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.

Cook Children’s Center for Community Health conducted the 2024 Community Health Needs Assessment (CHNA) to identify and prioritize health needs and resources available for children in the service area. The results indicate a complex set of factors that create obstacles in caring for children and accessing health services.

Every three years, the center compiles the CHNA by surveying and interviewing parents and caregivers in Cook Children’s service area. Survey responses came from more than 7,300 parents, caregivers, and community leaders in Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant, and Wise counties. That region encompasses almost 1.2 million children (0-17 years), according to U.S. Census estimates.

KEY FINDINGS

The 2024 survey showed about 390,100 children from birth to 17 years old live in households that sometimes or often couldn’t afford nutritious meals. 

Along with food insecurity, about 287,100 children have a caregiver who shared that they were unable to receive all needed health services for their child. Reasons cited include lack of insurance, high health care costs, transportation difficulty and the financial impact of parents missing work for their child’s medical appointments.

Barriers played a role in 139,600 children ages 1-17 not receiving needed dental care, and 79,900 children ages 6-17 going without needed mental health services. Immunization levels in the service area showed 89% of children up-to-date on vaccines. 

“What stands out most is how many families are dealing with overlapping challenges that all affect their children’s health and well-being,” said Mandy Wolever, Ph.D., Research/CHNA Manager at the Center for Community Health. “Caregivers shared that they’re constantly making tough choices -- between covering basic needs like food, housing and utilities——and trying to get their children the health care they need.”

Fewer caregivers reported they have a source of emotional support for raising their children. That finding aligns with the U.S. Surgeon General’s advisory in August 2024, calling attention to parental stress due to financial instability, work-life balance, lack of social support and other factors.

The struggle to put nutritious meals on the table or visit the pediatrician adds another layer of stress that impacts a child’s health and development, Wolever said.  

The top three health needs reported by caregivers were preventive health care, treatment for short-term illnesses and immunizations. Mental health care or counseling topped the list for community leaders, followed by wellness opportunities and preventive dental care.

Other takeaways from the parent/caregiver survey include:

• Eighty-four percent of children in the service area had “excellent” or 
  “Very good” health in 2024. That compares to 87% of children across Texas and 90% of children in the United States in 2022.
• In the past year, 1 in 5 children (about 217,700) in the service area experienced chronic or frequent dental problems. Children with poor or fair oral health are twice as likely to miss school due to dental problems.
• Approximately 237,000 children ages 6-17 have a diagnosed mental health condition such as anxiety, depression, or attention-deficit/hyperactivity disorder, according to their caregiver. Two out of every 5 children (about 304,100) have been bullied at school.
• Approximately 233,300 children received emergency care for an accidental injury.
• Asthma impacts 104,500 children in the service area. Asthma symptoms sent about one-fourth of those children to a hospital emergency department in the past year. 
• Almost 90% of children had continuous health insurance coverage for 12 consecutive months before completing the survey.

FROM DATA TO ACTION

These results, along with many other survey data points, give context to the center’s key priorities: children’s overall health and well-being, asthma, healthy lifestyles, caregiver support, injury prevention, mental health and oral health.

Becki Hale, AVP at the Center for Community Health, said takeaways from the survey will help the center respond to evolving needs in collaboration with more than 700 organizations across the region.

“We’re incredibly grateful to be part of such a strong, compassionate health care organization that invests and prioritizes giving back to the community and helping families thrive,” Hale said. “We also recognize that Cook Children’s is one of many partners committed to improving the health of our communities. Today’s health and social needs for families are too complex for any one entity to address alone. It takes all of us, working together.”

One example of how Cook Children’s utilizes the CHNA results in collaboration with others to implement innovative approaches that address the greatest needs: the Center for Community Health teamed up with Texas Health Resources in January 2025 to open a Good For You Healthy Hub at Fort Worth’s Eastside YMCA. The hub provides fresh fruits, vegetables and other nutritious foods for free to residents of the Eastside neighborhood.   

Chris Pedigo, senior vice president of system planning, health analytics and the Center for Community Health, pointed out that the CHNA provides insights that help Cook Children’s keep its Promise to improve the well-being of every child in our care and communities. 

“Our next steps include comparing this year’s results to those of previous years to identify areas where we’ve seen change, as well as identifying new communities that need focused programming,” Pedigo said.

Surveys were collected from a sample of households across the service area at large, not just Cook Children’s patients. Surveys were also collected from parents of special under-resourced populations, including those experiencing homelessness or living with an undocumented family member. The results are weighted to represent the actual population of children living in the service area.

