schools. Or my practice was impacted, and I’m not going to do free dentistry.’ But they didn’t do that. They didn’t tell us no,” Dr. Fuqua says. “I’ve always thought, ‘Wow. These dentists already do so much’—but to do it through a pandemic? It just makes me that much more proud to know they really feel there’s a need and that our program is worthy. That the kids are deserving of the treatment.”

The school-based, grassroots program has been part of the Promise that’s guided Cook Children’s Medical Center’s efforts to connect children in our communities with the care they need, says Chris Pedigo, senior vice president for System Planning, Health Analytics and The Center for Children’s Health.

“We’re beyond proud of the work Save a Smile has done in addressing the oral health of our children, especially during challenging times,” Pedigo says. “It’s fulfilling our Promise to the families we serve, and it’s what sets Cook Children’s apart.”

Save a Smile, which began in 2003, targets 21 elementary schools that are Title I schools (where at least 80% of the student body receive free and reduced-cost lunches) in Tarrant County. The schools are in Fort Worth, HEB and Keller school districts, respectively. Throughout the school year, the program’s team screens students to determine the level of urgency for immediate and potential oral health needs.

The program’s community health workers also help families determine if they are eligible for oral health care under Medicaid or CHIP coverage and get them connected to an appropriate provider. Students’ families who may not be eligible for those programs—but still can’t afford the cost of oral health care—are helped through Save a Smile.

The coordinated care and social service component of the program is the key element, Dr. Fuqua says, to ensuring children receive the dental care they most desperately need to be happy, healthy and productive in school.

A young girl who was recently seen by Cook Children’s C.A.R.E. (Child Advocacy Resource and Evaluation) Team sat sobbing on the exam room floor, distraught after receiving a series of immunization shots.

Many of the children seen by the C.A.R.E. Team have experienced extreme trauma, says C.A.R.E. Team Medical Director Jamye Coffman, M.D., so even getting shots may cause intense anxiety. The team knew who to call for help.

Enter Kitty, a 7-year-old, silky-haired Golden Retriever and one of Cook Children’s six facility dogs, who quickly assessed the situation and knew exactly what to do. She went straight to the young girl who sat next to her sister and laid her head on the child’s lap.

“The little girl starts petting her,” Dr. Coffman says, “and her sister, who had been here before, says, ‘Just pet Kitty. It makes it not hurt as much—it’s Kitty magic.’ So, the little girl continues to pet Kitty, and the tears slow down, and she finally stops crying, and then she looks at her sister and says, ‘It did help. It is Kitty magic.’”

“Seeing is believing, right?” says Dr. Coffman, who also handles her canine helper. “Seeing how she helps bring kids down when they’re super anxious…and not only the kids, but the parents, too. They start petting the dog and the whole level in the room just comes down. It’s amazing to watch. She knows who to go to instinctively—I don’t know if it’s their smell, I don’t know what it is—but she tends to go to the most stressed person in the room. Sometimes it’s the parent, sometimes it’s the kid.”

But Kitty may not be the only one with magical powers.

Whether it’s highly trained therapy dogs, laid-back emotional support cats or pet pot-bellied pigs, animals appear to shoulder some of the emotional load as they interact with humans—and may even promote healthier mental health for their people, some researchers and animal handlers say.

So, what’s the secret behind “Kitty magic”? And could the human-animal bond make a difference for children and teens facing mental health issues, such as anxiety, depression, or suicidal inclinations—all on the rise since the pandemic began? The JOY Campaign asked experts who work with children and/or animals on a daily basis to discuss.

Kitty’s magic, as well as other animals’ abilities, may begin on the most basic level for humans, experts agree. The animals don’t judge. And that nonjudgmental approach may help those facing mental health issues.

“You can talk to your dog or your pet, and they love you no matter what,” Dr. Coffman says of the unique human-animal relationship.

“I think the biggest thing is the animal accepts you, however you are,” she adds. “They don’t see if you have disabilities. They don’t see if you have scars. They don’t see any of that. They just love you and accept you for you. And that’s it.”

For children and teens who are developmentally peer-driven during this part of their lives, that can be significant, says Dr. Janet Hoy-Gerlach, Ph.D., a professor of social work at The University of Toledo in Ohio. In June, she released the first peer-reviewed research study on the beneficial effects of emotional support animals (ESAs) for those with chronic mental illness.

“It’s a unique kind of support. It’s not an evaluative relationship in the way that humans have, especially with some of the challenges kids face with their peers during that excruciating adolescence, where it’s like hyper-judgment time,” says Dr. Hoy-Gerlach, who also co-authored a book titled The Human-Animal Interactions: A Social Work Guide. “The animal is safe. Animals aren’t making a value judgment on what they’re wearing or what they’re saying or what their hair looks like.”

With extensive work in counseling, crisis work and public mental health, she became interested in the human-animal bond and how it might help people with mental health issues after years of working as a crisis clinician in community mental health, where she conducted risk assessments of clients every day. Part of assessing people in crisis involved questioning them about what stopped them from following through on suicide to help identify their lifeline, she says, adding it’s important to figuring out “what’s keeping them alive.”

Common responses she heard were what she’d been taught to expect—usually protective factors, such as “I’m afraid about what will happen to my kids,” or “I don’t want to hurt my family,” or “I wouldn’t do that to my friends,” or “It’s against my faith, my spiritual beliefs, my religion.’ But another response she frequently heard during the assessments was one she hadn’t been exposed to in classes or training, which was “I can’t leave my pet.”

“I guess I had two reactions to that. One was on a personal level as somebody who has lived with animals my whole life and loved them tremendously. Like I totally got that response. It just made sense to me on a human-to-human level,” Dr. Hoy-Gerlach says. “As a clinician, it really hit me that this was something really overlooked. People were literally saying the reason they were alive was because of their animals.”

“And this was something that had never been talked about,” she says. “I was like, how are we missing this strength? This protective factor that many people have in their lives, and we don’t ask them about it. We don’t talk about it. And we certainly don’t support them, like help them keep the animal in their life if they’re facing a barrier or struggle.”

So began Dr. Hoy-Gerlach’s journey to merge a personal passion for animals and professional passion for mental health. Much of her work since has been focused on educating others, such as social workers, mental health workers and health care workers about the benefits of relationships with animals for human wellbeing, she says, adding she also supports a more intentional approach to using those benefits in how we help people stay healthy.

Dr. Hoy-Gerlach’s recently published study focused on 11 adults with stable, chronic mental illness—ranging from anxiety to depression to schizoaffective disorder—who were matched with a shelter cat or dog through the Hope and Recovery Pet Program, a community partnership between The University of Toledo, Toledo Humane Society and ProMedica. (Six adult cats and five dogs were involved in the study.)

Using saliva tests, researchers studied the participants’ biomarkers, such as cortisol, alpha amylase, both stress indicators, and oxytocin, known as the hormone that bonds mothers to babies. During home visits, the participants took saliva tests after focused interaction with their animal for 10 minutes at one month, three months, nine months and a year.

“What we saw, while not statistically significant in this study, was a visual pattern in oxytocin going up and cortisol going down,” she says. There was no significant rise or fall of alpha amylase.

Initially, several participants mentioned an adjustment phase where they experienced a bit of stress from their routines changing with a new animal. But after that, the participants “overwhelmingly talked about an improvement in their mental health, generally and with their symptoms,” Dr. Hoy-Gerlach says.

“They talked about their animal helping or distracting them from symptoms and being a source of comfort for them,” she says. “Those probably are the two things we heard most.”

While her study focused on adults, most of the results are still relevant to youth, she says, because we’re all humans and similarly hardwired for connection.

For example, in the case of ESAs or companion animals for children and teens, it’s looking at the benefits the animals can offer in everyday interaction based on whatever impairments need to be addressed, Dr. Hoy-Gerlach says. Unlike service or therapy animals, ESAs and pets aren’t trained to do special things.

“So, if a child has a lot of anxiety, physical contact with an animal who enjoys that could be a source of regulation that could help downregulate their stress responses,” she says. “It’s not that the animal is doing anything except typical friendly dog or cat behavior, like ‘I want to sit on you.’ But for somebody who has trauma, for instance, that can be grounding. I’ve talked with people who like the cat’s purr, the feel of the fur, the warmth of the body and pressure of their weight on them.”

“It’s multisensory, plus there’s comfort in the relationship. So, it’s thinking about the ways the animal can help, based on the evidence we have on how living with companion animals can benefits humans, then looking at the child’s specific symptoms and issues,” Dr. Hoy-Gerlach says.

Other groups are also following the human-animal bond and its advantages, especially during the pandemic, which has left many Americans of all ages feeling isolated, lonely and stressed.

As part of its “COVID-19 Pulse Study,” the American Pet Products Association (APPA) reported that 11.38 million households in the United States welcomed a new pet during the pandemic, according to an October 2020 article in Today’s Vetinary Business. And three out of four pet owners said spending time with a dog, cat or another animal species “helps reduce their stress and increase their sense of well-being during COVID-19,” the article stated.

In May 2020, the Human Animal Bond Research Institute (HABRI) along with Mental Health America (MHA) released a report stating pets not only “help alleviate stress, but they also improve owners’ moods and help fight depression.” In their survey, 74% of pet owners reported mental health improvements from having pets, and 75% said a friend’s or family member’s mental health improved. The report also mentioned 96% of pet owners agreed their pet has a positive impact on their life, based on a survey conducted by Nationwide and HABRI.

The scientific research showed the human-animal bond supports better mental health and “indicates pets can make a difference for those facing mental health concerns, including anxiety, depression, loneliness and stress,” according to HABRI’s report.

About three months ago, APPA launched a “Pet Feels” Campaign in conjunction with Mental Health Awareness Month that highlighted the advantages of pet ownership as part of its Pets Add Life (PAL) program. The campaign, posted with links on the APPA website, uses a series of videos that demonstrate the way pets help people cope with everyday stressors while also giving love and support during challenging times.

Despite promoting relationships with animals, Dr. Hoy-Gerlach cautions that they’re are not always for everyone. They shouldn’t be brought into a home if there’s a history of animal violence, extreme fear of animals, severe allergies or if a family member is unable to safely interact with an animal or vise-versa.

Laura Sonefeld, “Sit…Stay…PLAY” facility dog program coordinator and child life specialist at Cook Children’s Medical Center, often is approached by families who are considering getting a pet after watching their children interact with facility dogs at the hospital. The team of six dogs—Kitty, Steve, Neely, Chanel, Zuni and Brienne—are trained to work alongside a healthcare worker to provide comfort and socialization with patients and families in a hospital setting.

Sonefeld, who handles Steve, a 3-year-old Golden Doodle on the canine team, says she frequently is asked, “How do we get a dog like your dog?” She makes sure they understand the difference between service, therapy and support animals.

The first question she asks is “Are you wanting a dog to be able to bring to the hospital with you or one for emotional support and comfort at home?” That helps her determine the type of animal they’re looking for.

Most people want a pet, not a service or therapy animal.

“They say, ‘We’ve seen the benefits on our child when they’re here and interact with one of the facility dogs, and we want that at home, too,’” she says. “And I say absolutely. You get a pet. I feel like all animals have that potential to provide therapeutic support for families.”

Whether dogs, cats or other types, animals might help the entire family, not just an individual child.

“I highly recommend it, just for that everyday stress that all of us feel because we’re human,” Sonefeld says. “It doesn’t have to be someone that’s had a huge hospital experience. It could be someone simply dealing with everyday anxiety of school, of work, of making friends. I feel like the dogs help build that confidence and remind everybody that they are loved and special—that they deserve to feel that from people they interact with, too.”

Sometimes the entire family isn’t on board with getting a pet, Sonefeld says. It might be the mom or dad who is hesitant to take on more responsibility by having an animal.

But it seems the mysterious “Kitty magic” might work on that, too.

“Whoever the one is that’s not totally convinced usually ends up being the one who loves the dog the most,” Sonefeld says with a laugh. “Once they have had the experience, they’re like, ‘Oh, OK, I get it now.’”

“This is an incredible achievement and demonstrates our unwavering commitment to providing the very best service to our more than 160,000 members,” said Karen Love, president of Cook Children’s Health Plan. “This recognition from NCQA distinguishes us as a premier provider with the continuous goal of keeping our members engaged in improving their health.”

In order to receive NCQA accreditation, health plans must support care that keeps members at optimum levels of health while also controlling costs and meeting government and purchaser requirements. NCQA standards are a roadmap for improvement—organizations use them to perform a gap analysis and align improvement activities with areas that are most important to states and employers, such as network adequacy and consumer protection.

Standards evaluate plans on:

• Quality Management and Improvement.
• Population Health Management.
• Network Management.
• Utilization Management.
• Credentialing and Recredentialing.
• Members’ Rights and Responsibilities.
• Member Connections.
• Medicaid Benefits and Services.

NCQA standards also provide a framework for improving key health plan performance in care coordination, access and member connections, availability of health resources such as wellness services and self-management tools for chronic disease management. NCQA is the most widely-recognized accreditation program in the United States and most comprehensive evaluation in the industry.

About Cook Children’s

Cook Children’s Health Care System embraces an inspiring Promise – to improve the health of every child through the prevention and treatment of illness, disease and injury. Based in Fort Worth, Texas, we’re proud of our long and rich tradition of serving our community.

Our not-for-profit organization encompasses nine companies – a medical center, two surgery centers, a physician network, home health services and a health plan. It also includes Child Study Center at Cook Children's, Cook Children's Health Services Inc., and Cook Children's Health Foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet their unique needs.

We’ve worked to improve the health of children from across our primary service area of Denton, Hood, Johnson, Parker, Tarrant and Wise counties for more than 100 years. Based on the exceptional care we provide, patients travel to Cook Children’s from around the country and the globe to receive life-saving pediatric care built on leading technology, extraordinary collaboration and the art of caring.

For more information, visit cookchildrens.org and cookchp.org.

There is nothing more inspiring than seeing a child with a disability overcome the daily challenges they face. Their determination, strength and courage are what superheroes are made of. But, even superheroes sometimes need help carrying the mental and emotional weight of living with a difficult medical diagnosis, a developmental delay, a physical disability or a learning obstacle. It’s the part of their struggle often unseen, yet profoundly impactful to them, their families and their well-being.

Carla Morton, Ph.D., spends a lot of time with little superheroes. She is both a neuropsychologist at Cook Children’s Jane and John Justin Neurosciences Center and the mother of a child with special needs. Morton is also an advocate for children with disabilities as a founder and current president of the Fort Worth ISD Special Education PTA.

“Kids who receive special education services are at increased risk of psychiatric issues,” Dr. Morton said. “It could be the result of a primary medical diagnosis like multiple sclerosis, for example, which in and of itself causes you to be more likely to have depression. Or, it could come through an indirect route, like attention deficit and hyperactivity disorder (ADHD), which results in more social difficulties and an inability to regulate behavior.”

No matter the cause, depression is not something to ignore. It’s a risk factor for suicide.

Studies show that adolescents with physical, developmental and learning disabilities have an increased risk of suicide compared to those without a limitation. Contributing factors may include increased stress, social isolation, discrimination, a psychiatric diagnosis and substance abuse.

Take epilepsy, for example. It’s a disorder that can be associated with physical, developmental and learning impairment.

“Epilepsy and depression occur together at high rates,” said Crystal Cooper, Ph.D., principal investigator at Cook Children’s Jane and John Justin Neurosciences Center. “If you think about the general population, you might have 5 to 15% that are going to have depression in their lifetime. But if you look at those with a condition like epilepsy, their rate of depression can be up to 50%. So it's much higher compared to the general population. Given this knowledge, it is not surprising to hear the CDC report a 22% higher rate of suicide among those with epilepsy compared to the general population.”

In her role as a principal investigator, Dr. Cooper examines the relationship between neurological medical conditions and psychiatric health in order to better understand how to treat people with medical disorders of the brain. She is currently studying the impact of epilepsy on the psychological health of children.

It’s hard for a child with a physical disability to watch their friends do things their bodies won’t let them do. Constant questions from others about their limitations, burnout from intense therapies that interrupt time with their friends, and self-consciousness about their differences can erode a child’s mental health. Each of life’s developmental and social milestones they reach has the potential to present a new emotional challenge.

Depression and suicide can capture the thoughts of anyone with a limitation, even those with an intellectual and developmental disability. A review of literature by the National Institutes of Health indicates the rate of suicidal thoughts, behavior and completion among children with an intellectual disability are as high as 42%.

“Unfortunately this population has been understudied for their risk for suicide,” said Rachel Talbot, M.D., a child and adolescent psychiatrist on the medical staff at Cook Children’s Medical Center. “In general, I would say that this population is at an increased risk for depression and anxiety in addition to suicidality as they are more susceptible to the risk factors for suicide.”

