Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health service clinic for information on clinics.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the recommended shots, the Human papillomavirus (HPV) vaccine often raises questions.

Hospitalist Laura Romano, D.O., explains the key facts about HPV and the vaccine that prevents it.

What is HPV?

HPV is a viral infection that causes flesh-colored warts on certain mucous membranes, most commonly affecting the mouth, throat and genitals.

HPV infections can lead to cervical cancer in women, as well as head-and-neck and anal cancers in both men and women

Most people with HPV have no symptoms and don't realize they carry the virus, yet they can still pass it to others.

How can the disease be prevented?

Vaccinating older children and teenagers can provide lifelong protection against HPV and helps prevent several types of cancer as well.

What would you like families to know about the virus or the vaccine?

Vaccinating boys and girls offers lifelong protection against a virus that can cause warts but also against deadly cancers. The vaccine protects your child now and helps safeguard their future partners down the road.

Last year, for the first time, the United Kingdom announced zero deaths from cervical cancer among women under age 30. Australia and New Zealand have seen similar results alongside increased vaccination rates.

Other countries have also reported declines in cervical cancer among women, as well as head and neck cancer among men.

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Wellness

• Schedule a Check-up: The American Academy of Pediatrics (AAP) recommends annual checkups from age 3 through adolescence. Schedule early to secure an appointment before the school year starts.
• Mental Health: Have open and honest conversations with children about their concerns. Speak with the pediatrician on tools to help with anxiety.
  • Parenting & Back-to-School: Emotional Safety Starts at Home
  • Raising Joy Podcast: Back to School Anxiety
• Oral health: Children should visit the dentist every six months. Make sure kids brush twice a day for two minutes and floss daily. Make an appointment.
• Update child vaccinations: Navigating vaccines can feel overwhelming. Talk to your pediatrician. The Texas Department of State Health Services requires certain immunizations before children can attend school.
  • To schedule an appointment, visit Cook Children's website or your county's health department website.
  • If a child is not of school age but attends daycare, other requirements may apply.

  • College students are required to receive the meningococcal vaccination.

    

• Sport physicals: The annual UIL pre-participation physical evaluation form applies to middle school and high school students. Sports physicals give doctors the opportunity to check for a variety of concerns, from vision issues and asthma to a lingering sprain or even a serious heart condition.

Healthy Routines

• Sleep: Sleep fuels a child's memory and concentration. Without consistent rest, children struggle to focus in class and retain what they learn, impacting their academic performance.
• Key elements for building a bedtime routine:
  • Establish a consistent schedule by going to bed at the same time each night.
  • Limit screen time at least one hour before bedtime.
  • Keep bedrooms quiet, cool and dark.
  • Create a calming routine, such as reading together.
• Transportation safety:
  • E-Bike and E-Scooter safety: Always wear a helmet.
  • Driving: Drive slowly through school zones and watch for pedestrians.
  • Car Safety: Ensure your child is in the correct car seat or booster for their age and size.
• Nutritious meals: Plan balanced breakfasts and lunches to keep energy levels stable throughout the day.
• Screen time: According to the American Academy of Child and Adolescent Psychiatry, children ages 8 to 18 in the United States spent an average of 7.5 hours a day using screens in 2025. Set clear daily limits for non-academic screen use.

Make a Plan

• Virtual care: If school district offers it, sign up for the Cook Children’s School-Based Virtual Health Program.
• Allergy action plan: Provide updated emergency allergy plans and medications to the school nurse.
• Medication management plan: Submit required doctor authorization forms for any daily or emergency medications needed during school hours.

You've got questions? We've got answers covering everything about immunizations and vaccines. They each have a different role, but they both have the same goal. Learn more here: Immunizations and Vaccines Resources

Raising a child can come with a lot of questions, especially when it comes to their health and well-being. Vaccines, in particular, often spark a lot of conversation and curiosity among parents. It’s our priority to provide parents and caregivers with clear, reliable guidance. That’s why we asked Laura Romano, D.O., a hospitalist at Cook Children’s, to share the top 10 questions she receives from families.

