Every year, approximately 2,000 seemingly healthy people under the age of 25 die from sudden cardiac arrest (SCA), a tragic statistic that Cook Children's Health Care System is working to change.

In recognition of National Sudden Cardiac Arrest Awareness Month this October, Cook Children's is highlighting its year-round commitment to ensure schools and communities are prepared for such a medical emergency through its Project ADAM program, which provides life-saving training and resources.

Sudden Cardiac Arrest occurs when the heart stops beating, which leads to loss of breath or irregular breathing and prevents blood flow to the brain and other vital organs.

“With the proper training, anyone can do CPR and use an AED, and with enough of us trained and empowered to do so, we have the ability to potentially save someone’s life,” said Sarah Thieroff, Project Adam Program Coordinator.

Project ADAM (Automated Defibrillators in Adam's Memory) is a program named after 17-year-old Adam Lemel. In 1999, while playing high school basketball, Lemel collapsed and went into Sudden Cardiac Arrest. His family learned that he could have been saved with the right preparation and equipment. An automated external defibrillator (AED) was not available. His parents helped start the Project ADAM program at the Children’s Hospital of Wisconsin in his memory. Cook Children’s was the first in Texas and is now one of 52 hospitals and program sites to provide free cardiac resources, including training and AED devices. 

Thieroff recalled the motivating force behind the program's founding: "What we learned now is that Adam could have had a chance. I was faced with a choice. I couldn't save my son, but maybe I can save yours," Adam's father said.

More than 780 schools and 28 school districts are recognized to be Heart Safe. A designated Heart Safe school and district have completed a quality AED training program that includes a CPR/AED trained emergency team, an emergency plan for their AED and required AED drills.

“Knowledge of what to do, and muscle memory from practicing the appropriate steps may correspond to earlier action and in turn lead to a more successful outcome,” said Danielle Moyé, M.D., at Cook Children’s Heart Center.

Beginning the 2026-2027 school year under Senate Bill 865, also known as the Landon Payton Act, public and private schools will be required to implement a cardiac emergency response plan, mandate CPR and AED certification for specific school employees and volunteers, and require drills to test their emergency response.

“With the SB 865 bill, we have legislative support to encourage schools to act now and prepare,” said Dr. Moyé. “And we are ready to help them. We are here and happy to walk through what this looks like and ease some of the burden from the school’s administration, nursing team, and district.”

An AED is supported by the FDA to detect ventricular fibrillation. It has been designed and tested in both children and adults. Cardiac arrest is reversible in most victims if it is treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation. A shock delivered by an AED within 3-5 minutes can save a life and for every minute that passes, survival rates drop by 10%.

Through the Cook Children’s Project ADAM program, anyone can be trained. The program provides schools across Texas with the necessary tools and education to plan and develop their public access defibrillation (PAD) program.

“The expectation is that schools will be prepared for if it happens, not just putting it off or waiting to establish an emergency team, plan and/or drill if/when it happens,” explained Thieroff.

Signs and Symptoms of Sudden Cardiac Arrest

• Not breathing or irregular breathing (i.e. agonal gasps)
• Unresponsive and/or sometimes there are “seizure-like” movements.
• If someone witnesses a collapse:
  • Check for responsiveness.
  • Tap/lightly shake the person and ask if they’re okay, then if they’re not responsive, call for help/have someone call 911 immediately
  • Send someone to get the AED. If they’re unsure where the AED is, when they call 911, the 911 dispatcher should tell them the location of the nearest registered AED in the area.

Cook Children’s provides free Hands Only CPR/AED training, cardiac emergency response planning, and AED drill assistance to any school in Texas. Call 682-885-6755 or email ProjectAdamTexas@cookchildrens.org. For more information on free resources on the local Project ADAM program, visit www.projectadamtexas.org or the national Project ADAM page at www.projectadam.com

The saying “timing is everything” could not be more true for Crystal Schnabel, Eric Massey and their son Rogan Massey. Rogan was born on April 13, nearly six weeks early, but not a minute too late.

A few days prior to her son’s birth, Schnabel had an appointment scheduled with maternal-fetal specialist Holly Dunn, M.D., an Abilene-based high-risk obstetrician with Cook Children’s Health Care System. Because Schnabel experienced low amniotic fluid levels in her first pregnancy, she needed to be monitored closely. But a scheduling conflict led her to cancel her 34-week appointment. Two days after her missed appointment, just to be on the safe side, Schnabel, a radiology technologist, asked a fellow sonographer to do a quick ultrasound to check her fluid levels. Her colleague told her to stop by the next day during a break in her schedule.

