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

Ok, maybe we didn’t need a study to find that out, right? But new research does show how much pizza kids consume and how unhealthy too much of a good thing can be.

The study published in the journal Pediatrics focused on kids 2-19 years of age. The data found that pizza is a staple in most kids’ diet, taking in an average of 136 calories per day from pizza and that on any given day, about 20 percent of children and teens eat pizza.

This is not surprising, but on the days when children ate pizza that means more saturated fat, salt and calories. On those days when they do have pizza, teens eat 230 more calories per day and younger children average around 84 extra calories.

The study was conducted from 2003 to 2010. The bright side of the report was that the amount of pizza consumed during the study decreased by 25 percent.

So, what can you do at your house? Theresa Nash, director of Food and Nutritional Services at Cook Children’s, said start by making your own. She offers this recipe for healthy pizza crust that you can find on the Cook Children's Pinterest page.

What we commonly refer to as “whoa foods” from the Go-Slow and Whoa plan, should not be a staple in a child’s diet,” Nash said. “Just like a cheeseburger, you should focus on portion size, the type of toppings ordered, the frequency of how often a child or teen is making this type of food his or her meal. For pizza, parents should be aware of the toppings, the crust and the amount and type of cheese your child is eating.

Making pizza at home can be extremely easy and healthy, Nash said. The simplest individual pizza can be made using English muffins or flat bread rounds of various flavors. Utilizing a basic pizza sauce with a variety of healthy toppings such as veggies, grilled chicken or other lean meats can make your pizza unique and nourishing. Selecting vegetable toppings such as spinach, broccoli, bell peppers, mushrooms, onions and artichoke are just a few to have available. Going lighter on the amount of cheese, compared with the typical pizzeria and even selecting a ‘lighter” or lower fat version of mozzarella adds to a healthier pie.

There are many crust mixes and already prepared thin crusts available for purchase. Gluten free pizza mixes are obtainable if needed. If you going grain free or want to increase your vegetable intake even more, you may make a crust using cauliflower.

When eating out, Nash suggests parents should always go with the thinner crust:

At restaurants:

Thin crust cheese - 388 calories. You save 50 calories and 200 milligrams of sodium by opting for thin over regular crust, without sacrificing flavor. Always choose thin crust, no matter what the topping.

Mixed vegetable - 466 calories. Add spinach and broccoli to a thin crust and this is as healthy as restaurant-ordered pizza gets. “Now if only we could lower the sodium, which can add up to approximately 1,020 milligrams per slice,” Nash said.

Compared with:

Deep dish (cheese) - 640 calories.Two slices from a 12-inch deep-dish pizza have more than twice the calories, fat and sodium you would get with a thin crust.

The works/supreme - 606 calories. We bet you knew it was high, but did you know it would be this high? If you must have meat on your pizza, choose one kind. This meat “works” contains 12 grams of saturated fat and almost 1,400 milligrams of sodium in only two slices.

*The study was conducted by the Health Policy Center at the Institute of Health Research and Policy at the University of Illinois at Chicago.

About the source

Theresa Nash is the director of Food and Nutrition Services at Cook Children’s.Through medical nutrition therapy, a Cook Children's pediatric dietitian can help prevent and manage diseases that affect your child's health, fitness and overall well-being.Cook Children's has registered dietitians and dietetic technicians on staff to help with your child's nutritional needs from birth all the way through the teen years.