1. Should my child receive the flu and RSV vaccines now? There seems to be so much confusion in the news, plus I’m not sure my insurance is going to cover all of this anymore.
Yes they should. Please get your seasonal vaccines as soon as possible!

Infants under 8 months whose mother did not receive an RSV vaccine while pregnant should receive their RSV immunization in October. If you did receive an RSV vaccination while pregnant, your child might still need their immunization. Please talk to your pediatrician to see if your child is eligible. RSV immunizations protect up to 90% of severe RSV infections.

Everyone in your house 6 months and older should also receive their seasonal flu vaccine. Ask your pediatrician whether your child should receive the COVID vaccine. These vaccines are recommended by the AAP among other organizations. Unfortunately, healthy children and adults can still have serious complications from the flu and COVID. 

I encourage you to have a conversation with your doctor and the financial representative in your primary care office. We all want to help your family and do what is best for your child.

2. Are vaccines safe and effective? 
Yes. Each vaccine is rigorously studied prior to its approval and is monitored even after it's approved to make sure it’s safe. 

Vaccines have saved nearly 200 million lives in a century, many of those lives were young children and babies. 

3. Do vaccines cause autism?
No. Decades of research have shown over and over again that there is not any link between vaccines and autism. The overwhelming majority of articles that have tried to show any association have been widely discredited by the medical community at large.

4. I heard vaccines contain things like aluminum and formaldehyde. Is that safe to put in my child's body?
Yes! Many of the ingredients found in vaccines are necessary to help the body produce an immune response, like aluminum, and can be found in nature. Aluminum is actually found in fruits and vegetables. It is also found in meat, dairy and produce in small amounts.

And yes, by itself, formaldehyde is dangerous and you wouldn’t want to ingest in any way. However, the amount contained in vaccines is so minimal, so it is very safe. The formaldehyde prevents bacteria from getting into the vaccine vial. 

These ingredients are necessary to make sure the vaccine is safe to give and that the body produces the best immune response. Think of these ingredients like baking cookies. You have to put baking powder and baking soda into the cookies for them to turn out delicious. 

5. Why are there so many shots these days? 
It is a good thing! Science and technology have allowed us to study more diseases and develop more vaccines to prevent children from getting sick! 

Also, many vaccines are now given in combination so there are less injections. 

6. Why don't you recommend a delayed vaccination schedule? 
We know based on years of study how the newborn’s immune system works and when the maternal antibodies begin to fade so vaccines are recommended at specific intervals to provide the most protection to the baby.

7. Will vaccines weaken my child's natural immune system?
Absolutely not! Multiple studies have shown that children who are fully vaccinated are not more at risk for other illnesses. 

On the other hand, certain vaccine-preventable illnesses like measles can cause complications like “immune amnesia” that damages their immune system and makes them more susceptible to other illnesses. 

8. Why does my healthy child need vaccines? Won't their immune system naturally protect them? 
Some vaccine-preventable diseases can cause serious complications including meningitis, seizures, blindness, hearing loss, loss of a limb, permanent brain damage, developmental delays, and pneumonias. Some diseases can be fatal. 

These are complications that we need to protect your child against. While their immune system might be able to fight off the disease, the complications would be devastating and life-changing. It is not worth the risk. 

9. Isn't Hepatitis B an STD? Why should my child get that vaccine? 
Yes, one of the ways that Hepatitis B is spread is through intimate contact but it can also pass from the mother to the baby and cause serious liver damage. Some mothers are not able to receive prenatal care and wouldn’t be tested for Hepatitis B prior to delivery so we vaccinate all babies to protect against liver damage. 

Hepatitis B can also be spread through blood transfusions, bites, lesions, certain sanitary habits, or contact with an infected person’s secretions. 

Vaccinating your child early against a potentially chronic disease is always a good idea! 

10. Are your kids vaccinated? 
Yes! I have two kids (a 7-year-old daughter and a 4-year-old son). Both of my kids are fully vaccinated for all the reasons listed above. 