On April 13, at 2:45 p.m., Schnabel met her colleague for the scan, and they both noticed something peculiar. Rogan’s heart rate was irregular and beating faster than normal at 254 beats per minute. The sonographer urged Schnabel to go to the labor and delivery department at Hendrick Health in Abilene for an exam. Schnabel alerted her obstetrician, called her husband and made her way to the hospital.

There, she was hooked to a fetal heartbeat monitor that produced what appeared to be normal readings for the baby’s heartbeat, but Schnabel’s obstetrician asked Dr. Dunn to take a second look.

“Her OB called me, had me look at the monitor strip and something didn’t sit right with me. So I told her to send mom over,” Dr. Dunn said.

Schnabel and Massey immediately made their way to Dr. Dunn’s office located just across the street from the hospital. By this time, it was a little after 3 p.m.

Schnabel was seen and counseled by Dr. Dunn’s nurse practitioner who recommended that she be admitted to the hospital for overnight monitoring. As the couple left to make the short trek back across the street to the hospital, Dr. Dunn reviewed her sonogram images and made the call to act sooner than later.

When the couple arrived at Hendrick Health’s labor and delivery department they received shocking news. Schnabel needed an emergency cesarean section.

In the five minutes it took Schnabel and Massey to walk from Dr. Dunn’s office to the hospital, the labor and delivery team received a call from Dr. Dunn to alert them that Rogan’s heart was in supraventricular tachycardia (SVT), a fast and erratic heartbeat that prevents the blood from pumping throughout the body, potentially leading to congestive heart failure and death.

“The baby’s heart was barely moving,” Dr. Dunn said. “The rate was quick, so the electrical conductivity was passing through, which is what we were detecting on ultrasound and monitors, but the heart itself was barely moving and weary from working so hard. There can be some arrhythmias that are benign, that are sustained for days to weeks. But SVT, in this case, is something that can only be sustained for a few minutes to hours before the baby either comes out of it spontaneously or death occurs.”

Rogan needed to be delivered immediately. His life depended on it.

“We walked in and all of the nurses are standing around and anesthesia is ready,” Schnabel said. “The doctor was ready. The NICU team was there, and I was in a gown with all my jewelry off and an IV going within a matter of probably four minutes. It was very fast.”

The couple knew something was wrong but they had no idea how serious it was.

“Everything happened so fast that it was hard to understand the severity,” Massey said.

Rogan was born at 5:25 p.m., a little more than two hours after Schnabel met her colleague for that impromptu ultrasound.

Schnabel and Massey were able to see their newborn for a few brief moments before he was whisked off for care. Around 8:30 p.m., Cook Children’s Teddy Bear Transport arrived at Hendricks Hospital to transport Rogan to Cook Children’s Medical Center – Fort Worth for treatment of his dangerous heart arrhythmia.

Collaboration Counts

Schnabel’s on-the-fly ultrasound that fateful Thursday set in motion a number of collaborative efforts between pediatric specialists that resulted in an accurate diagnosis and treatment plan, and much of it came together during the couple’s short walk from Dr. Dunn’s office to the hospital.

“It's a reassurance to know that they're in sync with one another to be able to communicate so quickly and get an accurate specialty-type diagnosis within five minutes of the scan,” Massey said.

After connecting the dots between Rogan’s unusual heart rate, the ultrasound, monitor readings and the report from her nurse practitioner, Dr. Dunn made an urgent call to Lisa Roten, M.D., a pediatric cardiologist at Cook Children’s Medical Center. Dr. Roten is the medical director of Cook Children’s fetal electrocardiography program. Scott Pilgrim, M.D., medical director of Cook Children’s adult congenital heart disease program, was also looped into the case.

“There's constant collaboration between us, but in this case, it was just so seamless and easy and I was able to orchestrate the management plan between Dr. Roten and myself, and then Dr. Pilgrim became involved as the handoff happened from here to the medical center in Fort Worth,” Dr. Dunn said. “There was also so much collaboration with the Hendricks Health staff, with anesthesia, the nursing staff and the neonatologist.”

Dr. Roten recommended an immediate c-section for any chance of saving Rogan’s life.

“SVT, or atrial flutter in this case, is not life-threatening if for a short duration,” Dr. Roten said. “However, if it does not break, as was the case here, it results in death. This baby’s heart function was very poor and we did not have time for medicines to be given to mom to try to correct the rate.”

Undetected arrhythmias are the suspected cause of many stillbirths where there is no known genetic syndrome or structural problem, according to Dr. Dunn. If the sequence of events had been any different, Dr. Dunn says it’s likely Rogan would not be alive today.