Such risk factors can include having traumatic experiences—both physically and mentally—being bullied by peers, increased impulsivity, inadequate coping skills, and an inability to manage and appropriately express their feelings.

“We need to make sure that our kids with disabilities are being screened for anxiety and depression, including those with intellectual disability,” Dr. Talbot said. “We can’t overlook it.”

Impulsivity also puts children with ADHD at risk. They can quickly go from a suicidal thought to completion before anyone has a chance to intervene, according to Anne-Marie Hain, M.D., a pediatrician in the developmental pediatrics division of the Cook Children’s Child Study Center.

Superheroes Under Stress

This year has been particularly difficult for children with special needs and their families. The pandemic complicated already stressful lives and disrupted critical therapies that help these children reach their full superhero potential. Normal daily routines were in constant flux, triggering a loss of comfort and security for children in general but especially for those with special needs.

“Regular routine and ritual is important for any child,” Dr. Hain said. “But it's especially important for a child with a developmental disability. It allows them to understand what’s coming next, especially if there are communication issues.”

By nature of their disability, many struggle with anxiety, depression, isolation and a sense of loss on a good day. Add a pandemic on top of that and you have the makings of a perfect storm. Physicians at Cook Children’s Child Study Center, an educational haven for children with developmental disabilities, said they have seen an increase in the severity of their patients’ behavior disorders and aggression over the past year.

“At the beginning of the pandemic, a lot of children with developmental disabilities had a little bit of anxiety or a little bit of disruptive behavior or a little bit of weight problems,” Dr. Hain said. “And then the rug got pulled out from all of these families and the child couldn’t go to school or therapy. When all of that happened, a lot of little problems became big problems.”

Dr. Hain encourages parents to make sure their kids are sticking to a sleep schedule, getting regular exercise and participating in safe activities that spark joy to help boost their child’s mood in good times and bad.

How To Rescue A Superhero

Children with disabilities can never escape the reality of their circumstances, but there are ways to help them cope and soar to personal success. Christina York, Ph.D., is a licensed psychologist at Cook Children’s Behavioral Health Center. When she works with children who are struggling mentally and emotionally with a disability, she takes a page from the superhero playbook.

“Every superhero has a superpower. I encourage kids to focus on their ‘superpowers,’ which may be hidden,” Dr. York said. “Think of Superman and his adoptive parents figuring out he had superpowers as he grew up. We may discuss their ‘hidden superpowers’ that they aren’t yet aware of due to focusing on what is wrong.”

Maybe the child has a wicked sense of humor and is able to make others laugh and smile. Perhaps their circumstance gives them a keen sense of awareness of the needs of others and they are eager to help, encourage and show kindness. Does the child have an athletic, artistic, musical or creative talent that outshines their disability? Whatever the strength, the key is to help your child identify it, own it and use it to reframe their focus on what they can do rather than what they can’t. Show them they are more than their disability.

“Finding either character strengths or other areas of functioning where they feel confident can help buffer the effects of their disability,” said Amanda Smith, Ph.D., a licensed psychologist at Cook Children’s Behavioral Health Center.

Dr. Smith encourages her patients to research and learn about well-known people with similar challenges, as well as connect with other kids with disabilities, in order to see life’s possibilities and develop a circle of support.

Age-appropriate explanations about their diagnosis help kids better understand and cope with their circumstances. Telling a child too much or too little, or getting too technical, may lead them to think the worst, Dr. York said. Once you and your child have a good grasp on the diagnosis or disorder, consider sharing it with those in your circle.

“I think the most important thing is having the correct knowledge,” Dr. York said. “Then we walk kids through choosing who and what they want to tell about their disability. We can go into the school and tell school staff so that they're aware and can provide support. In some cases the school counselor goes into the classroom to talk to a child’s peers about their disability so they have a better understanding of what is going on and aren’t constantly asking the child ‘what’s wrong with you.’ Some kids may not want to tell anyone and feel isolated. They may benefit from discussing why they don’t want to tell anyone and how they might tell trusted people about the diagnosis, including good friends, if they change their minds.”

There are so many things children with disabilities cannot control about their bodies and lives. Where they can have a say, they should.

“Let them have a voice because it feels like their body is constantly at war with them,” Dr. York said.

Listen to what they are saying they need and work with their medical team to safely adjust care and therapies to achieve a balance for physical, mental and emotional health. A short break from therapy or a restructure of their therapy schedule may be all they need.

When a child’s disability can’t be seen, like in the case of a learning difficulty or chronic illness, it’s easy to mislabel them as lazy or having a behavior issue. This can open the door to feelings of frustration, failure, rejection and isolation. Protect against these hurtful labels by informing your child’s school and teachers about their challenges. Help your child understand the strengths and weaknesses associated and not associated with their disability and teach them how to advocate for themselves, according to Dr. York.

Most importantly, if you think your child is struggling, don’t wait to get help. It never hurts to talk to someone, even with the most basic concern. Intervening early can be a buffer to more serious issues, including suicide.

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Talking about hard things isn’t easy, especially for a child or teen. It’s scary to be vulnerable. But talking can bring clarity. Sharing your hurts, struggles and stress can be a release, and leaning on someone you love can lighten your mental and emotional load.

“Feelings really are visitors trying to tell you a story,” said Denise Coover, LCSW, a trauma informed care specialist at Cook Children’s Medical Center. “If you ignore the story it just keeps building and building and will demand to be heard. Think of holding in feelings like a trash compactor. You keep pressing it down, pressing it down, but eventually it explodes like a volcano. Usually with frustration, anger and aggression and that’s the danger. These things need to be expressed within a safe environment and relationship. That is key.”

Kids need adults—parents, teachers, counselors, pastors and mentors—to create an environment where they feel secure and free to unpack the things that weigh on their minds and hearts. Trusted adults can help release the pressure on the trash compactor, so to speak.

“By talking with someone we trust, we are able to process our feelings as they arise,” said Marissa Benners, Ph.D., LP, a psychologist at Cook Children’s. “It makes it easier to manage the everyday demands of life without the pressure of unresolved feelings weighing us down. Sharing our feelings with others gives us an extra person who can help us problem solve and figure out the best coping strategy.”

Michael Garcia, MS, LPC, is a trauma specialist for the Fort Worth Independent School District where he works with children in crisis every day. Without a trusted adult, he cautions that a child’s development could be influenced by less positive sources.

“A child who is struggling wants to be comforted and feel safe,” Garcia said. “A loving and caring adult provides the necessary attachment a child needs to learn how to effectively communicate needs, meet those needs and manage emotional regulation. A positive and connected caregiver greatly influences the child’s ability to navigate difficult challenges.”

But many parents have their own hurts, experiences, worries, commitments and unfulfilled expectations that are barriers to being a sounding board and source of strength for their kids.

“Parenting isn’t easy,” Garcia said. “As a matter of fact, it’s my most challenging undertaking. It’s not always easy to listen to our children with empathy and compassion when our heads are spinning with finances, deadlines, relationships, piles of laundry and a myriad of daily speed bumps.”

On the flip side, kids don’t want to be a burden to their parents who they see juggling the demands of daily life.

“Kids often tell me the adults in their lives don’t care, are too busy, have their own problems and they don’t want to cause more problems,” Garcia said. “A lot of kids are empathetic to what their parents are going through and don’t want to be another burden.”

In a recent focus group conducted by Cook Children’s, several teens said feelings of fear and insecurity also get in the way of opening up to others. They are unsure how their message will be received, and are afraid of getting in trouble, being misinterpreted and, especially these days, being canceled.

When adults allow the complications of daily life, difficult pasts, fear of other’s perceptions and shame to lead, the unwritten no-talk rule sets itself up as the standard in the home and muzzles any opportunity for communication, connection, teaching and healing. It’s one thing for a child to suffer. It’s another for them to suffer in silence. Pushing hard issues under the rug, or ignoring a child’s emotions—a natural sign that something is going on—won’t make things go away. Instead, it teaches kids to hide their struggles and sets up a breeding ground for shame, guilt, rejection, lack of trust and hopelessness.

So how can parents, teachers and child advocates be a trusted adult that welcomes the hard conversations? How can trusted adults encourage communication that sheds light on the root of the issue and helps them guide kids to problem solve through a situation?

Take stock. Garcia said we can’t be a trusted adult when we feel like we have nothing left to give. Ask yourself what you need as a parent so that you can be truly present with your kids. If you need help with your own struggles, reach out. Equipping yourself will help you take care of and equip your children.

“We are all doing the best we can, and we can do better,” Garcia said. “Kids need us to be present, loving, comforting, empathetic, compassionate and honest. They need to know that they can trust us with whatever storm is raining down on them. We have to take care of ourselves so that we can take care of our children.”

Harness your own emotions. Parents have emotions too. It’s easy and natural for those emotions to surface, especially when it comes to your children. But harnessing those feelings like anger and frustration in the moment can help you see and respond to the reality of the situation, rather than getting caught up in the emotion. Responding out of anger will only frustrate a child, but responding out of love, patience and wisdom will teach them important coping skills that will benefit them for life.

 “One of the most important factors in creating a safe space is responding to your child in a calm and compassionate manner,” Benners said. “When adults regulate their own emotions during conversations, it helps those around them feel more at ease or relaxed. Parents can help foster open conversation by being honest about their own feelings. By calmly expressing our feelings during periods of stress, for example saying, ‘I’m feeling very frustrated at the moment and I need a few minutes to calm down,’ we help normalize feelings and we teach our kids an adaptive way to express them and to ask for help.”

Watch their cues. Kids will demonstrate they need to talk through their emotions and behavior.

“When we bottle our feelings up, they tend to come out in other ways,” Benners said.

Stomachaches, headaches, fatigue, difficulty concentrating, sleep problems, irritability, meltdowns and oppositional behavior are all indicators that your child might have something weighing on their heart and mind.

Listen. This is the most important thing an adult can do for a child, according to Garcia.

“Trust comes from actively listening without judging,” he said. “Listening with empathy, compassion and curiosity is how we encourage kids to share openly.”

Embrace your child’s communication style. Kids communicate in different ways. The key is to figure out what works best for them at their current age and stage of life and go with it.

For younger kids, play is always a good communication tool.

“What kids can do in play, they can do in life,” Coover said. “I like to give a young child a toy, like a dinosaur, and throw out a scenario. Maybe T-Rex is bullying and saying you’re green, fat and ugly and pushing. If the child doesn’t have good coping skills, the dinosaur will just sit there.”

That’s when you can start talking to them about how they would handle the situation. Ask questions that help them think through how to respond. Could you tell mommy dinosaur? Can you walk away?

For older kids, especially teens, seizing the moment while you are doing another activity together is a great way to set the stage for conversation.

“I'm a big fan of asking kids questions when you're on a car ride,” Coover explained. “There's something about that side-by-side movement where they don't really have to look at you. Maybe music is playing. You get the vibration of the car. You're not really looking at them because you're concentrating on the road. Then, all of a sudden you can get all of this information from them.”

Striking up a conversation around the dinner table is another good way to check in. Coover suggests asking your child what was one thing that made them mad, sad, happy and worried that day to get the conversation flowing.

When a child can’t find the words to speak, let them draw it or write it.

“Some kids either don't have the verbiage to be able to say it or they're feeling insecure or are afraid you're going to get mad,” Coover said. “So they'll feel more comfortable writing it. I really like notebooks for pre-teens and adolescents. Like a regular composition book. Nothing fancy.

Tell your child, ‘if there's something going on you can write it and put it right here and I'll read it and respond to you.’ With little kids, if you have them come home and just draw about their day, it’s amazing what you’ll find out.”

Be an equiper, not a fixer. It’s easy for adults to want to fix a problem for a child. That takes a lot less time than letting a child express what they are thinking and feeling, but that’s not always beneficial.

“When we constantly fix things for our kids, their brains don't grow,” Coover said. “They become adults who can't manage any kind of problem in life because they've never had to. Someone has always stepped in and just took care of it for them. So their brain didn't grow in that way. They didn't create those neural pathways to know how to consider their solutions. I think it’s important that parents know that they don’t necessarily have to fix that feeling, but actually ask if their child wants advice or insight.”

Encourage them. Help them think through the issue, and make sure they know that you are here to help them figure things out.

Check in. No matter how you communicate with your child, it’s important to check in with them regularly.

“Allocate designated time with your children on a weekly basis,” Benners said. “Put your devices away and just focus on having fun together. Teens often feel like they don’t have much control over their lives, so allow them to choose an activity that appeals to them. During this time, don’t be overly intrusive by asking questions. Instead, follow your child’s lead and you may find that they will eventually open up on their own.”

When your kids know that you can be a trusted sounding board and source of wisdom for them, you’ll have the opportunity to equip them with the life skills they need for healthy living, hopefulness and resilience.

The onset of loneliness, anxiety and depression in teens and adolescents during the COVID-19 pandemic has fueled a sharp rise in reports of dangerous eating behaviors.

The National Eating Disorders Association (NEDA) helpline saw a 54% spike in calls for support and resources to treat anorexia nervosa, bulimia, binge eating and other illnesses. Experts blame the surge on factors including stress, isolation and excessive use of social media during the coronavirus lockdown beginning last year.

Health care professionals have long known that eating disorders can be brought on by major life changes. Specialists say that for some young people who already were predisposed, the disruptions from COVID-19 triggered a full-fledged illness or a relapse from their recovery.

“Eating disorders are somewhat of a secret disorder. The more isolated you are at home, the more these types of disorders thrive,” said Joy Crabtree, a licensed psychologist at Cook Children’s. “These disorders often go hand-in-hand with anxiety disorder and depression, and the pandemic has played a role in that.”

At Cook Children’s, we initiated the Joy Campaign – a weekly series of stories addressing mental health issues in children and teens – in response to an alarming rise in suicide attempts in the past year. Eating disorders carry an elevated risk of suicide, particularly in those who suffer from anorexia. One out every of five deaths among anorexics is by suicide, according to the NEDA.

But the hopeful news: Although serious and complex, eating disorders can be treated through a combination of medical, behavioral and psychological tactics. Early diagnosis and intervention lead to better outcomes, Crabtree said.

Keep in mind a few key points:

• Eating disorders cover a spectrum of mental and physical illnesses that in the most severe cases lead to death. Anorexia typically involves severely restricted calorie intake, dramatic weight loss and distorted body image. Binge eating involves rapid and often secretive consumption of large amounts of food. Bulimia causes cycles of binge eating followed by forced vomiting, misuse of laxatives and/or excessive exercise. More information and other types of eating disorders are listed here.
• Eating disorders happen more commonly in girls and women, although boys and men can struggle too. The disorders affect people regardless of age, race or body shape.
• The American Academy of Pediatrics reported the estimate that 0.5% of adolescent females in the United States have anorexia nervosa, and that 1-5% meet criteria for bulimia.

Depression often co-exists with eating disorders. When it comes to adolescents, studies cited by the National Library of Medicine recommend a strategy of aggressively treating the depression and not just the unhealthy eating behaviors alone. Studies also recommend routine monitoring for signs of suicidal ideation, which surface when someone doesn’t want to live anymore.

The reported rise in new or recurrent eating disorders remains a relevant story, even as many of the COVID-19 restrictions have ended, because these illnesses require specialized and sometimes long-term care. As one dietitian put it … eating disorders don’t go away overnight. Treatment options range from outpatient visits to residential care to hospitalization for complications from severe malnutrition (heart disease, organ failure and electrolyte imbalance in the most extreme cases). But access to treatment isn’t always available.

In the past year, inquiries about eating disorders have trended up at Cook Children’s, although the medical center’s behavioral health Intake department doesn’t keep an exact count. Crabtree sees a tie-in to the general anxiety and depression that the COVID-19 pandemic inflicted. She listed contributing factors such as last year’s school closures, cancelation of extracurricular activities and separation from friends.

What else came into play during the pandemic? Lack of routine for sleeping and meals. Poor coping skills. Messages about food hoarding. Fears about weight gain. Pressure to look thin in social media photos and on the Zoom screen.

“Seeing yourself on camera, seeing others on camera, making those comparisons has played a role” in the rise of eating disorders, Crabtree said. “It was kind of a perfect storm, all this focus on food and bodies. It was very overwhelming.”

She urged parents to watch for signs of eating disorders in kids. Red flags include preoccupation with dieting, dramatic weight loss, withdrawal from friends, fatigue, dizziness, fainting, anemia, hair loss and menstrual irregularities. Anyone with concerns should contact their child’s pediatrician or call Cook Children’s to discuss referral options or possible psychological or psychiatric treatment, Crabtree said.

Getting started on treatment

Jean Mankin, a registered dietitian with Cook Children’s Outpatient Nutrition Services, works with primary care physicians to help with food allergies, obesity, picky eating and other issues. When it comes to someone with significant weight loss, Mankin starts by trying to determine whether the patient’s weight fluctuation is intentional.