Vaccines protect my children, my patients, my husband, and our community. Children who are fully vaccinated are less likely to spread disease to at-risk individuals, like my dad with diabetes, my daughter’s best friend who has a new baby sister at home, our friend who had a kidney transplant a few years ago, our neighbor who is undergoing chemotherapy, a co-worker whose daughter has congenital heart disease. 

Vaccines protect my kids and our friends and family. We vaccinate because it is the right thing to do and it is the safe thing to do.

Our goal at Cook Children’s is for our community, our patients and our patient families to stay as healthy as possible. If you have any questions, please contact your pediatrician. We’re here to help!

August is a chaotic month for any busy parent. Between back-to-school preparations and the last days of summer, it's easy to get overwhelmed. On top of that, August is also National Immunization Awareness Month—a perfect time to make sure your children are up-to-date on their vaccinations.

When people learn that I’m a pediatrician they often ask if my own two children are vaccinated and I always reply with a resounding yes. My children are vaccinated for several reasons: 

Vaccines are safe! 

• Every vaccine that is currently in use has gone through a rigorous testing phase to make sure that the vaccine is safe. Side effects and potential reactions are closely reviewed by multiple agencies at the federal level. Even after the vaccine has been approved, the Vaccine Adverse Effect Reporting System (VAERS) continues to monitor for additional side effects. 
• Millions upon millions of vaccines will be administered this year with minimal side effects. The most common side effects are low-grade fever, redness around the injection site or maybe some mild muscle aches. 

Vaccines are effective! 

• Vaccines have led to the eradication of previously fatal diseases like Smallpox. 

Vaccines save lives!

• Vaccines have saved the lives of nearly 200 million people in the past century. Many of those lives saved are of young children and babies. 
• Vaccines prevent diseases and illnesses that have serious consequences, even in healthy children. 
• Vaccines prevent diseases that can lead to hospitalizations, pneumonia, potential hearing loss, potential loss of an arm or a leg, brain damage, and even death. 

Vaccines do not cause autism. 

• Decades of research has shown again and again and again that there is no link between vaccines and autism. 

The ingredients in vaccines are safe. 

• Just as the individual vaccine is studied, the ingredients in vaccines are also rigorously studied. 
• Some vaccines contain ingredients like aluminum, which can be found in fruits and vegetables. Aluminum helps the body produce an immune response and is perfectly safe. 
• Vaccines can be preserved with very small amounts of formaldehyde, so small that it is not harmful at all. 
• These ingredients are like baking powder when you’re making cookies. By itself, baking powder does not taste good but in small amounts, it’s needed for your cookies to come out looking and tasting great! 

Vaccines are recommended by my children’s doctors.

• My kids’ pediatrician - along with the American Academy of Pediatrics, the American Academy of Family Physicians, the Infectious Disease Society of America, the American College of Physicians, the American Medical Association, and the American Nurses Association - all support routine childhood immunizations. 

Vaccines help keep my community safe. 

• My children are vaccinated because doing so protects them and our community. 
• Vaccines can help prevent your child from spreading illnesses to at-risk individuals such as your parents who have diabetes, your child’s classmate who has a newborn at home, your neighbor who is undergoing chemotherapy for cancer, your co-worker who just received a kidney transplant, or the cashier in the grocery store who has an autoimmune condition. 
• We rely on everyone to get their vaccines to keep the community safe. 

And the most important reason to me is that I want to protect my dad. My dad has type 1 diabetes and is immunocompromised. My kids will always get their flu vaccines every year so we can give him the BIGGEST hug without worrying about making him sick. 

So, this month, in between back-to-school shopping, meet the teacher nights and the ever-exciting first day of school, please call your child’s pediatrician and make sure that they are up-to-date on their vaccines. We would love to talk to you more and answer all of your questions and concerns! 

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Measles is highly contagious; one infected person can potentially infect 12 to 18 unvaccinated individuals. The virus spreads through infectious respiratory droplets and airborne transmission (from coughing or sneezing), where tiny droplets can remain suspended in the air.