The center takes steps to include a cross-section of the population through data collection and interviews. The team analyzed approximately 1.2 million data points, said Lauren Purvis, MPH, CPH, MCHES, Director of Child Health Evaluation.

“This approach can help partners feel confident using our data to inform their organization’s strategies to improve children’s health in their communities,” Purvis said.

Significant effort goes into developing and carrying out the research strategies that make the CHNA as inclusive and representative as possible.

“It’s important to us to gather a wide range of perspectives so we can thoroughly assess community needs,” Wolever said. “This approach helps us better understand how to support families and improve the well-being of children, ultimately living out our Promise.”

Regional Summits

Cook Children’s Center for Community Health is hosting two free, virtual Child Health Summits to share the survey findings with the media, community partners and other professionals.

• Part 1, May 6, 9-10:30 am: Cook Children's Child Health Summit Part 1 Registration, Tue, May 6, 2025 at 9:00 AM | Eventbrite

Focus areas: Overall Health and Well-being, Asthma and Healthy Lifestyles

• Part 2, June 3, 9-10:30 am: https://www.eventbrite.com/e/cook-childrens-child-health-summit-part-2-registration-1095338770749?aff=oddtdtcreator

Focus areas: Caregiver Support, Injury Prevention, Mental Health and Oral Health

For more survey results, please visit the data dashboard or contact CHNAFeedback@cookchildrens.org.

RELATED STORY

Parent Survey Underscores Need for Mental Health Focus

By Ashley Antle

If there is one thing kids know, it’s how to get dirty. So why not let them play in the dirt with purpose and create a home garden where they can experiment with growing their own food or flowers.

Experts say gardening positively impacts everything from food choices to physical fitness and even mood, and kids can reap these benefits, too.

“Gardening saved my brain,” said Dora Garcia, community health program coordinator at The Center for Children’s Health, led by Cook Children’s. “I had always been curious about growing my own food, but really got into it when I was doing a really stressful job. Being outside and digging in the dirt helped alleviate my stress and helped me relax.”

Garcia believes in the benefits of gardening so much so that she turned her stress-release activity into her day job and heads the gardening program for The Center for Children’s Health.

In partnership with the Johnson County Alliance for Healthy Kids and the Healthy Children Coalition for Parker County, Garcia advises schools in Johnson and Parker Counties on how to incorporate gardening into daily school and learning activities. The oldest coalition school garden is now seven years old, surpassing the average school garden life span of two years. 

Reap What You Sow

“Gardening is a hands-on way for kids to experience growing their own food,” Garcia said. “Research has shown that children who grow their own food are more apt to try different fruits and vegetables. They learn where food comes from and learn responsibility as they water and tend to the garden and watch their food grow.” 

Gardening also teaches patience and perseverance, as not everything planted will produce. Garcia says learning what works and what doesn’t is a part of the process and, like in life, working hard to overcome a challenge reaps reward.

Other benefits of gardening with your child include:

●     Decreased screen time and increased physical activity and exposure to mood-boosting sunshine.

●     Family bonding and team building as you work together to dig, plant, grow and harvest.

●     Interactive opportunities to explore and learn science and math concepts related to gardening.

●     Expands creativity and curiosity as kids design and build a green space where they can relax, read a book and explore. 

Bloom Where You're Planted

Growing your own garden doesn’t have to be hard, expensive, or take up too much space. It doesn’t even have to be in the ground. Gardens can be grown in pots, small outdoor beds or even bags. Garcia says to keep it simple and start small. Grow herbs or microgreens in a pot, or turn a galvanized tub into a small vegetable garden.

If you prefer sowing flowers over food, use the thriller/filler/spiller rule for planting an eye-catching flower pot. Choose one focal plant as your “thriller” to add height and drama. Pair with it “filler” flowers that are round or mounding to fill in the space around the thriller. To finish off the look, add a “spiller,” or trailing plant to soften the edges of the container.

When combining plants in containers, whether food or flowers, be sure to pair them according to their light and watering needs. In other words, don’t put shade-loving flowers like impatiens with full-sun plants like hibiscus, or moisture-loving herbs like basil with drought-tolerant plants like rosemary. To learn more, turn to resources such as Texas A&M Agrilife Extension and local plant nurseries that can point you in the right direction on what to plant and how to care for your garden.