“If you feel like they’re purposefully withholding food or telling you that they’re binge eating or purging, it’s important to get help,” she said. “A lot of kids are finding themselves having issues they didn’t have prior to the pandemic.”

Mankin emphasized that adolescents need to eat a well-balanced and sufficient diet because all vital organs and bone are rapidly growing and developing at this stage. Anxiety and depression can cause a dramatic decrease in appetite for some, and for others it can lead to stress eating or binging. As long as mental health problems go unresolved, the eating behaviors won’t improve, she said.

At Cook Children’s, patients with suspected eating disorders are referred to local specialists such as Carol Ann Darwin, a registered dietitian in Fort Worth who has met over her career with clients from age 8 to age 70. In April 2020, Darwin started seeing a big increase in anorexia and bulimia mainly among the 13- to 17-year-old set. She called the pandemic a nightmare.

“I went from working three days a week to working six days a week just to get these kiddos in,” Darwin said. Some individuals with eating disorders had to be hospitalized with feeding tubes until spots opened up in residential treatment centers, she said. Dietitians, therapists and treatment centers in North Texas and nationally still have waiting lists up to a month, Darwin reported.

The pandemic caused an onslaught of maladies that Darwin’s youngest clients bring up: isolation, stressful dynamics in a quarantined household, frustration with online school, loss of control. Food became a crutch to comfort and to alleviate loneliness. The challenges that were particular to 2020 compounded the usual causes of eating disorders, such as genetic predisposition and being bullied.

There’s no quick fix; Darwin typically meets with her clients in weekly nutrition consultations for two or three years – although the time frame can be less for those whose underlying depression and anxiety are mild. She said she prefers to use “gentle nudging,” rather than scare tactics, to motivate her clients to start eating appropriately.

“I’ve had several (clients) where I thought, ‘Would this have happened if COVID hadn’t come along?’ Maybe not,” she said.

Disconnection and disappointments

Dawn Dillon, a therapist in Fort Worth who has specialized in eating disorders since 1998, characterized the current demand for mental health services as an explosion. Disordered eating can come from the instinct to take action during times of uncertainty and fear, Dillon said. She drew an analogy to the people who rushed out to buy toilet paper in the early days of the pandemic. The same instinct applies to food and body image.

“We take all these things that are messy, uncertain or scary, and we manifest it through our body,” Dillon said. “Instead of saying ‘I’m scared, I don’t know what to do,’ it gets put onto the body as ‘I’m fat. There’s something to do with that – I can lose weight. I can sculpt. Or I can tone.’”

Eating disorders can originate out of a misplaced attempt to manage distress when someone feels stuck or trapped. Dillon listed a variety of scenarios that particularly applied to life for teens and young adults during the height of the COVID shutdown: Disconnection from social support. Disappointment when prom and graduation got called off. When will colleges and dorms reopen? So many unknowns.

Additionally, refusal to eat can be a way that teens, like toddlers, exert their separate identity. “In a home with no personal space and no autonomy, a lot of times eating disorders will creep up because it’s a way to assert boundaries,” she said.

Once a patient’s medical condition and food intake have stabilized, Dillon said, the mental health piece of treatment becomes vital to get to the root of the anorexia, bulimia or binge eating. Everyone involved in treatment stays vigilant for warning signs of suicide.

No one chooses to develop an eating disorder. Dillon’s current clientele includes first-timers as well as patients with persistent struggles in and out of treatment. Some patients who were handling recovery well prior to COVID-19 had to return for more therapy.

“From the research, we know that life-stage transitions are high-risk times,” she said. “You look at this pandemic, and it was a huge transition that nobody planned for, nobody expected, and nobody knew how to do it. So it makes sense that there would be a rise” in cases.

Dillon acknowledges it can be a terrifying experience for families to go through. Don’t blame yourself or make it a power struggle, she advised. “It’s hard on parents on a fundamental level, but it’s not their fault. The goal is to be aligned with your loved one as the two of you fight against the eating disorder together rather than the two of you fighting with each other.”

Imagine living through a tornado. The wind howling over the sound of sirens. Lightning illuminates your home. Then, you hear it - the roar. You watch the ceiling start to give way. Fear turns to panic. Running on adrenaline, your body prepares for the worst.

This is what trauma can feel like. While a severe weather event can be traumatic, there are many reasons a person may experience trauma. It is defined as anything that overwhelms a person’s ability to cope. But trauma isn’t always easy to spot, even though its effects can last a lifetime.

“There are three different kinds of trauma. The first is acute, or a one-time event like a dog bite or car wreck,” said Denise Coover, LCSW, a trauma informed care specialist at Cook Children’s Medical Center. “Then there’s chronic trauma, where you may have several things happening at once, like domestic violence at home and bullying at school. Complex trauma happens when traumatic experiences occur within the context of a close relationship, such as sexual abuse committed by a family member, or someone who should keep you safe.”

During a traumatic event, the body releases two major stress hormones: norepinephrine and cortisol. Similar to adrenaline, norepinephrine boosts the heart rate and controls the fight-or-flight response. Cortisol is your body’s main stress hormone and slows non-essential functions, like digestion, when a threat is perceived.

“If your body experiences this stress response on a regular basis, it can cause long-term health problems,” said Kia Carter, M.D., co-medical director of Psychiatry at Cook Children’s. “A lot of people don’t realize that chronic exposure to stress hormones can cause high blood pressure, obesity, diabetes, issues with sleep and fatigue, as well as feelings of depression and hopelessness.” 

These hormones can also increase your memory of the event, leading to flashbacks, nightmares and PTSD. But when it comes to memory overall, people who’ve experienced significant trauma may find it hard to remember in general. This is due to the part of the brain that stores memory, the hippocampus, being overexerted.

The amygdala is another part of the brain affected by the stress response. This region controls emotions and can cause someone to react differently to something as simple as a door slamming. You can think of the amygdala as the brain’s ‘watchdog.’

“If someone has experienced something like domestic violence or a shooting, they may be sensitive to loud noises,” said Dr. Carter. “That’s because their amygdala is working overtime to keep them safe. We call this hypervigilance.”

For children, hypervigilance can make it hard for them to concentrate at school and follow directions. Instead of focusing on the classroom, their brain may be trying to anticipate what bad thing is going to happen next.

The prefrontal cortex is connected to the amygdala and is responsible for rational thinking. Chronic stress in childhood can damage the prefrontal cortex, which is still developing, and lead to a survival response being triggered even when there is no danger.

Understanding Trauma

According to the National Council for Behavioral Health, 70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. That's 223.4 million people. 

“Sometimes, when people experience trauma, they will compare themselves to others. For example, they may say, ‘I’m not a Syrian refugee so I haven’t experienced real trauma,’” said Coover. “But it doesn’t matter, if something overwhelmed your ability to cope, that makes it traumatic for you.”

At Cook Children’s, 94% of hospitalized psychiatry patients in 2020 reported experiencing at least one form of trauma. Untreated trauma in children can cause a number of problems including behavioral issues, mood swings, depression, anxiety, self-injury, hopelessness and thoughts of suicide. Kids may feel isolated because of how the traumatic event has affected them. Coover says it’s important for parents and teachers to be aware of the signs of trauma because they’re not always obvious.

“A child who’s falling asleep at school may seem like a problem student, but when you start digging into their history you may realize that they don’t feel safe at home and they’re in survival mode. But when they’re in the classroom, they feel safe so all of the sudden they can sleep,” she explained.

Another sign of trauma in both children and adults is physical pain without a known reason, called somatic symptoms. This is often seen in the form of migraines, stomach aches, and rouge pain the body that is not associated with injury. This phenomenon has been documented by experts such as psychiatrist Bessel van der Kolk in his book ‘The Body Keeps the Score.’ Kolk claims that stress and trauma becomes stored in the body if not addressed, and can eventually lead to illnesses such as autoimmune disorders and cancer.

“Whether you remember the trauma or not, your body always does,” said Coover. “I’ve had parents tell me this or that happened but their child was too young for it to affect them and I have to tell them, “No, that’s not the case.’”

Some examples of childhood trauma include:

• Physical, sexual and emotional abuse
• Neglect
• Domestic violence
• Homelessness
• Parents with untreated mental illness and/or substance abuse
• Divorce
• Bullying
• Losing a parent
• Incarceration of a parent

“Domestic violence is one that seems to surprise people, because they think if the child isn’t being hit it doesn’t affect them,” Coover said. “But it absolutely does, even if they just hear it. Sometimes what they’re imagining is even worse, or maybe it’s spot on. And kids tend to blame themselves for their parents fighting. They take on that guilt even though it’s not theirs to carry.”

Experts like Coover and Dr. Carter also warn that isolation triggered by the COVID-19 pandemic has led to even more traumatic experiences for many kids, especially those growing up in unhealthy environments. With so many students being forced into virtual school last year, their ability to escape and connect with people outside of their home was taken away.

“We are starting to see more kids talk about the effect the pandemic has had on them,” said Dr. Carter. “I had a patient tell me recently they’d been home alone for many months and hadn’t been able to see their friends or other people. They said they were tired of living that way, this patient became hopeless about life changing, which resulted in this patient attempting suicide.” 

The Power of Sharing

Dawn Hood-Patterson, Ph.D., thinks about trauma in the context of her own life. At 17, she was living in Colombia with her family when her trauma story began.

“I lived in Colombia during the time when Pablo Escobar had a grip on many regions in the country—there were car bombs, protests and the sound of gunshots. During that period of unrest, my dad was murdered outside our home,” she said. “So when I think about my trauma story, I think about what fostered my capacity for dealing with that.”

Dr. Hood-Patterson attributes her resilience in part to her parents who gave her a loving and supportive home. She also credits the school counselors who recognized that her frequent stomach aches were not just random pain, but the result of the stress that comes with living in a country experiencing civil unrest.

“It was all the adults who recognized the trauma was bearing impact on my life, and who said, ‘This trauma is real and we see Dawn in the midst of it,’” she said. “These same people gave me tools that helped me make meaning out of the chaos. And they said, ‘Here are some friends around you that have experienced similar things so you don’t feel so alone.’”

As program manager of Community Health and Adverse Childhood Experiences at the Center for Children’s Health, led by Cook Children’s, Dr. Hood-Patterson is using her experience to help people in North Texas. She’s part of the team behind The ACEs Task Force.

Adverse Childhood Experiences (ACEs) is a term based on a study conducted between 1995 and 1997 by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC). The study, which involves 10 questions about what a person experienced before the age of 18, shows ACEs are associated with high-risk behaviors, chronic disease and reduced quality of life in adulthood. In 2019, The ACEs Task Force unveiled their “Blueprint for Safe, Healthy and School-Ready Children”. The plan includes 25 ways pregnant women, families, children and caregivers need to be supported in order to counteract adversity. Access to health care, healthy food, quality, affordable and safe housing are among the top concerns. Transportation, mental health services, substance use disorder treatment and high quality, affordable child care are also priorities for the task force.

Currently, Dr. Hood-Patterson and team are working on a project that would create support groups for parents and caregivers living with adversity. The so-called ‘Caregivers Alliance’ is part of the Build-a-Bridge program, led by Cook Children’s, and is in the early planning phases. It would focus on giving people a chance to share their stories of trauma and connect.

“This was born out of conversations that we had with community partners where we learned that a lot of people who are struggling with adversity often feel like they have a laundry list of things to do,” she said. “For families who receive things like housing assistance or SNAP benefits, every conversation they have is about updating paperwork and not missing deadlines. We envision this alliance to be a space where people can be seen and heard, and support one another.”

The Caregivers Alliance would also include access to education from the Center for Children’s Health for topics like car seat safety, water safety, safe sleep practices and more.

“I’m a believer that something powerful happens when we share out stories with each other,” said Dr. Hood-Patterson. “When we have the opportunity to share our stories, whether they’re of triumph or trauma, it hones our ability to make meaning out of the seemingly meaningless chaos of suffering.”

Over the past few weeks, we’ve published a series of articles about the mental health crisis shaking the foundation of our youngest generation. It’s been a difficult and heart-wrenching conversation as, together, we’ve opened our eyes to this issue. This week, we want to bring you some good news.

An innovative yet practical collaboration that embeds family therapists into Cook Children’s Neighborhood Clinics (NHCs) is expanding access to mental health services for children in some of Tarrant County’s most underserved communities. It’s a silver lining, if you will, amidst a rapidly growing crisis.

The Crisis

The critical issue of mental health struggles among children isn’t a new one. It’s been lurking under the surface for years. One Centers for Disease Control statistic states that the percentage of children ages 6 to 17 who have ever been diagnosed with either anxiety or depression increased from 5.4% in 2003 to 8% in 2007 and to 8.4% in 2011-2012. To put skin on that, approximately 4.4 million children in the U.S. ages 3 to 17 have diagnosed anxiety, and about 1.9 million have diagnosed depression. Couple that with an inadequate supply of mental health professionals across that country and you have an undeniable gap in mental health care for hurting kids. According to the American Academy of Child and Adolescent Psychiatry, there are only 8,300 practicing child and adolescent psychiatrists in the United States—a country with 74.2 million children.

Pile a pandemic on top of all of that and you have the makings of a nationwide mental health disaster. In many ways, COVID-19 opened Pandora's box. For millions of children, each measure taken to address the virus either triggered a new mental health struggle or exacerbated an existing one. The results are devastating, evidenced by the record number of children attempting or committing suicide. Some as young as 5 years old.

“I would say that, compared to last year, I have certainly experienced and seen a significant rise in the number of patients reporting anxiety, depression and even suicidal contemplation,” said Vida Amin, M.D., Neighborhood Clinics and Population Health Advisor.

The Silver Lining

Cook Children’s Health Care System took note of the adolescent mental health situation and the gap in services years before the start of the pandemic. Concern turned to action when the system began including mental health outreach as one of its yearly strategic initiatives. Over the course of several years, these initiatives have evolved from requiring universal depression screenings for all adolescents to improving access to mental health care for patients of Cook Children’s Neighborhood Clinics in fiscal year 2021. This latest initiative steered the concept of integrating family therapists into the primary care setting.

The program launched in December 2020—perfect timing given the pandemic’s toll. Three licensed family therapists rotate through Cook Children’s seven Neighborhood Clinics each week providing services that range from mental health evaluations to outpatient counseling to education for families and clinical professionals.

In its first month, NHC physicians and nurse practitioners referred a little more than 100 patients to the therapists for evaluation. By April 2021, that number had grown to more than 380 in a single month. So far, more than 111 patients have received outpatient counseling through the program.

Breaking Barriers

This care model helps alleviate three critical barriers for families seeking mental health services—access, cost and a reluctance to trust someone new with something so sensitive.

Right now in North Texas, it can take weeks, even months in some cases, to get an appointment with a therapist. There simply aren’t enough to go around. The same is true for many parts of the country.

“The demand for behavioral health care far outweighs the number of treatment providers in the community,” said Christina Reed, LMSW, director of operations at Cook Children’s Neighborhood Clinics. “It’s just too much for nonprofits and other providers to keep up with. So for us to be able to offer this to our patients gives them that access that has been lacking in the community.”

Beyond adding much needed therapists to the landscape, bringing these services in house improves access by speeding up the referral and evaluation process. It also signals that mental health is just as important as physical health. As therapists share knowledge and integrate their care plans, physicians and nurse practitioners are increasingly looking through the lens of mental health when engaging with their patients.

“It helps to demonstrate that behavioral health care is a part of health care,” said Kelly Rand, LCSW, manager of patient and family support services at Cook Children’s Neighborhood Clinics. “You don't have to go to another office somewhere that you've never been before and that’s not familiar to get that support. It crosses that barrier to where it's not two separate services. It's all health care, and it's all here together.”

Access and cost go hand in hand. If one can be overcome, the other is often the next big hurdle. Many private practice therapists do not accept insurance, especially Medicaid, leaving families no choice but to pay out of pocket.

“We serve primarily Medicaid families,” Reed said. “If you are a child or a family on Medicaid trying to find mental health services, that is challenging and that's no secret. It’s always been challenging. Our families are left without many options because they can't pay cash for a private practice therapist.”

Counseling services at the NHCs are billed to the patient’s insurance provider, be it a private insurer or Medicaid. If a patient is not covered by insurance or Medicaid, therapists connect them to a counseling resource in the community that offers free or sliding scale fee services.  

Opening up about internal struggles can be hard. Knowing who to trust with such personal and sensitive information factors into a parent or child’s hesitancy to reach out. Embedding therapists within the primary care clinics where patients have established relationships and familiarity with providers helps build a bridge between reluctance and trust.