 Measles symptoms typically appear seven to 14 days after infection. 

They can include:

• Rash
• Fever, sometimes over 104º Fahrenheit or 40 º Celsius
• Runny nose
• Cough
• Red, watery eyes
• Sore throat
• Tiredness

How do we stay safe?

The most effective prevention against measles is vaccination. The size of the virus makes it more contagious. Measles can live in the air in a room where an infected patient has been for two hours after that patient leaves.

This means that if ten unvaccinated children are in a room and one of them has measles, nine out of ten of them will likely catch the virus. 

In addition to getting vaccinated, the spread of measles can be mitigated by proper hygiene. This includes:

• Handwashing
• Covering your mouth and nose when you cough or sneeze
• Avoid sharing drinks or eating utensils
•  Disinfect frequently touched surfaces

What about other illnesses?

While Cook Children’s Medical Centers in Fort Worth and Prosper are not seeing an abnormal number of cases for RSV, COVID, and Flu, these illnesses can be prevented with proper hygiene as well.

It is important to speak to your primary care physician if you have any questions or concerns about vaccines. There are now vaccines to help prevent the severity of RSV, COVID, and Flu.

Where can you get immunized?
Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options. 
   

If a parent suspects their child may have measles, they should call the primary care doctor before arriving at the office so arrangements can be made for safety and to minimize potential exposure in the waiting room.

Editor's note: An earlier version of this story included information about deaths during the measles outbreak in Ohio which was incorrect. We regret the error.

By Heather Duge

During the recent measles outbreak in Ohio, the majority of children under 5 years old who were infected did not receive the measles, mumps and rubella (MMR) vaccine. Of the 85 children infected with measles, 25 of those children were hospitalized and several were treated in intensive care. Mary Suzanne Whitworth, M.D., Medical Director of Pediatric Infectious Diseases at Cook Children’s, said the under 5 age group is more at risk for severe cases of measles.

Not only that, but even children who recover from measles, especially those younger than 2 years old, are still at risk for developing SSPE – delayed brain inflammation – seven to 10 years later.

“Delaying the vaccines only leaves children vulnerable for longer than necessary,” said Dr. Whitworth, who never questioned vaccinating her children. “I could not sleep until my children were vaccinated.”

The Centers for Disease Control and Prevention recommends that all children receive two doses of the MMR vaccine – one at 12 to 15 months old and another at 4 to 6 years old. One dose is 95% effective against measles and two doses are 97% effective.

Some areas in the U.S. are more at risk for outbreaks – particularly communities with anti-vaccine sentiment. Age makes a big difference – being exposed in early infancy can be devastating which is why herd immunity is crucial to protect the vulnerable ones.

Herd immunity means enough people are immune through having the disease or vaccination so the disease does not have an easy place to land and cannot spread. If a person with measles coughs in a room with 10 people and everyone has been immunized, it will not spread. But if four of those people are not vaccinated, it will begin to spread.

Devastating Effects of Measles

Measles infections typically begin with high fever, congestion, cough and watery eyes. Three to five days later a rash may appear with flat red spots starting at the head/neck area and working its way down the body along with spots in the back of the throat. For some children, the infection worsens to measles pneumonia.

“One out of 1,000 children have brain inflammation and one to three children out of every 1,000 will die from respiratory or neurological complications,” Dr. Whitworth said. “These potentially tragic effects of measles are completely preventable.”

View CDC facts about measles.

According to the National Conference of State Legislatures, Texas is among 18 states that allow families to opt out of vaccines for personal or moral beliefs. The Morning News reports that Plano, Fort Worth, Austin and Houston all ranked among the 15 U.S. metro areas with the most such conscientious exemptions for kindergartners. Each had more than 400 kindergartners exempted from vaccines.

Fifteen years ago, about 2,300 students opted out of at least one vaccine. Today, that number has grown to 56,737 kindergarten through 12th grade students.