“I think a lot goes into Rogan’s story,” Schnabel said. “I had the sonogram on that specific day and at that specific time when my coworker had an opening on her schedule and I could have her scan me, and the fact that his heart did what it did at that exact moment is proof that he is here for a reason. We were able to go to labor and delivery and have him within 15 to 20 minutes of showing up and the OR team was ready. Every little thing had to happen for him to still be alive. Through it all I was reminded I’m not in control, God is. This was his plan, not mine. The progress we’ve made over the past few weeks has been from above and I’m thankful for every moment.”

It’s unclear what caused Rogan’s arrhythmia, as is the case with many babies who develop the condition. Rogan spent 19 days in Cook Children’s Neonatal Intensive Care Unit where he was diagnosed with a type of SVT known as atrial flutter, in which the upper chambers of the heart pump rapidly. He underwent two cardioversion procedures to shock his heart back into a normal rhythm and is now on medication to control his heart’s pumping function.

It’s possible he’ll grow out of the condition altogether. If not, he may need a cardiac ablation in the future. An ablation is a procedure where doctors burn or freeze tiny scars into the heart to block irregular electrical pulses so that the heart stays in a normal rhythm.

“The electrical system of a newborn is immature and most babies outgrow the arrhythmia by one year of age,” Dr. Roten said. “But this rhythm was harder to control and sometimes they need to go to the cath lab to have an ablation.”

For now, Schnabel and Massey, are back home in Abilene with their newborn enjoying their full house, which includes Rogan’s brother and sister, both 10 years old.

“I'm just thankful for the support that we've had from the community,” Massey said. “Our friends and family have been overwhelmingly supportive.”

You can read my earlier posts on the symptoms of teething and my outright forbidding the use of teething gels.

After these, I think I have many of my readers wondering what in the world they are supposed to do when their child seems to be teething.

There are a select few of you out there who think you have found a loophole … their children are walking around sporting brownish yellow bling around their necks, are as happy as can be at all times and are sleeping through the night like little angels. Right?

Do amber teething necklaces work? If so, how?

Websites selling amber necklaces are all over the place when discussing how they might work to control symptoms that are commonly associated with teething.

They tend to center around three main concepts:

• Magnetism, energy or natural flow of energy

• Thyroid gland stimulation to control drooling

• Succinic acid released causing anti-inflammatory and pain relieving

Magnetism, energy or natural flow of energy

I found this quote in one of the top-ranking articles regarding how amber teething necklaces might treat teething pain:

“The unfavorable environmental conditions prevailing today block the natural flow of energy-related processes in cells. Blocks affect cellular metabolism and significantly weaken the immune system, but the natural energy of amber is able to stimulate its renewal.”

Thyroid gland stimulation to control drooling (or other symptoms)

The thyroid gland makes thyroid hormone which increases metabolism. This results in a whole list of changes inside our bodies, including:

• Increasing body temperature
• Faster, stronger heart beat
• Brain development and growth in children

Slowing drooling is not a function of the thyroid; thus stimulating it would not result in less drooling.

Stimulating the thyroid could result in increased body temperature (which is, ironically, often one of the symptoms of teething that people are trying to treat).

Succinic acid release causing anti-inflammatory and pain relieving

Perhaps the MOST logical explanation (and most often referenced) for why amber teething necklaces might work for teething pain is that amber contains 3-8 percent succinic acid.

Succinic acid is a chemical that is found naturally in the body and is involved in an energy producing chemical cycle known as the Krebs cycle. The basis of the reasoning behind why succinic acid treats teething symptoms is that it is reported to have anti-inflammatory properties.

Let’s look at a few problems with the assumption:

1. I can only find one study that even shows succinic acid to have anti-inflammatory effects. It is almost 30 years old and was published in a journal I have never heard of, in Russian.

2. Assuming succinic acid does treat pain associated with teething, how does the succinic acid get into the child’s body? Amber is fossilized tree resin which is formed under extreme heat and pressure. The Wikipedia article on amber states, “Exposure to sunlight, rain and temperate extremes tends to desintegrate resin, and the process is assisted by micoorganisms such as bacteria and fungi. For resin to survive long enough to become amber, it must be resistent to such forces or be produced under conditions that exlude these." How is it, all of the sudden, that amber decides to release succinic acid in response to 98.6* temperatures and gentle pressure from your child's neck? Seems unlikely.

3. Let’s assume that 1 and 2 are wrong and that succinic does treat pain associated with teething and will absorb into the child’s body from the necklace. How much is absorbed? Medication applied to skin is notoriously unreliable with children.

Let’s flip this around. Say an established drug company comes up with a treatment for a common condition that is not dangerous but may cause some discomfort. The drug rep comes to my office to promote the drug…

Me: Ok, this all sounds great? So, what is the dose? How does the dose change as the child gets older?