“There is something that our families value when it is a Cook Children’s name behind that referral or service,” Reed said. “When it's their pediatrician saying, ‘it's this person I work with right here that can help you,’ there's a lot of comfort and trust in that in a world that can be really scary. There's still a lot of stigma. There's still a lot of hurdles to jump through, even just internally, when seeking out that service.”

Comprehensive Care

For children who need emergency intervention or more intensive care than can be provided through outpatient therapy, NHC therapists work with Cook Children’s emergency department, behavioral health intake department, partial hospitalization program and inpatient psychiatry program to get patients the level of care they need.

“The NHCs are now performing 200-plus psychosocial assessments and plans of care each month,” said Robert Goodwill, senior vice president and chief operating officer of Cook Children’s Physician Network. “This is an integral part of identifying specific needs related to the level or type of care a child may need. These added resources have resulted in increased counseling sessions at the NHCs as well as the ability to connect patients and families to other services in our system and our community.”

Of the nearly 1,200 referrals NHC therapists have received since the start of the program, depression and anxiety rank as the top two issues.

“Depression and anxiety are by far the most common,” Rand said. “A third one would be ADHD or issues around attention concentration. From there, I would say, issues around some kind of trauma transition or loss. So a death loss, the loss or separation of parents, a traumatic family event, or some kind of big transition in the household. Of course, those things contribute to and cause depression, anxiety and attention difficulties in children.”

As the rising referral numbers demonstrate, this collaboration is bringing critical services to the doorsteps of underserved communities. It’s making the mental health care space easier to navigate and offering help and hope to hurting children.

Sometimes the first step toward saving the world begins in your own backyard.

That’s the hope for Frances Wampler and Blair Williams, two staffers at the Center for Children’s Health led by Cook Children’s, who are part of a team exploring how communities might target youth suicide as a standalone issue.

There are several “ifs” to contend with, but the two women believe it’s worth exploring the steady climb of youth suicide cases in the nation and determine what’s happening on the local and state levels.

“We see it in the headlines, see it on social media—even clinicians are expressing concern over it,” said Williams, who is a community health analyst and member of the community health needs evaluation team at the Center. “So, we’re seeing this as a rising need.”

Wampler and William’s decision to pursue the issue resulted from a culmination of events. In September, Wampler’s nephew, 19, died by suicide, leaving her family reeling from his death. And years earlier, Williams suffered the loss of a close family friend, a 15-year-old who took her own life. Their shared experiences, along with other data—including the Center for Disease Control’s report marking suicide as the nation’s second-leading cause of death among ages 10 to 24 in 2018 and a reported increase of self-harm cases seen at Cook Children’s last year—propelled the two women to pitch the idea of collaborating on exploring whether area communities needed help with this complicated issue.

“I know how hard it was for me and my family to experience the things we did,” said Wampler, program coordinator at the Center who focuses on child abuse. “He was my nephew, but he felt like one of my bonus kids. I felt like I lost one of my children, and I would take that heartache away from any person I could. I don’t want that to be the end of his story. He was not the last decision he made in his life...he was so much more than that.”

“I just want to do something with that—and I don’t know­­—try to save the world,” she said.

While discussing Wampler’s nephew’s death, she and Williams made note of how often youth suicide overlaps with other issues, such as firearm and poison injuries, child abuse and neglect, Adverse Childhood Experiences (ACEs), mental health and so on.

“These are things that the Center already has programming around,” Wampler said. “I was like, ‘We have to do something.’”

The two decided to take it to Center leadership and were given the green light to pursue it and “do some digging on the data,” Williams said.

“They’ve been really supportive of this,” she said. “That, to me, is really powerful because our leaders heard our concerns and supported us in our efforts to keep every child safe from injury.”

Wampler and Williams’s preliminary research efforts could potentially support the 2021 Community Health Needs Assessment. The Community Health Needs Assessment is conducted by Cook Children’s every three years to assess children’s health needs and the board uses the information to develop implementation strategies for addressing these needs.

They’re not sure how COVID-19 may affect this issue, let alone community health needs across the board, but youth suicide was on the rise well before the virus hit, Williams said. In 2012, the number of suicide deaths surpassed the number of cancer and heart disease deaths - causing suicide to be the 2^nd leading cause of all deaths in Americans ages 1-44 every year since.

“Part of it is recognizing there are several community partners and agencies that are well-equipped to handle this,” Williams said. “Part of the assessment is not only looking at the data, but it’s also looking at what resources are in the community that can be used to help.”

As it stands, the Center is in the data collection phase of the 2021 Community Health Needs Assessment process. They’ll sift through all sorts of data, such as what local health departments are seeing, what the CDC says, what the national and statewide numbers on children’s health needs show, and what’s happening inside and outside Cook Children’s walls. They’re currently conducting focus groups, a parent survey, a community leader survey, and key informant interviews, among other things. When finished, the data will be synthesized and a report published as the 2021 Community Health Needs Assessment.

Wampler and Williams are proud that the question they raised about what the Center can do to support youth suicide prevention has been met with a team approach to investigate this important topic further. They acknowledge this task is a huge undertaking. But both are passionate about getting help to children and families who need it.

Recognizing that this is becoming more of a trend is an important step, Williams said.

“There are so many great resources in our community, so many great partners. We have a wonderful health care system, a great employer who recognizes this issue. So, what can we do with these great assets and protective factors to keep kids safe from all types of harm, including harming themselves?”

Regardless of their findings and the various factors that come into play, Wampler and Williams believe ramping up awareness surrounding self-harm and suicide is key to preventing it among young people. But awareness doesn’t equate applying stereotypes, they said.

Even if children do “check off those boxes” for suicide risk factors, it doesn’t mean they’ll try suicide, Williams said. She encouraged all families to have a mental health plan to address any crisis that may arise.

“There are people who have multiple adversities and risk factors who lead very successful, healthy lives, and probably go on to help many other people, too,” she said. “It’s just recognizing that it needs more awareness. It can happen to anyone and to be prepared. If you’re in crisis, it’s going to be harder to seek out help. So, have that help lined up for you.”

Wampler agreed.

Normalizing conversations about thoughts of suicide, even if it’s uncomfortable for families, she said, also might help with prevention. Her nephew had supportive friends and family, played football in high school and had joined the military, she said, adding the family “had no idea he was feeling that way.” No one saw his suicide coming.

“I don’t think it’s talked about enough,” she said. “I don’t know how hard that would be to say, ‘I want to hurt myself.’ But you don’t have to suffer in silence. You can tell somebody that you’re struggling and get help.”

There may not be a simple answer to preventing youth self-harm and suicide, Wampler and Williams said. What leads to it and how to prevent it is often muddied by a multitude of factors, some controllable and others not.

But one aspect of it is clear to both women.

“For me,” Williams said, “if we can save one child, well, that is (saving) the world.”

“Yes. That’s right,” Wampler quickly agreed. “That one child is somebody’s whole world.”

Like an earthquake rumbling underfoot, crumpling the ground beneath, the suicide of a loved one has a way of knocking you to your hands and knees.

After the initial shock wave throws you, constant aftershocks of emotions—running the gamut from guilt to shame to horror to inconsolable sadness—may leave you struggling to regain footing long after your loved one has died.

Survivors of suicide often experience a complicated type of grief that differs from other types of bereavement, mental health experts say.

“With suicide grief, they’re dealing with a trauma on top of the loss,” says Sharon Walker, LCSW, a therapist in Arlington who specializes in complex trauma and trauma grief. “With most people who die by suicide, it’s usually violent or tragic in some way. So, the person grieving has to deal with the fact that a person chose to take their life and that how they died. That changes the grief process.”

Walker, a former longtime-facilitator of the support group Survivors of Suicide (SOS) in Fort Worth, says another dynamic comes into play—the social stigma attached to suicide.

“Death can be tragic, like a murder or a car vehicle accident. But the stigma around suicide still exists today, and so family members have to contend with that piece, as well,” she says. “It makes their grief different.”

In April 2020, the Centers for Disease Control and Prevention (CDC) ranked suicide as the 10^th leading cause of death based on its most recent data collected in 2018. It was listed as the second-leading cause of death for Americans ages 10-34 and the fourth-leading cause for ages 35-54, according to CDC reports.

It has long been accepted that when someone dies by suicide, six people are directly affected by it. But a researched-based estimate published on the American Association of Suicidology’s website suggests the ripple effect of one suicide extends far past that, personally affecting 135 people on average. Based on that, an estimated 6.9 million people are touched by suicide annually.

The Alliance of Hope for Suicide Loss Survivors, an international non-profit group that operates an online support group, lists the dynamics that can complicate suicide bereavement on its website. The factors include circumstances surrounding the loss; post-traumatic stress; stigma and isolation; prejudices involving suicide; investigations into the deaths; religious and spiritual beliefs on suicide; family and relationship tensions; and survivors’ questions about why their loved ones chose to take their own lives and whether they could have done something differently to prevent it.

Through her years working with suicide survivors, Walker has seen families experience all of these dynamics. And some, even more than a decade later, still wrestle with them.

“Grief is not something we ever get over, and it doesn’t ever stop. What we learn to do is grow around our grief, to encompass it and incorporate it or manage it into our own life,” she says. “We walk with it.”

When talking with families and friends facing a loss from suicide, she reminds them that they can get hijacked by their grief. And that everyone has their own process of grieving the loss.

“Every time you turn around—there’s a reminder, there’s a statement, there’s a feeling, there’s an emotion—and you are overwhelmed by your grief,” she says. “And as we walk with this, and you learn to understand your own grief process, it becomes something that you can manage.”

“It’s not that the grief gets smaller, but you grow big enough around it to start being able to manage it,” she says. “And then you can take it off the shelf and touch it when you want. It becomes something that you can eventually manage and live with and incorporate in your life. But as far as ever getting over it, there is no such thing.”

Many suicide survivors circle back to help other survivors find their way out of the devastation caused by a loved one’s suicide. They take the energy from their own grief and put it toward helping others, Walker says. The success behind the SOS group she ran for 18 years was because survivors returned to give back “because they knew how devastating it was to other people.”

“And the very act of sitting there and saying, ‘You can survive this. We didn’t think we were able to either, but we’re here to help you know that you can.’ Well, as a professional, I cannot convey that any more brilliantly than what a survivor can to another survivor,” she says.

Just Breathe

Brad Hunstable, CEO of electric motor company Linear Labs in Fort Worth and an Army veteran, understands firsthand the complexities that grieving families face after losing a child to suicide.

Nothing prepared him for April 17, 2020, the day a figurative “nuclear bomb” went off in his world, altering it forever. Hunstable had just finished a call when his daughter, then 8, ran to him, telling him something was wrong with her big brother Hayden. The 12-year-old had been playing his favorite video game Fortnite in his bedroom while his dad worked from their Aledo home.

Hunstable rushed upstairs to his son’s bedroom and found Hayden in the closet, unresponsive. He called 911 and tried unsuccessfully to revive him. Hayden—described as a fun-loving, active boy who enjoyed playing sports and loved life––died by suicide four days shy of his 13^th birthday.

Hayden didn’t suffer from depression or have any diagnosed mental health issues. No one could have predicted he would take his own life, his dad says.

Hunstable believes isolation during the initial COVID-19 stay-at-home mandate—attending school online and not getting to see friends regularly—took a toll on his son and factored into his impulsive decision to end his own life. It was also later discovered that Hayden had accidentally broken a large-screen gaming monitor just before his death—a monitor he used to play Fortnite and similar to one he’d broken months earlier but had worked to replace.

He was excited about his new replacement monitor and was set to have friends over to play Fortnite at his upcoming birthday party, says his dad, who founded Hayden’s Corner, which advocates mandated resilience classes for children and champions responsible gaming education, in honor of his son.

Hunstable—who also produced a short documentary about Hayden’s death titled “Almost Thirteen”—has spoken to various mental health experts about youth suicide and believes impulsivity plays a huge role. (Parental guidance and discretion is advised when watching Hunstable’s documentary because the disturbing subject matter may cause emotional distress.)

“When you look at youth suicide, 55% of them are impulsive and 50% don’t have a previous mental health diagnosis,” he says. “They may have something, but it’s not diagnosed. Impulsive suicide in youth happens because a boyfriend broke up with me…I got into a fight with my parents…a girlfriend just broke up with me…I’m being bullied.

 “In Hayden’s case, he broke his monitor for a second time right before his birthday, in the middle of a pandemic,” Hunstable says.

Developing resiliency is key in addressing suicide among children and teens, he says.

 “It’s always complicated. It’s never simple,” he says of life and what sometimes leads young people to impulsively choose suicide. “When you get the perfect storm of complexity, and they haven’t developed some resilience capabilities—and you haven’t taught them or had open dialogue about these things or it’s just too much—this is where you end up.”

Hunstable believes parents need to have “uncomfortable conversations” with their children about suicide so they know how to cope if the impulse ever hits them. Research shows that bringing up the topic of suicide in an age-appropriate manner does not plant the idea in children’s minds, he says, adding “that’s a myth.”

Find a way to help them contend with their emotions and impulses, like teaching them breathing techniques, meditation, playing guitar or screaming into a pillow, he says. Let them know it’s okay to talk about it, Hunstable adds, and if it happens when you’re not around, teach them to go to a trusted adult like a teacher or a grandparent.

What would he say to parents who are hesitant to discuss suicide with their children and methods to cope with their feelings?

“I’d say, ‘Do you want to be in my shoes?’ My son disappeared off the face of the Earth. I still struggle with that concept. He was there one minute—and then he went poof. You don’t want to do this,” he says. “It has nearly broken me. It nearly broke my family. It still might.”

“Hayden doesn’t have PTSD—we have PTSD,” Hunstable says of himself and his daughter, who found her brother. “I know it sounds like a cliché because I used to think the same thing. I’d hear parents say, ‘It can happen to your kid.’ Now, I’m that parent, saying that it can happen to your kid. And what’s scary is—it really could.”

Open up

Jamye Coffman, M.D., medical director of The Center for Prevention of Child Abuse and Neglect at Cook Children’s, knows firsthand it can happen to anyone. She lost her son Aaron, 20, to suicide on Aug. 10, 2010.

“I’ve been very open about his death, open about his suicide. And what I’ve found is that a lot of people came to me with similar stories, maybe it wasn’t their child, but with suicide in their family,” she says. “I was amazed at how many people have been touched by suicide. I think they just don’t talk about it because they don’t know how people will receive it.

“I want to talk about it because I want people to know it can affect anybody,” she says. “The rain falls on everybody, right? It doesn’t matter how good, how bad, how rich, how poor––none of that matters.”

Dr. Coffman still recalls getting the call while on vacation as she, her husband and daughter were about to enter Yellowstone National Park. The news sent her and the rest of the family reeling.

Less than a week before his death, she’d been on the phone with him. He was living and working in Lubbock, where his dad, her ex-husband, lived. He wanted to go to community college, so the two had discussed plans.

She didn’t know until after his death that his girlfriend had dumped him just before the suicide. He’d been drinking heavily that night and called a friend, who urged him to call his mom. But he never made that call.

“Obviously, he wasn’t thinking straight,” she says. “He was angry, upset, drunk, sad––all those things. But at the time, nobody really expected this to happen.”

Dr. Coffman wears a necklace with the letter “A” in memory of Aaron, who “gave the best hugs ever.” She describes him as “a super loveable guy,” who was a daredevil and enjoyed skateboarding. He was accepting of others and a good friend. He also was a great big brother to his half-sister, who was seven years his junior, she says.

“He was just a sweetheart. He would call me at times just to chat, which most boys don’t do,” she says, adding the step-family issues caused tension at times, as did Aaron’s troubles with alcohol and marijuana. “Sometimes things were strained, but we still managed to maintain a relationship through all that. We knew we loved each other.”

After Aaron died, Dr. Coffman says the pain was terrible, especially that first year. She wasn’t sure she could endure it and often found herself in her closet, her designated “crying spot.” She spent a lot of time in that closet, she says.

 “When it happens, initially, you don’t think you’re going to survive it,” Dr. Coffman says. “There’s no way around it…you have to work your way through it and own it. But even though you do, it still never goes away.

“It does get better,” she adds. “The really bad moments hit you less and less as the years go by. There are less triggers. I think it was the five-year mark when I figured out, ‘I can survive.’”

She also keeps a piece of paper tacked to a corkboard on her office wall. She doesn’t know who wrote it or even where she found it, but it has made a difference to her as a suicide survivor.

The typed words on the paper are simply put:

I don’t like it.

I don’t have to like it.

What I do have to do is make a choice about my living.

What I do have to do is accept it and go on living.

The choice is mine.

Dr. Coffman has read those words daily for more than 10 years as a reminder that the choice is hers.

Tackling the magnitude of this type of grief is different for everyone, she says. Some people do well with therapy, while others may not. Some may do better with families and friends who are present and just sit and listen. Try different things until you find what works for you, she says.