Porch ponds can add tranquility to a small outdoor space. Use a galvanized tub or water-tight container to house water plants and a small filter/fountain combination to circulate water. Adding mosquito fish to your pond is an effective and environmentally friendly way to control mosquitos, and your kids will love the aquatic life.

Above all, let your kids get their hands dirty and have fun with your garden, be it big or small. Together, you’ll harvest far more benefits than just healthy food and beautiful blooms.

But I hear from my patient families all the time that it's anything but relaxing.

The American Academy of Pediatrics recommends doctors ask parents three questions about mealtime:

1. How anxious are you about your child’s eating?

2. How would you describe what happens during mealtime?

3. What do you do when your child won’t eat?

When offered a healthy, well balanced meal with fresh fruits, vegetables, and lean proteins, kids will stop eating when they are full. Children will naturally refuse to eat when they are not hungry. We often describe these as normal appetite slumps. We can disturb children’s natural satiety cues by either forcing them to eat or by offering foods high in added sugar or salt when they won’t eat. This results in a child who will “only eat chicken nuggets.”

Parents are most successful in feeding their children more fruits and vegetables when they model healthy eating, set appropriate limits, and have a positive attitude at mealtime. “The parent determines where, when, and what the child is fed; the child determines what to eat.” ⁽¹⁾ In other words, “parents provide and kids decide”. ⁽²⁾ 

Here are some tips on eating mindfully and encouraging your kids to eat in a manner that gives them more energy and helps them avoid chronic disease. These are easy ways to change your lifestyle that don’t involve a ton of work and expensive supplements.

1.Drink more water. Kids should not drink juice or soda except on special occasions.

2.Drink milk with meals. Children from age 1-2 should be on whole milk. After the age of 2, low fat or skim milk is recommended.

3.Vitamin supplements are not needed unless your child does not drink milk. Vitamin D is essential for bone health and immune function and may play a role in prevention of chronic disease.

4.Serve 5-9 servings of fruits and vegetables daily. Encourage your children to at least take a bite of everything you serve. Remember that children will need to taste a food 10-15 times before they decide they like it. Lean protein like fish and baked chicken might be better accepted if you add ketchup as a condiment.

5.Add healthy protein likes nuts (for older children) and legumes. Peanut butter is fine for younger children and new allergy immunology guidelines suggest that early introduction of peanut may actually decrease the risk of peanut allergy.

6.Eat more meals at home. Keep staples such as eggs, whole grain pasta, pasta sauce, yogurt, carrots, frozen vegetables, chicken breasts, and fruit stocked at all times so that in a pinch you could throw together a simple meal.

7.Double your recipes and freeze 1 meal at the same time that you cook the other meal. This will save you from making a trip to a fast food restaurant when you have that go to meal in your freezer.

8.Serve only whole grain breads and pastas.

9.Avoid buying, eating, or serving processed foods (chips, cookies, cakes).

10.Avoid fried foods and fast foods.

To read more about nutrition needs of children at different ages, I highly recommend the book “Nutrition: What Every Parent Needs to Know" available on the American Academy of Pediatrics (AAP) online bookstore.

See choosemyplate.gov for more information about how your child’s plate should look at meal time.

Realize that children’s tastes will change over time. They will sometimes refuse foods they readily accepted in the past, and they will readily accept foods that they refused in the past. Involve your children in shopping and meal planning. Let them help in the kitchen! Take them to a local farmer’s market and let them choose something new for everyone to try.

Take a matter of fact and pleasant approach to meal times and ENJOY YOUR FAMILY! Create wonderful childhood memories.

References:

1. “A Practical Approach to Classifying and Managing Feeding Difficulties” Pediatrics Volume 135, number 2, February 2015

2.Nutrition: What Every Parent Needs to Know. AAP

Fiber is a part of plant foods (ex: whole grains, vegetables, fruit) that our bodies can’t digest.

There are two types: soluble and insoluble. Soluble fiber is most helpful for lowering cholesterol, and insoluble fiber is like a scrub brush that helps to prevent constipation. Most foods deliver a mix of soluble and insoluble fiber.

Most children and adults alike aren’t getting enough fiber in their diet each day. Are you?

Here is a table of recommended intakes:

To increase fiber intake, eat more vegetables, choose fruit instead of fruit juice, and choose whole grains such as brown rice instead of white rice. Be careful to increase fiber slowly, and increase water intake as you do to avoid bloating and gas.  

So, add some fiber to your summertime cookouts!