Drug rep: Ummmm, we don’t know really. We haven’t really looked into “dosing.”

Me: So, how do you know this works?

Drug rep: Well, it’s actually been around a long time, we just put it in a different package so we’re pretty sure it works and is safe.

Despite the fact that on the surface it seems plausible, I don’t think the succinic acid claim holds up as a mechanism where amber necklaces could work for teething.

Is it a choking hazard?

We have to address these necklaces as a choking hazard. It’s interesting. People say they aren’t a strangulation hazard because they break. Ok. But then they say they aren’t a choking hazard because the beads are tied individually.

I say, you can’t have it both ways. If they break, they have to break somewhere and a bead has to get loose. And if you’ve seen the size of these beads … looks like a choking hazard to me.

So, why do amber teething necklaces “work?”

It’s really based on three points…

1. Teething symptoms are vague and most are only mythically related to teething.

2. Teething symptoms go away on their own 100 percent of the time.

3. Parents are desperate to help when they assume their kids are in pain.

Studies are pretty clear that teething symptoms really only last a day or two around the day that the teeth erupt. Many of the symptoms commonly associated with teething may actually be normal developmental issues-drooling, waking up at night, etc.

Knowing whether a specific treatment for “teething symptoms” works or not is almost impossible. But, for parents who had concerns and tried amber teething necklaces, the results seems magical. Doing something is often thought to be better than doing nothing. It’s certainly easier to brag about.

I have yet to see a Facebook post that says, “My kid was MISERABLE with teething last week but look at him today!! I found the miracle cure - I did absolutely NOTHING! You should try it too.”

I’m coming into a place where I’m not sure treating teething with anything makes sense, even your typical pain relievers. For this reason and because I cannot find a plausible explanation for why they work, I think parents should save their money when it comes to amber teething necklaces.

“Palpitations” is a word that we use when we become aware of the beating of our own hearts. Like many things in medicine, palpitations can be both normal and abnormal. Who of us cannot remember feeling our heart race after we have been scared or excited? This sensation is typically normal. Our bodies respond to emotional stimuli by secreting hormones and activating nerves that tell our hearts to beat faster and harder (perhaps to get ready to run away from danger).

However, palpitations are not always normal sensations. Palpitations can also be felt when we experience an “arrhythmia.” The heart’s beating is controlled by electricity. Typically, the electrical impulses start in a specific location in the top chambers of the heart (the “sinus node”) before traveling down specialized conduction pathways (like “wires”) to activate the rest of the heart. Most arrhythmias in children come from a short circuit in the wiring of the heart. Instead of the sinus node dictating how fast the heart beats, it is the characteristic of the circuit that dictates how fast the heart beats.

Palpitations occur frequently in kids. Older children and adolescents typically have no problem describing their symptoms (feeling that their heart is “racing”, or “beating out of their chests”). However, young children cannot often accurately describe what they are feeling. Some may say “my heart is beeping,” but others might indicate that their chest or heart is “hurting” or “feeling funny.” It is not uncommon for children to “feel their heart beat in their neck.” Babies, of course, cannot tell us anything about the way they are feeling. Frequently, all that we notice in babies with arrhythmias are actually signs of heart failure (which occurs after about 24-48 hours of arrhythmia), such as poor feeding, trouble breathing, lethargy or fussiness.

How can we know the difference between normal sensations and those of an arrhythmia? Here are a few tips:

1.Onset and termination: Because arrhythmias are “short circuits,” they tend to start and stop suddenly. Often patients can remember the exact moment when the sensation started and stopped. Palpitations that come from anxiety, fear, excitement, etc. tend to start and stop more gradually.

2.Heart “beating in the neck:” Many arrhythmias alter not only how fast the heart beats, but how it squeezes, making it less efficient. Instead of all of the blood traveling forwards, some may travel backwards to the blood vessels in the neck, causing this strange sensation.

3.Associated symptoms: Arrhythmias are frequently accompanied by symptoms such as chest pain, shortness of breath, and dizziness.

4.Signs of heart failure in babies: Poor feeding, trouble breathing, lethargy, or fussiness could indicate an arrhythmia in babies and should prompt parents to seek immediate medical attention.

However, even with these tips, the difference between normal sensations and those coming from arrhythmias can be difficult to tease out. The only way to know for sure is to monitor the electrical activity of the heart (using an “electrocardiogram” or “EKG”) during symptoms. There are now many types of devices that can aid diagnosis in this way, and your cardiologist may send you home with one.

The good news-arrhythmias in children are typically very treatable-either with medicines or with a procedure called an “ablation.” Either way, the goal is for the child can carry on with normal life … without a beeping heart.