Something she learned early on at a grief support clinic and has found to be true is that there are three camps of people: Those who are hurtful. Those who are neither hurtful nor helpful. And those who are helpful.

“Go to the helpful, avoid the others,” she says for those grieving the loss of a loved one’s suicide. “There were some people that I had to just not communicate with because things they said were hurtful––things they didn’t mean to be hurtful. But, you know, things like, ‘God has a reason for everything.’ Well, when you have somebody die, there isn’t a good reason. That’s not helpful.”

What was helpful for Dr. Coffman was a supportive family and friends. Those who didn’t try to fix anything but would listen when she needed to talk and let her cry when she needed to cry. It made the difference because “it was somebody who really understood me, understood Aaron,” she says.

The family also continues to talk about Aaron, which was important, she says. They still laugh together about the “silly things he did.”

“Whether it’s the cousins or my parents or his brother or sisters…we still have memories and talk about them,” Dr. Coffman says. “I think that’s important––to keep that person alive in your heart. And I think it’s one of the hardest things for people who’ve not experienced something like this. They don’t want to say their name or talk about it because they’re afraid it’ll bring up something bad for you. Well, the bad is always there. But knowing people still remember him and can talk about him and remember the fun things about him, that’s important.”

Like many parents who lose children to suicide, Dr. Coffman also struggled with self-blame and guilt after her son’s death and battled her share of “what-ifs.” She needed reaffirmation that she was a good parent and a good person. That affirmation came from a woman who worked as a secretary at Cook Children’s Emergency Room at the time of Aaron’s death. The woman, who lost her brother to suicide, sent Dr. Coffman a letter, which she says she carried in her purse for many years.

In the letter, one of the things the woman wrote was, “We do the best we can with what we know at the time.” It’s a message that applies to most everything, she says, but as a grieving parent who lost her son to suicide, it was really helpful.

“I had to remind myself of that over and over because any mistakes I made as a parent weren’t intentional. They were done because I thought it was the right thing to do,” she says. “So, hearing that from her, in what she had gone through with her brother…when I would get into the depths of guilt, I would have to preach that to myself, and I would pull out the letter and reread it.”

The death of Aaron has had a lasting effect on Dr. Coffman and her family. It changed every part of her, and it was for the better, she says.

“I don’t think I could ever be the same person,” she says. “I always tell people it has changed me down to the molecular level. It affects every part of you. It can get changed for the worse…you can become bitter. Or you can choose to change in the sense of ‘let me learn from this, let me see what ways I need to change to be a better person.’”

After his death, she did a 180-degree turn on her parenting style “because it changes your ideas of what’s important and what’s not important,” she says. She became more accepting of others, something her son excelled at. And though she thought she was already a kind person, his death helped her become even more so, Dr. Coffman says.

She wants her son to be remembered and encourages others to talk to suicide survivors about their loved ones. It’s one of the most important parts in their healing process.

“It may help them to know that someone else is thinking about their child and has fond memories. And that that person, like Aaron, affected their life in a good way,” Dr. Coffman explains. “Especially when they die young and haven’t had the opportunity to really do a lot. But, even in a short life, they made a difference and still make a difference. Because (Aaron’s life and death) changed me. It changed my husband. It changed my daughter. It changed us to be better people.”

You matter

North Richland Hills resident Ellen Harris understands that sentiment. She lost her 22-year-old daughter Jordan to suicide on March 27, 2012.

Not long after, she and her husband Tom started The Jordan Elizabeth Harris Foundation to ensure their daughter would be remembered. The Fort Worth-based non-profit group focuses on suicide prevention training and awareness, as well as funding research efforts in depression.

“There’s no question that the foundation was and continues to be therapeutic for us because it’s our way to honor her life,” Harris says. “And to bring awareness to a subject that people weren’t willing to talk about.”

Jordan was a former valedictorian and National Merit Scholar in high school and named a Stamps Scholar at the University of Michigan, where she was about to graduate with a degree in organizational studies, a field that focuses on social justice. She had been diagnosed with depression the last six months of her life, which came as a surprise to the Harris family.

None of them would have described her as depressed. Instead, Harris used adjectives like “loving and joyful,” “funny,” “smart” and “full-of-life” to describe her eldest child of three, who loved to travel and help others.

“She didn’t want to worry us, so she never let on. I can remember my brother-in-law over Thanksgiving making the comment that she was the happiest depressed person he had ever known,” Harris says. “So, deep inside, she was struggling, and none of us knew the extent.”

Jordan had done well in college but wasn’t sure what she would do after graduation. She had high-performing roommates and friends who “all seemed to know what they wanted to do. And she didn’t, which weighed on her heavily,” her mom says. “I think she believed she was a failure.”

She had told her mom she was a disappointment to the family and hadn’t done much right in life. Which couldn’t have been farther from the truth, says Harris, adding she has no doubt her daughter was dealing with mental illness at the time of her suicide.

 “She became severely depressed, only I didn’t know what that meant,” she says. “I didn’t know what depression looked like.”

Looking back, she also believes Jordan had “hit a bump in the road” but didn’t have the resilience to overcome it, Harris says. Her daughter had excelled academically, had lots of friends and was pretty. Even though she worked hard for her grades, she hadn’t had to struggle for most of her young life, Harris says.

“I think resilience is a huge part of protection when it comes to suicide,” she says. “That’s part of my theory. I think she just didn’t have a good personal resource for bouncing back when she dealt with adversity.”

“It’s really important that children do (face adversity), even if it’s breaking up with a boyfriend or having acne or something that causes you to struggle a little bit,” Harris says. “I think you need to let your kids fail and figure out how to succeed again without you fixing it.”

Jordan’s death left an “enormous hole” in her heart, Harris says, and she faced a difficult time, especially in the early days. She still can’t watch a video of her daughter, and “I don’t know how long it took me before I could even look at a picture of her without feeling crushed,” she says.

For suicide survivors, it’s important to get a support system in place to help them because the suicide rate for people who have lost someone to it is higher compared to the general public, Harris says. While trying to cope with Jordan’s death, she and her husband tried therapy and various grief support groups but acknowledged that neither of them is much of “a sharer.” Reading books about people who had experienced what she had seemed to help her, she says.

And she immediately put her son and daughter, who were both attending the University of Texas at Austin at the time, into therapy to help them deal with Jordan’s suicide. Both were extremely close to her and devastated by her death. That seemed to help them cope with the loss of their big sister, Harris says.

“Whether it’s going to your church or wherever you find comfort, I think it’s important” to get support, she says.

 It took more than a year for Harris to feel comfortable in large social groups.

“I hated the look in people’s eyes, you know, how sorry they were but how glad they were that it wasn’t them. I mean, let’s face it, that goes through people’s heads,” she says.

Harris also saw firsthand the social stigma attached to suicide. One of the foundation’s missions is to address that issue. From the beginning, she and her husband didn’t try to hide that Jordan had taken her own life. So many people with similar stories approached her, but they had never let on about what really happened with their loved ones, Harris says.

“I think death and serious illness, in general, kind of bring out interesting traits in people,” Harris says. “There were people who didn’t come around and didn’t call because they were obviously uncomfortable with what had happened and with the subject of death, perhaps, and especially the death of a child.”

“But there were other people, who were not necessarily our best friends, who just really stepped up and supported us,” she says. “Some people don’t know how to talk about things like that, and death especially is a really difficult subject. But death by suicide––there’s still such a huge stigma attached to it.”

The foundation’s goal is to have conversations with the public to eliminate that stigma and create an understanding of what’s actually behind the act of suicide. For instance, a common misconception is that those who die by suicide are just selfish, Harris says.

But, in their minds, they’re doing the opposite of selfish, she says. Many of those who kill themselves think they’ll be a burden to their loved ones for the rest of their lives and everyone would be better off without them. With the love she had for her family, Harris says, Jordan wouldn’t have taken her own life if she had been thinking clearly or really understood what her family and friends would face for the rest of their lives.

“It’s not a selfish act on their part,” she says. “This is reaching a depth of hopelessness so deep that they can’t even see anything except how they get out of this pain.”

“They don’t want to die,” she adds. “They just don’t see any other way out.”

TXT4 Tarrant Cares offers a convenient, safe and simple way to search for assistance with food; clothing and housing services; early childhood care; family support; mental health and counseling services; substance abuse programs; child abuse and neglect services; COVID-19 testing and vaccine information; and other critical needs.

By texting the word FIND to 67629, users are offered a guided search to access a list of nearby organizations to contact and provided with a ZIP code-specific list of resources. TXT4 Tarrant Cares is offered in English and Spanish and is available to anyone in Tarrant County in need of services. Examples of searches might include information on the nearest food pantry, rent assistance, or resources that can help residents apply for Supplemental Nutrition Assistance Program (SNAP) benefits.

The new texting service is associated with Tarrant Cares, an online information service populated with the most up-to-date community resource listings by United Way’s 211 helpline. TXT4 Tarrant Cares draws on the Tarrant Cares database and gives users a quick, ZIP code-specific report of nearby resources to contact for support. The community-based solution is a collaborative effort by Mental Health Connection of Tarrant County (MHC), The Center for Children’s Health, led by Cook Children’s Health Care System, and Tarrant County.

“We have a lot of amazing local organizations and nonprofit agencies standing by to support individuals and families in our community, but sometimes it can be tough to figure out where to turn when you are in the midst of a crisis,” said Tarrant County Judge B. Glen Whitley, who founded the Tarrant Cares website with MHC in 2010. “TXT4 Tarrant Cares puts those answers in the palms of their hands, literally.”

The need for the new service came from feedback by a local task force chaired by Cook Children’s that studied the impact of Adverse Childhood Experiences (ACEs). These experiences include exposure to abuse or neglect, family violence, mental illness, or any experiences that can disrupt a child’s development and lead to chronic health conditions. The ACEs Task Force worked with more than 60 partners and advisers in developing community recommendations to prevent and reduce adversities in children prenatally to age 5, to improve their health, safety and school readiness. Findings by the task force determined that getting help into the hands of local families most at risk of ACEs meant creating a more efficient and effective way for those families to access critical resources.

 “Texting is probably one of the best ways to communicate resources and information because people feel more comfortable texting than they do picking up the phone,” said Roderick F. Miles, a member of the ACEs Task Force and executive administrator in the Office of Tarrant County Commissioner Roy Charles Brooks. “Our vision is to keep people from falling through the cracks and we do that by creating space for them to advocate for themselves and be their own navigators, their own social workers—and then they become advocates for other people and help them navigate through the process as well.”

“The collective, long-term financial cost of not meeting the physical and mental health needs of our community’s most marginalized and vulnerable families is high, and the individual human cost is much higher,” said Virginia Hoft, executive director of MHC. “TXT4 Tarrant Cares is an important step forward in our efforts to level the playing field by giving everyone in our community immediate access to vital resources.”

TXT4 Tarrant Cares does not provide emergency response or the full range of service offerings provided by 211. A resource navigator can still be reached by calling 211 and information about services can be accessed online at www.tarrantcares.org. Individuals needing immediate assistance from a first responder should still contact 911.

About the ACEs Task Force

In 2019, the Tarrant County ACEs Task Force, created Circles of Support, a Blueprint for Safe, Healthy, and School-Ready Children. The effort was led by Cook Children’s Health Care System; the office of Mayor Betsy Price; the Office of Tarrant County Judge B. Glen Whitley; the Office of Tarrant County Commissioner Roy Charles Brooks; JPS Health Network; and supported by the Morris Foundation. The need for an easy-to-use texting service is a component of 25 priority recommendations detailed in the Circles of Support blueprint to assist families through difficult times.

About TXT4 Tarrant Cares (67629)

Launched in April 2021, TXT4 Tarrant Cares is a community-based texting service designed to help individuals and families in Tarrant County locate information on where to obtain critical resources—including food, housing, counseling, and childhood services. The texting service offers a guided search and delivers ZIP code-specific access to a database of local agencies and service organizations. TXT4 Tarrant Cares is an extension of Tarrant Cares, an online information service for individuals, families, caregivers and agencies. The community-based solution is a collaborative effort by Mental Health Connection of Tarrant County (MHC), and The Center for Children’s Health, led by Cook Children’s Health Care System, and Tarrant County.

One year into COVID-19, it’s clear the pandemic is taking a toll on the mental wellbeing of children and teens.

In March, a record 43 patients were admitted to Cook Children’s Medical Center after attempting suicide. This staggering figure is nearly double the number of suicidal patients seen during the same time period of 2020. Even worse, kids are dying. Last year, Cook Children’s recorded seven suicide deaths, marking the first time suicide was the leading cause of trauma deaths at the hospital, surpassing child abuse and car wrecks.

“The mental health crisis was already happening, then it met a global pandemic and these are the consequences,” said Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s.

“They’re less engaged and have less interaction with others, and instead are spending more time online and in virtual settings. And it’s hard for them to be hopeful about anything because so many things, like prom and graduation parties, are canceled.”

The issue is not unique to North Texas. Doctors and nurses from across the nation are reporting similar statistics. In February, NPR released an article titled “Child Psychiatrists Warn That The Pandemic May Be Driving Up Kids' Suicide Risk.” It found that children’s hospitals across the U.S. are seeing up a 250% increase in suicidal patients in emergency rooms since the pandemic began. While there are no nationwide numbers on child suicides in 2020 available yet, experts agree there is reason to be concerned.

The Impact

More children are suffering from stress, anxiety, depression, and suicidal thoughts than at any time in recent memory. Pediatricians like Kathleen Powderly, M.D. from Cook Children’s Pediatrics Magnolia say children as young as 7 are needing help.

“I’ve had a couple of elementary school students, which you don’t see very often, who are actively suicidal or have already had a suicide attempt. I’ve also managed more kids on antidepressants since the pandemic because it’s hard to get into doctors right now,” Dr. Powderly said. “COVID-19 is not as impactful in terms of volume of cases in pediatrics, but our volume of psychiatric patients has increased quite a bit.”

Previously, Dr. Powderly was the medical director of Cook Children’s Hospitalist Group, the attending physicians who care for children in the hospital. She says her team was seeing an increase in suicidal patients before she transitioned into the office setting five years ago and that the pandemic created a perfect storm. On top of the stressors kids were already dealing with, they’re now struggling with isolation, virtual school, and a loss of activities.

“We’re not going to be able to flip the switch and just go back to normal when this is over,” said Dr. Powderly. “This is going to take some time to come out of. I’ve even had patients tell me they’re struggling with being around people.”

Members of Cook Children’s Youth Advisory Council shared similar experiences in a recent meeting. The teens said they feel more anxious being around their friends in person because they’re so used to only seeing people online now. In addition to new stressors, there is a severe lack of mental health resources across the board.

A Growing Need

“There weren’t enough psychiatric beds to begin with, and then COVID happened and the capacity was reduced because you can’t have patients sharing rooms,” said Dr. Pyrc.

The need for more inpatient psychiatric beds for children and teens has been known for years. In 2017, Cook Children’s opened the Rees-Jones Behavioral Health Center to help address the issue. The unit has 15 inpatient beds available for children between the ages of 2 and 12. As we reported when the center opened, the kids who end up here are patients with complex trauma, medical and social needs. They are often suicidal or have tried to hurt someone else. Eight out of 10 have had something traumatic happen to them. They have either been abused physically or sexually, or they have experienced some sort of neglect.

Teenagers who need inpatient psychiatric care have to be treated elsewhere but often end up waiting on the medical floor of Cook Children’s until a bed opens up in the community, which can take days. With more kids needing these services, it’s not uncommon for Cook Children’s to have a dozen or more patients waiting in a regular hospital room for a transfer to a psychiatric facility that can care for them.

“There are just not enough resources in general,” said Dr. Pyrc. “It’s an awful place to be in. This is a national problem, but it affects us here locally. We need more funding and we need more mental health professionals to care for these patients.”

On the outpatient side, finding a licensed therapist to see a child can take months. The waitlist just to see a counselor at Cook Children’s can be as high as 250 days at any given time. Even with easier access to appointments with virtual visits, there are not enough mental health professionals to meet the need.

Kia Carter, M.D., co-medical director of Psychiatry at Cook Children’s, has been a vocal advocate for increased mental health funding. Testifying in front of the Texas Senate’s Committee on Health and Human Services recently, she said early identification, intervention and treatment is essential to preventing further complications from mental illness. But there are roadblocks.

“We get insurances denying a specific level of care saying that a child doesn’t need an inpatient level of care. We also get a lot of pushback about medication,” Dr. Carter said.

She also asked lawmakers for increased support and to consider giving mental health care providers more leverage with insurance companies.

Hoping for JOY

In the meantime, Cook Children’s aims to bring awareness to the mental health crisis affecting children and teens with the launch of a new suicide prevention campaign.