Grilling vegetables adds a new dimension to their flavor. Slice vegetables with skin still intact, brush with some olive oil, season to taste, and toss on the grill. You can add grilled bell pepper or onion to your sandwiches, or make a side of grilled vegetables to go with your meal. Try this recipe to get started.

If grilling vegetables doesn’t appeal to you, here are a few other options:

• Try a variety of vegetables dipped in salsa, hummus or light ranch dressing.
• Add a fruit salad for a side or dessert.
• Choose whole wheat buns for sandwiches.

* Moshfegh A, Goldman J, Cleveland L. What We Eat in America, NHANES 2001-2002: Usual Nutrient Intake From Foods as Compared to Dietary Reference Intakes. U.S. Department of Agriculture, Agricultural Research Service, 2005.

About the author

Lauren Mullins is a clinical dietitian for the Endocrinology department’s REACH clinic at Cook Children’s.

But Aaron’s latest role is that of a young man whose weight has become such an issue, weighing in at 550 pounds, he was recently asked to leave a plane because he took up two seats.

“As I saw the seats, I’m literally hoping that no one had to sit next to me because I knew it wasn’t going to work if they did,” Aaron told NBC News.

The Centers for Disease Control and Prevention (CDC) report that Aaron’s struggles with his weight aren’t as unusual as you might expect. The CDC says that more than one third of kids and adolescents in the U.S. are overweight or obese. In addition to facing isolation and embarrassment, potentially continuing into adulthood, these children are at increased risk for numerous health ailments. Endowed Chair of Cardiovascular Health and Risk Prevention at Cook Children’s Don Wilson, M.D., warns, “most children with risk factors for cardiovascular disease will have them as an adult; being overweight or obese often results in weight related to health risks such as diabetes, high blood pressure, injury to bones and joints, disturbed sleep, fatty liver disease, abnormal blood fats and isolation and depression.”

To help children avoid problems caused by obesity in their adult life, parents have a responsibility to address concerns early. According to Wilson, “it is important to determine what, if any, cardiovascular risk factors your child may have, and begin working with your health care team in finding safe and effective long term solutions. Small changes at a young age can make a big difference in making sure your child has a healthy future.”

Becoming overweight or obese can happen to anyone; some factors can be controlled, while others are inevitable. One can’t control being predisposed to developing high blood pressure, having abnormal blood fats or family members with diabetes, for example, but there are always opportunities to improve one’s health, make lifestyle changes and develop a plan of action to reach a healthy weight.

Since children’s bodies are still growing, it can be difficult to identify when weight gain reaches a level of concern. Dr. Wilson suggests the following guidelines: “Is often difficult to simply look at a child and tell they are developing an unhealthy weight. That's why it's important that you calculate your child’s body mass index (BMI); there are several calculators available on-line. A BMI above the 85th percentile for age/sex is considered overweight, above the 95^th percentile is considered obese and over the 99^th percentile is regarded as morbidly obese.” The first step is to identify patterns that may indicate a problem; regardless of BMI, be sure your child is not gaining excessive amounts of weight each week or month and alert your doctor to any sudden changes. Bring up concerns during your child's health checkup and ask for guidance.

A common misconception is that poor diet and exercise is the only culprit for childhood obesity. These factors indeed have an impact in many cases, but an overweight child should never be blamed or labeled as “lazy,” as there are many other elements that can contribute to unhealthy weight gain. Be sure to rule out health-related causes while you are developing an appropriate weight-loss plan. Just as with adults, encouraging and motivating kids to lose weight can be a touchy issue. Parents often have the biggest influence to help their children become better informed about healthier food choices and the benefits of daily exercise. Wilson says, “As a concerned parent, you can help set realistic goals for weight, food and activities, talk about your child's food in terms of preference, preparation and portion size, increase physical activities for the entire family, discourage smoking and avoid smoking yourself and make healthy living a family affair.  Perhaps the most important thing you can do is to be a good role model for your child.

Aaron is using the uncomfortable experience of being kicked off his flight as motivation to speed up his weight loss plans. Remember, if you child’s BMI rises above the 85^th percentile or their weight gain is excessive (i.e. crossing percentiles on the CDC’s growth chart) be sure to discuss any underlying causes with your doctor and work with your family to develop healthy lifestyle patterns early on. Your child’s future depends on it.

For more information and to determine your child’s BMI, try using the American Academy of Pediatrics’ and Centers for Disease Control and Protection’s BMI calculators.