This has many doctors, including myself, worried about more measles outbreaks in Texas.

"Populations who choose to not follow the recommended vaccine schedule for themselves and for their children are actually setting up the perfect conditions for the diseases they are unvaccinated for to erupt into an outbreak. It is really not a question of whether these outbreaks will occur but when," Jason Terk, M.D., a Cook Children's pediatrician in Keller.

News about vaccine preventable diseases is important for us to share, but it brings up many strong opinions.

Here’s how the debate usually goes:

“Please vaccinate your children.”

“If your child is vaccinated and vaccines are such a good thing, why do you care if my child gets vaccinated?”

Most people don’t have a good answer for it so it tends to be a good trump card.

So why do I care?

There are two reasons.

1. I care about your child. I firmly believe that vaccination is the right thing to do. I vaccinate my children on time and on purpose. I would not want any child to receive less care than I would provide my own children.

2. Vaccines sometimes do not provide complete protection. Most provide protection in the 90-percent plus area (some nearly 100, some lower). Because of this, even a vaccinated child can contract the disease. I will go into this in more detail below, but the more children who are vaccinated for a disease the less likely it is that any child will contract that disease. This occurs through a process known as community, or herd, immunity.

Many people will stop reading right here because they have already decided or have read somewhere that herd immunity is not a real thing. Here are some of the arguments against herd immunity I come across from time to time:

• It’s not based on a science, but on epidemiology. Epidemiology is the study of the way diseases spread. It is a very complicated field, involves tons of statistics and research and IS science. To say that it is not science is a false comparison.
• We still have outbreaks even in areas where there are high vaccination rates. This is most definitely true, but does not prove that herd immunity is not real.

How does it work?

Since it's most timely, let’s use measles as an example. First, you need to know some things about measles…

Measles has an attack rate of a susceptible individual at 75 percent. This means that 75 percent of people exposed to measles who are not protected will contract the disease. I’ll use 70 percent to keep my numbers round and err on the side of people who would disagree with me.

Measles vaccination has a 95-100 percent protection rate. Again, I will use 95 percent so that I am not cherry picking the best results to prove my point.

There are two scenarios below. The first scenario has a case of measles in a classroom where everyone else is vaccinated. The second scenario is a case of measles in a class with one child who is not vaccinated.

Scenario No.1:

Scenario No. 2:

In scenario No. 1, all the children are vaccinated which means they have a 5 percent chance of catching measles. If that child goes to another class or event where all children are vaccinated, each of those children have much less than a 5 percent chance because the child doesn’t likely have the disease and they only have a 5 percent chance of catching the disease even if he did.

In scenario No. 2, one child in the classroom is unvaccinated. He thus has a 75 percent chance of catching the disease. He’s going to go to other locations with other children, even if those children are all vaccinated, we have potentially opened up a whole second circle of exposed children. Not to mention that the children in the first class have now potentially been exposed twice.

So, in scenario No. 2:

• If I gave you a choice, would you want your child in group A or B?

• Does it matter if your child is vaccinated or not?

• What if you also have a baby in your house who cannot be vaccinated?

• What if you child is in class B, but has a disease for which they cannot receive the MMR vaccine?

The answer is no, none of these things matter. Logically, we should all want our child in room A because it decreases the odds of our child being exposed. Is it 100 percent? No, but it doesn’t matter. Are you more likely to be angry about a measles outbreak if your child cannot be vaccinated? Yes, and I understand that.

For one last thought, consider this … a  study in Pediatrics described geographic clusters of people who choose not to vaccinate at all or to under-vaccinate their children. I suspect that is true across our area as well, but I also suspect that there is clustering according to other factors as well: socioeconomic status, church/religious affiliation, etc. Populations where there are multiple families who choose not to vaccinate would be particularly susceptible in an outbreak situation. Let’s pray we don’t get there.

This is herd immunity and why the question, “If your child is vaccinated and they are such a good thing, why do you care if my child gets vaccinated?” doesn’t end the conversation.