The Joy Campaign is an acronym that stands for:

Just breathe.

Open up.

You matter.

“If we can just get kids to slow down, realize that what they are experiencing is temporary and that they have a long life ahead of them, I think we can make an impact,” said Dr. Powderly.

For the next month, Cook Children’s will be releasing a series of articles on Checkup Newsroom weekly that address many of the issues at play, such as the pandemic, the role of over-the-counter medications, social media, as well as how minorities and LGBTQ+ young people are impacted. We’ll also be speaking with families who have lost a child to suicide to examine the effects on parents and siblings.

If you feel your child might be struggling, here are some of the warning signs to watch for:

• Anger
• Declining grades
• Lack of concern about appearance and hygiene
• Changes in eating and/or sleep
• Self-injury such as cutting
• Less motivation
• Alcohol/drug use
• Acting highly anxious or agitated
• Recklessness
• Giving away possessions 

If you’re concerned about your child’s mental health, seek help early. Schedule an appointment with a licensed counselor. If your child is actively suicidal, call 911 or take them to the nearest emergency room.

Read this story in Spanish here.

This is why the WATCH coalition and two of its partners, Connections Wellness Group and the Denton County Behavioral Health Leadership Team, are working together to spread messaging from the Okay to Say™ campaign.

Okay to Say is an award-winning public awareness campaign, initiated by the Meadows Mental Health Policy Institute and supported by The Hackett Center for Mental Health. Their message is simple: it’s okay to talk openly about mental health. Hope begins with open and honest conversations about mental health between trusted family members, friends, and other loved ones. WATCH, Connections Wellness Group, and the Denton County BHLT invite you to join us in working together to spread these messages throughout Denton County and the North Texas region so every child understands that it is Okay to Say.

Speak up by asking friends and family how they are feeling. Or, share how you are feeling.

Share hope by becoming a mental health supporter of someone close to you who might be struggling. There are great supporter tips on the Okay to Say website such as: Ask & Listen, Focus on Strengths, and Don’t Try to Fix.

Add your voice by sharing your journey at www.okaytosay.org or on social media using the hashtag #okaytosay.

WATCH, Connections Wellness Group, and the Behavioral Health Leadership Team have raised awareness of the Okay to Say campaign by purchasing a billboard in Denton on I-35W (Post Oak exit), sharing messages on social media, and passing out bookmarks with Okay to Say messaging at Denton County libraries. We’ve also purchased a billboard in Denton on I-35W Northbound (Post Oak exit), resulting in approximately 483,610 folks, age 18 and older, seeing this important message every week for 6 months!

“September of 2020 has been the highest month ever that we've seen suicidal patients admitted to our medical center,” said Kia Carter, M.D., medical director of Psychiatry at Cook Children’s. “We've seen this number rising year after year, so it's not surprising that it's this high. Suicide has become the second leading cause of death for kids and adolescents in the last year, versus two years ago when it was the third leading cause of death.”

This news comes after a near-record month in August when 29 patients were admitted for intentional suicide attempts. The patients admitted to Cook Children’s in September were between the ages of 6 and 18 years old. Dr. Carter says she feels the pandemic has played a moderate role in the increase, but that we typically see higher numbers in the fall months when kids return to school. In September of 2019, for example, Cook Children’s admitted 32 patients for suicide attempts.

“We've definitely seen this number rising in the last five years, but I do think that the amount of stress that we as a society have experienced in the last six months has caused some of our kids and adults to struggle more,” said Dr. Carter.

Virtual school may also be playing a role in mental health of kids. The Rees-Jones Behavioral Health Center at Cook Children’s has become a resource for children and teens who report feeling hopeless and not knowing how to cope with the isolation the pandemic has caused.

“I think everything in proportion is good, but when something is to this extent where some kids have had to do 100% virtual since March, it’s been very difficult,” Dr. Carter explained. “When kids have school, they have an outlet. They have other people to talk to. They have friends and social activities. Now, it’s just them, their parents and siblings.”

She says it’s important to know that some kids do very well with virtual learning, but it’s up to parents to know what works best for their child. Also, some families may have to choose virtual learning if the child or another family member falls into the high-risk category for COVID-19. In that case, parents should remember to ask for help when they need it. School counselors, nurses, teachers and their pediatrician are all great resources.

Warning Signs

Dr. Carter says the biggest thing to look for is a change in your child’s behavior, which she acknowledges can be difficult during the pandemic. She says little things like sleeping more than usual or not wanting to engage or interact in activities they used to enjoy can be signs of depression.

“Start engaging a little more and check in, like ‘Hey, are you feeling okay? I noticed you were getting a little angry at us for no reason,'” she said.

While it’s easy to write off irritation as a side effect of being a teenager, it is one of the primary symptoms of depression in children and adolescents.

Other signs to watch for include:

• Declining grades
• Lack of concern about appearance and hygiene
• Changes in eating and/or sleep
• Self-injury such as cutting
• Less motivation
• Alcohol/drug use
• Acting highly anxious or agitated
• Recklessness

Dr. Carter says girls are more likely to be hospitalized for attempting suicide, but boys tend to make more lethal attempts. As for age, Cook Children’s data shows 14 to 15 years old is the average for suicide attempt admissions, but more recently, the majority of patients have been around 12 to 13 years of age.

With many kids at home alone due to COVID-19, increased access to things like medication, firearms and the internet may also be contributing to the increase in patients. Dr. Carter says her team has also seen more patients participating in social media challenges where kids are hurting themselves.

“We have seen a rise in cutting behaviors, which are a form of self-injury. This is not always considered a suicide attempt but more of a maladaptive behavioral response to stress.”

She says these are things often picked up on social media, reinforcing the importance of knowing what your child is looking at and who they are talking to on the internet.

What Can Parents Do?

Get help.

If you’re concerned for the immediate safety of your child, take them to an emergency room. Trained professionals will evaluate your child to see what next steps need to be taken.

If you’re concerned about your child’s mental health (but not that they will harm themselves), you can contact your pediatrician, school nurse or counselor for a list of outpatient resources in your area.

If you feel your child may need a higher level of care (but it’s not an emergency), you can call Cook Children’s Behavioral Health Intake Department at 682-885-3917. Our team will help arrange referral for outpatient therapy and medication management, partial hospitalization day treatment options or inpatient treatment if needed.

Partial hospitalization allows children to receive treatment including medication management, family and group therapy at the Rees-Jones Behavioral Health Center during the day, while allowing them to go home at night. Children who are deemed an immediate danger to themselves may be admitted to the inpatient unit for 24/7 monitoring and treatment. The Rees-Jones Behavioral Health Center, is one of the few places in North Texas that offers inpatient psychiatric care for children between the ages of 2 and 12.

“Our biggest hope is that we can help families find the support and resources they need, and that we can educate our school systems about warning signs and screenings because they are hopefully going to come in contact with those kids before we do,” said Dr. Carter. “We don't want the numbers to continue to rise and we continue to lose our children. Remember that suicide is preventable.”

In the following video, our team answers the questions they hear most frequently, including how COVID-19 has impacted the program.

Learn more on our website.

They’re now making face shields to be used by clinical staff at Cook Children’s who are caring for patients with COVID-19 symptoms.

“We looked at the situation we’re facing, in the community and internally, and thought this is a great opportunity for us to get engaged,” said Brady Gendke, Vice President of Operations at Cook Children’s Home Health. “Right now, we’re producing about 20 face shields a day, which will help with some of the more intense COVID-19 isolation procedures that our doctors and nurses will be doing.”

With the help of a high-powered 3-D printer, the team is assembling the shields by hand. They hope to produce up to 200, which will be distributed to doctors and nurses at Cook Children’s Medical Center. Since the shields are made entirely of plastic, they can be properly cleaned and re-used, eliminating the risk of running out.

“It’s very important (to produce these shields) because you can help people survive and protect their health,” said Kirill Kirieiev, manager of the orthotics and prosthetics lab at Cook Children’s Home Health. “Then they can continue serving our patients and feel more protected. If we can accomplish this goal and make their life a little bit safer, that’s most important.”

The Home Health team is also creating cloth masks for Cook Children’s staff and visitors. Working in an assembly line, employees are stitching about 200 face masks a day. Earlier this week, Cook Children’s announced a new policy requiring staff, patients and visitors to wear masks at the medical center and other Cook Children’s locations. The masks produced by the Home Health department are being distributed for this purpose.

“It’s a great opportunity for us to give back in a different way,” said Gendke. “Home Health is often on the end of the spectrum as kids go home from the medical center. This is an opportunity for us to help kids going into the medical center, as well as other staff that are engaged in patient care.”

“I really appreciate that I can help people,” said Kirieiev. “That’s very important. We can improve our community and help our patients, and now doctors too. I’m really proud to be part of the system.”

We’ve gotten a lot of requests to write a post about nosebleeds so I thought I would cover some of the basics. As we’re going along remember this: While scary and annoying, most nosebleeds don't point toward anything concerning.

What causes nosebleeds?

If you are like me, nosebleeds will never be the same after Eleven and Stranger Things. But don't get things upside down on the actual cause of your child's bloody nose.

The nose has tons of blood vessels that go to it...and the tissue inside the nose is very fragile and can easily crack and bleed.

Anything that causes the tissue to be dry can lead to increased risk for nosebleeds, especially dry and very cool or warm air (winter and summer). Conditions which lead to nasal inflammation (especially nasal allergies) can also be a factor.

Ultimately, the most common trigger to a bleeding is nose picking but extreme heat, activity and stress can also be a factor. Yes, your kids pick their nose. Every kid picks their nose. I promise. Other common triggers are blowing and suctioning.

There are a few more unusual causes of nosebleeds that should be considered if the nose bleeds are consistent over time:

1. Structural problems - An abnormal bump or growth can be more prone to injury.
2. Bleeding problems - Children who have problems with blood clotting can be more prone nosebleeds.
3. Object stuck in the nose - Sometimes kids put stuff in their nose. Symptoms are usually one sided bleeding and a foul smell from the nostril.

How do you stop a nosebleed?

Pinch it. Pack it. Head up. Head down. What is the right thing to do?

There's no reason to tilt the head back or to lie down. This only increases the amount of blood that is traveling down the back of the throat and can lead to coughing or vomiting blood later.

• Have your child sit or stand and slightly lean forward and breathe through their mouth.
• Firmly pinch your child nose in the soft part just below the bony ridge.
• Hold pressure at that location for 10 minutes. Don't check. Seriously, if you're reading this now, don't check.
• If the bleeding does not stop, repeat again for 10 minutes.
• If the bleeding does not stop, continue holding pressure but get ready to head in to be checked out by a doctor.

When should you be concerned about nosebleeds?

It can be difficult to know what is normal and what is concerning with nosebleeds.

Here are some indications that you should probably see your doctor:

1. An individual nosebleed that doesn't resolve after  two attempts to control bleeding for 10 minutes.
2. Nosebleeds are happening more than 2-3 times per week or are significantly increasing in frequency.
3. There are other associated symptoms such as bruising or easy bleeding, fever, weight loss or rash.
4. Nosebleeds are consistently occurring from one nostril.
5. You should always seek care sooner if your child has an underlying medical condition.

How can I prevent nosebleeds?

In children who have frequent nosebleeds, there are some steps that you can take to help prevent them.

• Keep your child's nails clipped.
• Run the humidifier in the room with your child overnight.
• Apply nasal saline spray to the nose a few times per day. If this doesn't seem to be enough, saline gels or vaseline may also be an option but talk with your doctor.
• Seek medical care for underlying conditions, especially allergies and be consistent with your allergy regimen.

As I was writing this, I received a bunch of emails I plan to answer in a followup, but for now I'm going back to watching Stranger Things.

And at no time, do most of us feel more generous than during the holidays.

Sometimes, though, the people on the receiving end of your generosity don’t have the same great intentions as you.

We hear of these reports from time to time in our own community: Someone is going to door-to-door in a neighborhood selling something to support Cook Children’s. The Internet is full of scams in the name of giving that most of us would never dream of committing.

We want to make sure you aren’t scammed, especially in the name of Cook Children’s. :

1. We won’t coming knocking. Cook Children’s never solicits donor support door-to-door.  Cook Children’s also never sanctions door-to-door solicitations on our behalf.
2. We validate. Annually, Cook Children’s has more than 70 community partners who hold special event fundraisers that benefit Cook Children’s.  Each of these partners events have been approved by Cook Children’s Health Foundation and have been provided a letter of authorization to validate the authenticity of the event and its organizers.
3. We give our stamp of approval. The request for a proposed fundraising activity that will benefit Cook Children’s must be submitted for approval, including the use of Cook Children’s name and/or logo prior to the event.  Cook Children’s endorses wholesome, family or child-oriented events that provide a favorable community image.  “Proceeds benefiting Cook Children’s” may be used in promotional materials, invitations or advertising copy, if approved in advance by Cook Children’s Health Foundation.

In order to keep yourself from falling victim to a charity scam, take the time to check out the charity.

1. Visit their website and look for the following things:

• Correct spelling and use of grammar.
• Mission statement.
• List of board members.
• Permanent street address (not a PO Box) and a phone number.
• Statements of financial transparency.

2. Seek proof

• Ask the charity to mail you information on the program they are asking you to support and how the funds will be used.
• Request a copy of their tax information.
• Check the company’s status with the Better Business Bureau.

3. Ask if you can write a check

Donations of cash are not trackable and any legitimate non-profit organization would be willing and able to accept a check.

4. Use common sense

Don’t provide financial information to anyone over the phone.

If you receive a request by email, look at the email. Beware of emails coming from addresses such as Hotmail or yahoo, and not .org. Don’t make a donation through an email that you don’t know or can’t verify. For example, Cook Children’s would send an email such as foundation@cookchildrens.org.

Don’t give in to forceful or demanding requests for your immediate support.

Use caution on social media sites and websites that you are unfamiliar with.

Some organizations, like Cook Children’s, have groups within the community who raise money for the cause. These events are not run by Cook Children’s, but must be approved by Cook Children’s Health Foundation. If you have a question about the validity of a group or individual who is soliciting funds on behalf of Cook Children’s, contact our Community Partners specialist at 682-885-4105.

Don’t let the possibility of charity scam keep you from supporting the causes that you believe in, but do let it raise your awareness and guide you in your decision making. Do your research, identify your top charities of choice and reach out to them. Real charities have nothing to hide.

If you suspect that you are being solicited by or have fallen victim to a charity scam, document the details and contact your credit card company or bank to report the incident.

Cook Children’s is a 501(c)(3). IRS tax number 75-2051646. 

Parents can help by making sure that children plan accordingly for testing days at school. Find out from your children and the school how they’re doing and the likelihood of not performing well on tests. This will help alleviate fears by pacing preparation for the tests, creating a plan to help kids succeed and encouraging them to problem-solve their worries.

Here are steps you can take to help your child during this stressful time:

1. Ask for help. If your child is especially anxious about test taking, set up a meeting with the teacher and school counselor to come up with a plan to ease fears on test day.
2. Go online and get sample items of practice tests from previous years and, if needed, practice with your children at home.
3. Practice deep breathing exercises at home. Then on test day, they will be able to put these practices into action.
4. Make sure your child gets plenty of rest. Studies have found that people who get eight hours of sleep before taking a math test are nearly three times more likely to figure out the problem than people who stay awake all night.
5. Control your children’s anxiety by making sure they are prepared. Focus on good study habits and the importance of not waiting until the last minute to cram before the test. There’s still time. Also, make sure your child has everything he or she needs going into the test. Even if it’s a new sharpened pencil. Make a check list the night before to avoid stress.
6. Stay away from entertainment as test time approaches. It’s not easy, but your child needs to study and not spend all night watching TV, looking at Facebook^® or being on the computer. You can wait on that until after the test.
7. Help your child keep mistakes in perspective. Everyone makes them and nobody is perfect. As you move closer to tests and studying, use wrong answers as a learning opportunity.
8. Eat right. Make sure your child has had enough sleep, exercise and healthy food. Avoid heavy food or desserts that may upset the stomach. Avoid  high sugar foods that may keep your child up all night and  make sure your child has a healthy breakfast (low-sugar cereal or oatmeal) the morning of the test.
9. Expect distractions. Let your child know someone in the class will have sniffles. Some kid will be banging his pencil on the desk. Someone may be humming. Those kids have their own stress. Just warn your child this is going to happen, but don’t let it be a bother.
10. After testing is completed, create ways to celebrate with your child. What you want to focus on in this celebration is the success of managing their stress, and not whether they passed or failed, which they won’t know for weeks.

1. Health. Often, new teachers don’t know about your child’s health history. Many kiddos have severe nut allergies and teachers need to be aware of those food allergies, as well as if your child needs special medication or an EpiPen® injection. You should let your teacher know if your child has asthma, is diabetic or has any other serious health condition.

2. Educational Diagnoses. Teachers may not know your child has been diagnosed with a learning difference, dyslexia or an attention deficit problem. This is an opportunity to let teachers know about a 504 plan or IEP for your child. This is also a great time to let your teacher know what your child’s learning style is such as whether they are an auditory, visual or kinetic learner. Sharing your child’s areas of strengths and weaknesses is also helpful.

3. Emotional and family. Inform your teacher of any emotional factors that may impact your child such as divorce, death, illness or a parent being stationed overseas. It’s helpful for teachers to know the emotional factors that are impacting your child’s life which may help your teacher to understand and communicate better with your child.

4. Don’t settle for orientation. Teachers are bombarded with information at meet and greets during orientation. It’s hard to keep everyone and everything straight. My advice is to set up a conference with your child’s teacher as early as possible. One teacher told me she found it really helpful when parents provided a list of bullet points that included helpful information about their child, including the health and educational diagnoses, the strengths and weaknesses of the child, how the student learns the best, what the student responds to best when giving direction or correction and some points about the student’s social and personality style. Go in and set up an appointment one on one, especially if your child has special needs or considerations.

5. Be a team player. Every teacher I have spoken with has told me what they appreciate more than anything is for the parent to ask the teacher, ‘how can we help you? What information do you want to know?’ Most teachers prefer that team approach.

6. Be honest with yourself about your child. This is sometimes the most difficult tip for parents, but it’s so important. Know your child’s strengths and weakness. One of our biggest problems in today’s society is not teaching accountability. Set that example. Make sure your child knows his or her responsibility. Teachers have a difficult enough job without always blaming them, the school or another child. Please make sure you know how your child contributed to a situation and then take appropriate action from there.

Of course every child is different, and special, which makes communication between you and your teacher so important in having a great school year.

About the author

Lisa Elliott is a licensed psychologist and clinic manager of Cook Children’s Behavioral Health, located at 3201 Teasley Lane, Ste. 202, Denton, TX 76210. To make an appointment, call 940-484-4311. Cook Children’s Psychology provides care focused on children’s behavior, from ages 3 years through 17.

According to data released Thursday, suicide rates doubled among girls and increased more than 30 percent among teen boys between 2007 and 2015.

At Cook Children’s, this news comes as no surprise to the behavioral health care workers who see the young adults struggling with depression and other mental health challenges each day.

“It’s not surprising. It’s absolutely heartbreaking, but not surprising,” said Lisa Elliott, Ph.D., a licensed psychologist and manager of Cook Children’s Behavioral Health in Denton.

Since 2015, the number of children and teens admitted to Cook Children’s Medical Center after trying to kill themselves has increased significantly. There’s no data available yet to say for certain how many more of these cases there have been, but it’s safe to say the percentage is in the double digits.

“We see the increase in the numbers of calls we receive from parents looking for help whether it’s for therapy or hospitalization,” said Elliott. “Not only is this a real problem across the country, but it’s affecting families right here in North Texas.”

Elliott says one big mistake parents make is believing that stories like this don’t apply to their children. She says when suicide is in the news, parents should use those stories as an opportunity to talk to their kids and teens.

“Ask them why they think this is happening and if they find themselves wishing they weren’t here,” said Elliott. “You can find out a lot about how they are feeling, and how their friends are feeling.”

Also know that kids may not tell you the truth, even if you ask.

“I think it’s important for parents to be mindful and recognize warning signs of suicide, even if their child denies having suicidal thoughts,” Elliott said.

Warning signs of teen suicide include:

1. Increased use of alcohol/drugs
2. Preoccupied with death (writing, drawings)
3. Talking about feelings of hopelessness
4. Talking about being a burden to others
5. Telling loved ones goodbye
6. Decline in performance
7. Giving prized possessions away
8. Isolating and withdrawing
9. Acting highly anxious or agitated
10. Acting reckless and taking risks
11. Rages
12. Changes in sleeping and/or eating
13. Dramatic changes in personality and/or appearance

Bottom line, Elliott says kids need to understand that problems are temporary, but suicide is permanent.

If you feel your child needs help, please click here to find a Cook Children's Behavioral Health location near you. You can also address your concerns with your child’s pediatrician, psychologist or therapist.

Cook Children's Behavioral Health Center

Growing up in today's world is hard and many children or teens may go through life experiences that cause them to feel anxious, depressed or even suicidal. As a parent or a caregiver, it can be hard to know when to ask for help. The Behavioral Health Center brings all services together in an expanded space that will provide a talented, dedicated team of caregivers, physicians and professionals with the facilities, resources, tools and programs they need to ensure that these most vulnerable children receive the high quality treatment they need and deserve. Click here to learn more about an appointment or referral.

What's under the microscope now is how mental health played a role in these unsettling crimes. While one involved a documented case of schizophrenia, the other is not so clear but may have been tied to depression or possibly a head injury. Yes, these are extreme examples of issues regarding mental health, but they are also reminders of what could go wrong if mental well-being is left unchecked.

It's long been reported that Texas is lagging when it comes to mental health spending. In fact, the state ranks 49th in the country for such spending per capita. At Cook Children's, The Center for Children's Health is working with local partners to expand awareness and access to mental health resources in one local county that especially needed help.

"We have seen higher rates of diagnosed mental illness, bullying at school, self-esteem issues and experience in trauma in 2015 than we did in 2009," said Courtney Barnard, Coordinator for Regional Outreach Services at Cook Children's. "The CCHAPS data tells us what is happening according to parents, but it does not tell us why it’s happening."

Barnard says it could be that kids are experiencing mental health issues and bullying more often or it could mean that parents are more aware of these problems and know what to look for and ask about. The latest numbers from CCHAPS will be the focus of the Denton County Child Health Summit on May 12, 2016, which will be presented by Cook Children's Center for Children's Health. There will also be discussion about the efforts and impact of the Wellness Alliance for Total Children's Health (WATCH) of Denton County. WATCH is a coalition of public and private organizations, born out of the CCHAPS data. The group offers mental health resources to kids, teens, parents and professionals as well as critical support to service providers.

"Moving the needle on children's health is a long-term process because it requires people and organizations to make changes in knowledge, skills, attitudes, beliefs and behaviors," Barnard said. 

About WATCH
The Wellness Alliance for Total Children’s Health (WATCH) of Denton County is a collaboration of both public and private organizations and individuals who are invested in the total wellness of Denton County’s children. WATCH currently works to increase awareness of and access to mental health services in Denton County. Visit www.watchdenton.org for more information.

Obesity? That's one.

Car accidents? That's a big risk too.

But would you guess the number one issue is asthma?

In Tarrant County, 19.5 percent of children suffer from asthma, according to data gathered in a survey sent to parents by The Center for Children's Health led by Cook Children's. The Community-wide Children's Health Assessment and Planning Survey (CCHAPS) was completed by more than 8,600 parents in Tarrant, Denton, Hood, Wise, Parker and Johnson counties.

"We questioned parents on everything from how often their child is buckled in properly to how many grocery stores in their neighborhood sell fresh fruits and vegetables," said Larry Tubb, senior vice president of the Center for Children’s Health. "The information we are gathering is extremely valuable when it comes to measuring the overall health of children in our region."

Overwhelmingly, parents in Tarrant County (and all of the surveyed counties) reported their children are dealing with asthma. In fact, children in this area ages 6-9 are three times more likely to have asthma than children living in other parts of Texas. While we don't know why the numbers are so high, we do know people with asthma have varying triggers, and what affects one person will not necessarily affect another. Those triggers include, but are not limited to, cigarette smoke, indoor and outdoor mold, pet dander, air pollution, dust mites, cockroaches, pollen, smoke and strong odors.

The second biggest health issue on parents minds is obesity, with 17.8 percent reporting concerns about their child's weight, activity level and access to healthy foods.

Accidental injuries rings in third. In Tarrant County, 11.9 percent of parents reported their children had been injured and required medical care. Those injuries range from car and ATV-related incidents to drowning, bicycle falls and crashes.

The fourth issue on the list is a lack of dental care for children. Parents reported 9.7 percent of children either didn't see a dentist regularly, didn't brush their teeth enough or some even reported their child didn't have their own toothbrush.

Finally, mental illness is the fifth biggest issue concerning parents in Tarrant County. Behavioral and emotional development is on the minds of 8.5 percent of respondents. Many reported their children have suffered sleep problems, self-esteem issues or have tried to harm themselves.

The survey used to gather this data is part of a Cook Children's initiative to improve the health and well-being of every child in our six-county region by 2020. This initiative launched in 2009 with the very first survey of its kind sent to parents. Since then, the surveys have been sent out every three years.

"The information provided by parents in our community is available on-line and being used by a host of organizations, including Cook Children’s, to build programs and services. There isn’t one perfect answer, but, together we are making solid progress in improving the health of the children in our community by putting the child and family at the center of our planning," said Tubb.

About The Center for Children's Health

The Center for Children's Health, led by Cook Children's, is home to the Community-wide Children's Health Assessment & Planning Survey (CCHAPS), Community Health Outreach and Community Health Research. The center's goal is to create aligned collaborations that will allow us to make our North Texas region one of the healthiest places to raise a child.

Some estimate that children will have 8-12 upper respiratory infections (coughs and colds) per year. Because many of those will be clustered in the winter and viral respiratory infections can last 1-2 weeks, it’s possible your child might seem to be sick “all winter long.”

Anytime a child seems to be sick off and on for months at a time, people will search for answers. Anytime people search for answers, they will start to make connections where connections don’t really exist…

So, now it’s time for: Winter Weather Health Myths

Myth No. 1 - Feed a cold and starve a fever.

I don’t care if you decide to feed a cold. If a child is hungry and not vomiting, let them eat but starving a fever doesn’t make sense. Besides, the major thing is that you need to monitor a child’s drinking when they are sick more than their eating. Dehydration is frequently what causes a child with a cold or flu to get sicker and require medical attention. You should encourage (“force”) your child to drink small, frequent sips of whatever fluid they will drink. Pedialyte or Gatorade are good options but milk is fine too (yes, even with fever).

Myth No. 2 – It’s been too cold for my child to exercise.

Maybe, for like two weeks in late January, it’s too cold for your child to exercise OUTSIDE. Otherwise, buy you and your child a sweatshirt and go for a walk. During those two weeks, you can walk circles around the house together or just do some lunges or something. Even 10 minutes a day is better than zero.

Myth No. 3 – Going outside to the cold (wet head or not) will make your child sick.

Cold weather and getting cold doesn’t actually make you sick. Getting sick is the result of being exposed to an infection that makes you sick not by getting cold. We think that viruses tend to increase in activity during winter due to the fact that people are more likely to be crowded inside.

Myth No. 4 – Taking Vitamin C (or a multivitamin or Zinc or essential oils) will protect your child from colds and flu.

The supplement industry has become big business for both adults and children as people look for anything to prevent illness. Unfortunately, study after study show that they simply don’t work. Essential oils are one of the latest to promote the ability to “boost” the immune system but studies are still lacking to show benefit in children. For now, our best bets are simple things like washing hands, covering coughs and getting the flu vaccine (I know it’s not perfect but at least it’s something).

Myth No. 5 – If you don’t like the weather in Texas, wait 5 minutes.

While not technically a myth, because weather can change fast in Texas. Good evidence is the last week. But, we’re not alone. Most of the United States believes that the phrase “If you don’t like the weather in ____, wait 5 minutes” applies to their state. A Google search ranking for this phrase puts Texas at number 8 on the states where this phrase was searched for (behind Massachusetts, New York, Georgia, Pennsylvania, Maine, South Carolina and North Carolina).

Don’t buy into the winter weather myths. Here are some tips for preventing winter weather health issues:

• Help your child eat healthy and get good sleep.
• Get your child up and active in some way every day.
• Teach your child to wash their hand and cover their coughs.
• Get your child a flu shot (it’s still not too late).

School physical season is one of my favorite times of the year for many reasons:

• It’s really fun to see kids grow up and get big over time.
• I love watching my patients’ personalities mature.
• I love that the visits become progressively more about my relationship with the child in addition to my relationship with their parents.
• For the most part everyone is healthy and happy.
• For most children, the promise of a new school year and new beginnings is exciting.

I have a few things on my agenda for each back-to-school checkup.

I want to talk about diet, exercise and sleep. I want to talk about how school went last year and what the plans are for the upcoming year.

But checkups are more than just about what I want. In order for the checkup to be a success, it must meet the goals of the child and parent. Parents are all over the place when it comes to their expectations for physicals.

Here are just a few examples:

1.“Let me get out my list.”

Whether your weapon of choice is a spiral-bound notebook or long thumb-scrolling iPhone lists, you know who you are. And frankly, I love you. Having a guide that directs the visit through any questions and concerns that you have is beyond helpful. It keeps me from having to talk about stuff that’s not important to you and wasting both of our time. So, bring it on, Listers, and I promise not to roll my eyes.

2.“I’m just here to get my form signed.”

No worries. That may be all you need and that’s great. In the meantime I can provide a quick screen for height, weight, body mass index, high blood pressure, heart murmurs, risk for sudden cardiac death, hearing and vision (and much more). I can also screen for drug/alcohol abuse, depression, attention problems and other school issues. “Here’s your form, thanks for coming in.”

But seriously, even in those children who come in with no apparent concerns or complaints, we do pick up health problems that need to be addressed to maximize your child’s ability to function well in school or compete at their best in their chosen activity.

3.“I’m not worried, but __________ wanted me to ask about __________.”

This is a tricky one. I’m totally cool with it, but it can be hard to get at exactly what the concerns is if that person isn’t there to ask questions. My advice … if that person is close enough to be providing this type of advice, they could probably come to the appointment. If the concern is coming from the child’s teacher, a quick note explaining what is going on can be really helpful.

Just don’t leave it up to chance that we can figure out what the problem is, especially if you don’t quite understand why they are concerned. Get specific information about the concern or have them come along.

I’m sure there are many more ways that parents think about their children’s checkup, but these are some common ones I notice.

No matter what, regular checkups are an important part of helping you maintain your child’s health. Good health increases their ability to be present for and to participate fully at school and extracurricular activities.

Which category do you fall in? Is there a different one you think I should include?

Sports EKGs are free through the month of August at specific locations in Arlington and Fort Worth. Cook Children's offers a $25 Sports EKG (electrocardiogram) screening test at our Cardiology offices in Mansfield, Southlake and Denton. Adding a sports EKG to your child’s physical can help detect most heart conditions that may lead to sudden cardiac arrest. Click to learn more. 

For school physicals, visit your local Cook Children's pediatrician. Click to find one near you. 

You decide to seek out some information online and you find this:

“Although data to make specific recommendations as to when it is safe for infants to sleep in the prone or side position are lacking, studies that have established prone and side sleeping as risk factors for SIDS include infants up to 1 year of age. Therefore, infants should continue to be placed supine until 1 year of age. Once an infant can roll from supine to prone and from prone to supine, the infant can be allowed to remain in the sleep position that he or she assumes.”

AAP SIDS and Safe Sleep Guidelines

“Heh?”

Hopefully none of us really talk this way, but I have a feeling sometimes it’s close. Doctors have a notoriously bad rap for their handwriting; fortunately, we’ve mostly fixed that with electronic records. Unfortunately, some of us aren’t known for our amazing verbal communication skills, either.

A study released in Pediatrics this week highlighted this fact. The authors surveyed mothers of 4-6 months old babies about the education they received from their doctor when their baby was a newborn.

They asked the mom if they received advice on the following topics: vaccination, breastfeeding, sleep position, sleep location and pacifier use.

All of these seem like pretty basic newborn information. Most doctors would want to cover them during that time frame. They all are included in very specific guidelines with clear instructions for how the American Academy of Pediatrics wants us to educate our patients?

How did the doctors do? The following percentages reflect the number of mother’s who reported receiving correct advice for the respective topics:

1. Does it seem like we’re speaking in a foreign language?

For many cases, the study showed that either the doctors failed to mention some pretty important topics or they weren’t presented in a way that parents understood or remembered.

One of the reasons I love to write is that it forces me to have clear thoughts about the medical issues I deal with every day and to focus on clear strategies for communicating those thoughts to patients. Of course, I’m not perfect. Here are some of the communication mistakes I (and from the results of this study, other doctors) make and some strategies for the way things should go (with help from you of course):

Some people describe the first few years of medical school as being more or less a foreign language study. During those years, medical students learn terms that most people don’t need to know. We use them as a way to communicate with other doctors as we begin to learn from “real” patients in the later years. The problem is we sometimes forget that we can’t talk that way all the time if we want to be understood by our families.

How can you help us while we work to get better?

Don’t be afraid to ask questions or to stop us if you don’t understand. Your child’s health is important to us. We know that you have to understand our instructions if we want to have any chance to help your child stay healthy or get better when they are sick. Ask us to slow down or to re-explain a certain concept again if what we say doesn’t make sense.

2. Have we given you the best opportunity to hear us?

This newborn study is a perfect example of this. A newborn mom is tired and stressed and getting health advice from the nurse, the doctor, their family and the Internet, so what usually ends up happening? We rush right through with the messages that are important to us and hope that mom gets them in 5 minutes.

Thanks for coming in. Good luck, mom!

Other examples are when we deliver bad news or just simply have a baby with an ear infection that is screaming in pain while we get louder and louder to make sure we are “heard.”

How can you help us while we work to get better?

Some are easier than others. When we’ve delivered bad news, there’s probably nothing either of us can do to help in that situation. But we should definitely slow down and wait a minute to let you think before we plow through into “next steps.”

If your baby is fussy and you can’t concentrate, feel free to ask if a nurse could come help for a second while we talk. Even if the baby stays in the room, just having them out of your arms makes it easier to listen. During those newborn visits when you are sleep deprived, ask for resources that you can take home and read when your mind is a little more clear (if that every actually happens for any of us with newborns).

3. We try to cover everything, but did we focus on what you want to learn?

This has another medical school analogy. Some people refer to the first few years of medical school as “trying to drink from a firehose.” There is so much information coming so quickly, you have to learn how to decide what is important enough to waste brain space on and what can be discarded (or “Googled”) later. So, when it comes to giving advice, we assume that you can do the same. The other assumption we make is that you actually care about the things that are important to us.

How can you help us while we work to get better?

First and foremost, please bring a list of questions. This helps us to focus on the things that are important to you, which are the things that you are going to remember anyway. As I get to know my “listers” better, I tend to grab (nicely) the list out of their hands and start writing the answers down (in ugly doctor scrawl) as we go along.

This is another time when asking for resources can be really helpful. Ask us to highlight or point out sections that are related to what you have talked about in the visit. Now, for this strategy to work, the resources have to come out of the diaper bag before they get formula and other baby fluids spilled on them - better yet, maybe they can just be pulled up on your phone …

I work hard to avoid these mistakes. But as I said, I’m not perfect. Communication is vital between a pediatrician and a parent. In the medical community, it looks like we have a lot of work to do.

Fortunately, we have some great examples at Cook Children’s to learn from.

But we can all get better with your help and feedback.

Since Oct. 1, 2014 to present, 40 drownings have been seen here and three of them have been fatal.

Those numbers are chilling and once again place an emphasis on water safety in the area.

Dana Walraven, community health outreach manager for Cook Children’s, wants to make sure that parents are prepared for warm weather and children in the water. She said the safety begins with making sure a grownup is watching the kids in the water at all times.

“Active adult supervision and layers of protection such as door alarms and a fence can lower the risk for your child,” Walraven said. “The majority of these water-related incidents happen in the child’s own backyard pools and to children 4 years old and younger. Drowning prevention around the pool starts with adult supervision.”

Children are protected by layers of protection by using these safety techniques whenever children are around the pool:

· Always have adult supervision present when children are swimming or around pools.

· A fence with a locking gate should surround the pool.

· Install door alarms to alert adults when a child is entering the pool area.

· Require life jacket use for non-swimmers.

· Enroll children in swimming lessons.

· Parents and caregivers should undergo CPR training.

In nearly nine out of 10 child drowning –related deaths, the parent or caregiver said the child had been with them in the house or pool within five minutes of the accident. Walraven says she knows it is difficult to supervise children 100 percent of the time. She said the levels of protection provide barriers in case the child should slip out of supervision.

Safe Kids Tarrant County, led by Cook Children’s, also offers Water Watcher tags to anyone or group who will use or distribute them. These are especially helpful at parties around the pool or lake to help designate adults that are watching the water. After 15 minutes, the tag is given to another responsible adult – letting everyone enjoy the party while ensuring that the kids are being properly watched. To receive a Water Watcher Tag, call 682-885-4244.

In large pools, it’s ideal to split up in groups and take sections of the pool.

“If you are somewhere where children are in the pool, insist that an adult be on watch,” Walraven said. “It should be done by a sober adult and that should be his or her only focus during their time watching the kids.”

Aside from supervision, four-sided isolation fencing with self-closing/self-latching gates is the best protection for your child and pets. It could prevent 50-90 percent of childhood drowning and near-drowning incidents. This type of fencing goes beyond the yard, to fencing in the pool itself, preventing direct access from the house.

Door and gate alarms give another signal that a child may have access to the pool area without supervision. The tendency is to disconnect it – especially at parties where people are going in and out. But these are also the times when small children are the most vulnerable for injury because of the confusion.

Learning CPR can save a child’s life by restoring breathing and circulation until advance life support can be given by health care providers.

Swim programs for children should teach good water safety behaviors in and around the pool but should not be seen as the sole way to decrease the risk of drowning.

Use a U.S. Coast Guard approved lifejacket with children who can’t swim. It should fit snugly when the child is buckled in and should not go beyond the top of the ears when lifted at the shoulders. Many air-filled, float-type toys are thought to be lifesavers but are not.

Check your pool and spa for cracked or broken drain covers on a regular basis. The suction around the drain can catch hair or clothing, pinning the child underwater. Anti-entrapment drain covers are available for as low as $40 and serve as another level of protection.

Since beach balls, noodles and other toys are attractive to curious young children – put them away when not at the pool.

For more information

Cook Children's has many resources on drowning prevention, beginning here. Click the links below with downloadable information in both Spanish and English, as well as videos. 

• Drowning prevention tips - English
• Drowning prevention tips - Spanish
• Water safety resources
• Drowning prevention education (English and Spanish)

Videos:

• Pool safety video step 1: Supervision
• Pool safety video step 2: Fencing
• Pool safety video step 3: Pool and spa covers
• Pool safety video step 4: Alarms
• Pool safety video step 5: Safety drain covers
• Pool safety video step 6: Swimming lessons
• Pool safety video step 7: Learning CPR
• Safe Kids Tarrant County Drowning Prevention Tips
• Safe Kids Tarrant County sugerencias de prevención de ahogamientos 

“Proper dental care actually begins before the baby’s first tooth appears,” said Tonya Fuqua, DDS, director for the Save a Smile program, led by Cook Children’s. “As soon as the baby’s born, it’s extremely important to make sure that parents begin wiping the child’s mouth and gums with a nice clean baby wash cloth. The cloth should be soft and easy to get wet.”

The early cleaning with the cloth removes any remaining milk from babies’ mouths and helps them become accustomed to something going in their mouth for cleaning. So when babies begin getting teeth and brushing starts, they will be used to the parents placing their hands in the mouth for brushing.

Once you see the first baby tooth, you can begin using a toothbrush. You aren’t doing a lot, but you are introducing that feel of the bristles in the mouth so that as the baby develops more teeth, he or she will be used to a toothbrush in the mouth. Make sure you are using a soft bristled, age appropriate toothbrush. As your child has more teeth, a routine should be established of brushing two times a day, the morning and at bedtime. Dr. Fuqua gave us 10 other helpful tips parents should know about when caring for their child’s teeth:

1. Know the rules of twos. You should always brush your children’s teeth twice a day – every morning and every night for two minutes, regardless of how many teeth are in his or her mouth.
2. Did you know: A baby should never be put to bed with a bottle or sippy cup filled with anything other than water.
3. When should you schedule your first dental appointment? Find a dental home and take your child to the dentist by age 1 or earlier if you notice problems.
4. How dangerous is tooth decay (cavities)? Tooth decay (cavities) are the No. 1 long-lasting disease in young children – even more than asthma.
5. Can you catch a cavity? Germs that cause tooth cavities can be passed from parent or caregiver to a child. Choosing healthy behaviors from an early age will help prevent tooth decay (cavities) and improve a child’s overall health throughout his or her lifetime.
6. How do you prepare your child for visiting the dentist? Read your child a book about going to the dentist, schedule a tour of the offices before the first visit and role play at home on what to expect for the visit.
7. How long should you supervise your child’s brushing and flossing? As general rule, keep up with your child’s brushing and flossing activity until he or she is about 9 years old.
8. Which toothbrush should you get for your child? Choose a soft or extra soft toothbrush with the right size handle and head for his or her mouth.
9. How often should a toothbrush be changed? Every 3 to 4 months, when the bristles become worn or after there has been an illness.
10. What toothpaste should you use for your child? Use a rice-sized smear of fluoride toothpaste when the first tooth appears around 6 months until age 3. Then use a pea-size amount of fluoride toothpaste.

For more information:

The Children's Oral Health Coalition is working hard in the community to educate parents on the importance of caring for their children’s mouth and the impact their children’s oral health can have on their overall health. Find dental health resources here.

In the morning, they begin with stretching, but by the middle of the afternoon they are running with real-life Olympians or breathing their way across the United States – all from the comfort of their own classroom. GoNoodle is a new interactive resource that allows children to not only increase their physical activity, but improve their academic performance.

Thanks to a sponsorship from Cook Children’s, 60,136 kids in Tarrant County enjoyed GoNoodle this past year. GoNoodle allows children the opportunity to participate in a fun, interactive “brain breaks,” while measuring the minutes of moderate to vigorous physical activity. The brain breaks include running, dancing, stretching and calming exercises. Kids play the games that include spelling, vocabulary and math with physical activity.

“Other programs seem to focus on one or the other – activity or academics; but GoNoodle was unique because it focused on both areas,” said Larry Tubb, senior vice president of the Center for Children’s Health. “We look at bringing GoNoodle as an extension of our Promise, to help the well-being of every child. That doesn’t always mean treating them to get better in a doctor’s office. It also means helping them get better in the classroom. By bringing this physical activity to schools, we are improving the health of these kids. That helps our children and our community.”

GoNoodle brain breaks give the children activities to help keep them focused during the day. They have breaks that help them stretch, release energy or reduce stress. Some of the breaks align with core subjects such as spelling, math, vocabulary, geography, math, reading and even nutrition.

Breaks include:

Airtime. Students “breathe” their way across the United States. They pick their state and begin breathing in and out. The simulation of blowing out blows a balloon on a screen across the country, giving fun facts along the way.

Run with us. Real-life Olympians, on a screen, coach children in track and field events such as the hammer throw, 200-meter sprint and javelin.

To The Maximo. Children perform stretching activities to get their body and mind going early in the morning.

The faculty at A.V.Cato elementary have seen the benefits of GoNoodle. Michelle Miles, the school’s counselor, said she saw the breathing exercises work during the State of Texas Assessment of Academic Readiness tests. The kids did their breathing exercises to calm them before the tests and give them the chance to perform their best.

“GoNoodle has been the greatest opportunity for ADHD students because you can just tell when those students become disengaged from a lesson and are just tired and antsy and unmotivated,” Miles said. “If you can just get them up in between transitions for a few seconds at a time and give them an opportunity to either get the wiggles out or start focusing on how they are going to move forward, it tends to help them just get the energy out; and have it be OK and accepted before they move on to the next lesson. This has been ideal for some of our younger kids who have all that extra energy bottled up.”

Amber Grier, an elementary teacher at A.V. Cato, said she recently saw the benefits of GoNoodle. She had been working with her students throughout the day on mixed fractions and adding fractions. One child in particular just didn’t seem to understand the lesson. She had exhausted her efforts for the day. Then they began to play one of the GoNoodle games and was pleasantly surprised to see the child get every answer correct.

“I had a huge smile on my face because I was so relieved to know that he had learned what we were doing,” she said. “But he wasn’t able to produce the answer quickly until he got moving and stopped worrying about making me happy. He was just playing the game and he was able to get all the answers. True learning is play.”

1. Health. Often, teachers don’t know about your child’s health history. Many kiddos have severe nut allergies and teachers need to be aware of those food allergies, as well as if your child needs special medication or an EpiPen^® injection. You should let your teacher know if your child has asthma, is diabetic or has any other serious health condition.
2. Educational Diagnoses. Teachers may not know your child has been diagnosed with a learning difference, dyslexia or an attention deficit problem. This is an opportunity to let teachers know about a 504 plan or IEP for your child. This is also a great time to let your teacher know what your child’s learning style is such as whether they are an auditory, visual, or kinetic learner. Sharing your child’s areas of strengths and weaknesses is also helpful.
3. Emotional and Family. Inform your teacher of any emotional factors that may impact your child such as divorce, death, illness or a parent being stationed overseas. It’s helpful for teachers to know the emotional factors that are impacting your child’s life which may help your teacher to understand and communicate better with your child.
4. Schedule conferences. Teachers are bombarded with information at meet and greets during orientation and other group events throughout the school year. It’s hard to keep everyone and everything straight. My advice is to set up a conference with your child’s teacher as early as possible. One teacher told me she found it really helpful when parents provided a list of bullet points that included helpful information about their child, including the health and educational diagnoses, the strengths and weaknesses of the child, how the student learns the best, what the student responds to best when giving direction or correction, and some points about the student’s social and personality style. Go in and set up an appointment one on one, especially if your child has special needs or considerations.
5. Be a team player. Every teacher I have spoken with has told me what they appreciate more than anything is for the parent to ask the teacher, ‘how can we help you? What information do you want to know?’ Most teachers prefer that team approach.
6. Be honest with yourself about your child. This is sometimes the most difficult for parents, but it’s so important. Know your child’s strengths and weakness. One of our biggest problems in today’s society is not teaching accountability. Set that example. Make sure your child knows his or her responsibility. Teachers have a difficult enough job without always blaming them, the school or another child. Please make sure you know how your child contributed to a situation and then take appropriate action from there.

Of course every child is different, and special, which makes communication between you and your teacher so important in having a great school year; and appreciating one another.

Just in time, a new study released online in Pediatrics (the journal of the AAP) describes the risk of depression in fathers of young children (0-5). They started following males in adolescence and followed them for 23 years using a depression scale to document their level of depression.

The scales asked some fairly pointed questions regarding depression. Here are some examples:

• Were you were bothered by things that do not usually bother you?
• Did you feel depressed?
• Did you feel you were too tired to do things?
• Did you not enjoy life?
• Did you feel that people disliked you?

I found the results very interesting:

During the first 5 years of their child’s lives, fathers showed a 68 percent increase in depressive symptoms.

Does this surprise you or not?

While the study did not specifically describe the rate of depression in the immediate period after the baby was born, I would suspect that many of these depressive symptoms began to emerge during that time.  I have done this new parenting thing a few times (3 times in 5 years).  Having a new baby in the house is incredibly exciting and brings so much unspeakable joy. However, that joy comes with many changes.

I never felt that my symptoms rose to the level of depression but there were, at times, feelings of sadness and loss. Let’s walk through some of the reasons and some potential solutions.
 

Loss of routine
I am a man of routine and consistency.I like waking up, having a cup of coffee, reading and getting ready to go to work. Staying home with my wife for a week after our babies were born was very important to me but I did start to miss my routine.

Try to keep some semblance of your normal routine if possible. Remember that your sleep at night will likely be broken up (I was always the water boy for my breastfeeding wife and the post-feed burper and rocker) so you might want to get to bed earlier than normal so you can keep your morning routine in some form or fashion.

Loss of autonomy
When you got married you might have realized that your decisions were no longer just about yourself anymore. For me, having a baby is that feeling, on steroids. You suddenly feel guilty for wanting to do anything for yourself anymore as if in some way you will miss something or will be needed and not be there.

It sounds like a line from a self-help book, but remember that in order to be a good provider, you have to take care of yourself to some degree first. Find some time to do something by and for yourself at least every few days. For you, that might look like going for a run or going to read a book at Starbucks. But, whatever it is, take a little time for yourself.

Loss of intimacy
Yes, I do mean in the physical way (those OBs and their rules - seriously follow those rules). But, it’s much more than that. All of the sudden, you realize that those deep conversations you had with your wife (that you might not have thought were important) are less frequent. You are both tired and have a singular focus that tends to dominate your conversations (When was the last feed? Did I start on the left or right side last time? Is this yellow, runny stool normal?)

Try to find the time and energy to start one deep conversation per day. One great conversation starter in this time period can be: “How are you doing with all of this?” Don’t settle for, “Fine.” Ask deeper questions. Then, after you’ve taken the time to hear mom out, you’ll probably get a chance to share some things yourself. You’ll be glad you did.

The overlying concern for these feelings is that you might begin to feel guilty about having them. You know in your brain that this time is supposed to be one of the happiest times of your life. This tension is common and normal. It might be helpful to seek out other fathers whose advice you feel you can trust to talk through it. They may have more specific advice that will work better for you. The important thing is to resist the urge to tough it out and do it on your own.

Ultimately, you may feel that you are passing over from feeling a little down to actually feeling depressed.  If you have concerns about this, it’s best to seek out professional help from your doctor or a counselor.