Having a child in the hospital is tough on any family, but imagine navigating a hospital admission if English isn’t your first language. That’s the case for many families at Cook Children’s.

To help in situations like this, a group of parents and Cook Children’s employees formed the Hispanic Family Advisory Council (HFAC) to advocate for Hispanic families, identify gaps in family centered, culturally congruent care experiences and empower Spanish-speaking parents to be partners in the care of their children.

Hispanic Family Advisory Council (HFAC)

The Cook Children’s HFAC, which started in 2016, works to ensure our Hispanic patients and families experience the highest quality health care possible.

The HFAC meets once a month to share perspectives on their Cook Children’s experiences, partner with staff to implement suggested changes and provide general feedback on how to make care better for Hispanic patients and their families. The group serves families and care teams as it works to help raise awareness of how cultural differences affect families’ care in the medical center.

The HFAC members act as a resource to guide culturally sensitive services and interactions at Cook Children’s. Employees from various departments attend the HFAC’s meetings to gain feedback on system-wide initiatives and how they impact Hispanic families.

Two councilmembers, Lucía Nájera-Gartman and Lizdelia Piñon, Ed.D., share their families’ journeys to connect with and advocate for Spanish-speaking families admitted to the medical center.

Lucía’s Story

Lucía Nájera-Gartman is a Cook Children’s parent mentor, parent advisor, HFAC member and mother of two children – Danielle, 29, and Dennis, 24. Her family is Mexican-American and her children hold dual citizenships from México and the USA.

Her daughter, Danielle, has Lennox-Gastaut syndrome, a severe type of epilepsy that develops in young children and often leads to life-long disability. She received care in Mexico until she was 10 years old and began care at Cook Children’s in 2005 when her family moved to the U.S. Their health care experience was different from that which they received in Mexico.

“I had to come here and learn everything from scratch, which is the case for a ton of families,” she said. “It’s an extremely complex health care system that you have to learn, especially if you have a child with complex care needs.”

One of the biggest differences Lucía noticed at Cook Children’s was the focus on family-centered care. In 2010, Danielle was admitted to the medical center at the same time Lucía’s ex-husband was in a plane crash. The two family members were admitted to Intensive Care Units across town from one another.

“I noticed how the Cook Children’s staff took the situation into consideration when they were talking to me,” Lucía said. “They would ask, ‘Are you eating?’ ‘Are you resting?’ They knew I was running between two hospitals. And it immediately made sense to me. They were not only focusing on my daughter, which is great, but they were also thinking of all the other things happening and affecting my family. To me, that was just huge.”

When Danielle was discharged, she went home with a new set of needs, including a wheelchair and in-home medical equipment. Lucía said she hadn’t known those resources would be provided.

“I had no idea all of this was available,” she said. “I was learning so many new things. I think that’s how it goes in general for everyone, but if you come from a different country, you have a different set of expectations. I didn’t know I’d be receiving so much help. ”

That experience inspired Lucía to volunteer as a parent mentor and to join the Neurosciences Family Advisory Council. Lucía connected with families who were being cared for in the Neurosciences department.  

Soon after that, she met Vicki Kelley, director of family engagement at Cook Children’s. They recognized the need for a council dedicated to Spanish-speaking/Hispanic families and eventually helped to create the Hispanic Family Advisory Council.

Although her daughter has aged out of Cook Children’s Health Care System, Lucía returns to the medical center every week as a Parents As Partners volunteer to visit parents whose children are hospitalized. These visits are more than a social drop in. They are valued, purposeful opportunities to engage with and support Spanish-speaking patient families. Parents’ faces light up when they meet her because they find they have so much in common.

“I’ve met incredible parents,” she said. “It’s very easy for me to connect with them because I speak the same language and often use many of the expressions that are common within our culture. I tell them I’m a mom who has gone through very similar situations. That usually leads to very open and trustworthy conversations.”

Connections Lucía makes often result in some form of action, such as getting a parent a blanket, informing the family about how to get a food voucher or referring a family member to a social worker to arrange transportation. She makes a point to encourage each parent to place value in self-care.

 “Parents can only take care of their children if they take care of themselves,” she said. “So I tell the parents that if they are strong and feel supported, they’re going to be better supporters of their children.”

Lucia’s parent mentor contacts often also result in changes that benefit many patients and families. She is able to gather information regarding parents’ concerns and share with the HFAC. One example of information that brought about meaningful change was the expansion of Camelot Court’s menu to include cultural-related food options.

Liz’s Story

Lizdelia Piñon, Ed.D., is a HFAC member and mother of four children. Her 11-year-old triplets, Santiago, Frida and Felícita, were born at 25 weeks gestation, each weighing about one pound. They spent between 99 and 115 days in an Illinois Neonatal Intensive Care Unit.

When the triplets were six months old, the Piñon family established their care at Cook Children’s. They see multiple specialists in the Dodson Specialty Clinics.

“My kids are half-Mexican and half-Puerto Rican,” Liz said. “I tell them being Hispanic is our superpower! We have all these different things that make us unique and very special. We bring a different set of needs to the hospital.”

Kelley connected Liz with Lucia and the HFAC, and through the years, Liz has provided feedback about her family’s experiences to initiate positive change.

Liz and the HFAC have added cultural considerations and perspectives in many areas. Signage across the medical center has improved. The new P1 garage created for the Dodson Specialty Clinics has van-accessible spaces and wide elevators to accommodate wheelchairs and strollers. More images of Hispanic children hang on the walls. Departments within the Medical Center have a greater awareness of the importance of hiring bilingual staff.

Councilmembers work on a variety of projects to support Hispanic families at Cook Children’s. Liz said one of the council’s biggest events is a Hispanic resource fair, which will take place on Oct. 7, 2023. At the fair, bilingual staff and volunteers will share information about services offered at Cook Children’s. Community resource representatives will attend and provide information for staff and families.

“One big concern that we brought up is that there are services here that our Hispanic families may not know about,” she said. “We encourage all Spanish-speaking families to attend. This should be where our families who need care come to get the services they need, regardless of their status or language.”

“I’m grateful and I love being an advocate for all of our families – our Hispanic families and our special needs families,” she said. “I’m always fighting for the needs of all our kids! I wanted Cook Children’s to be even more inclusive of all our families who come visit. The Dodson Specialty Clinics building now has a companion care restroom large enough to fit a wheelchair and multiple children. These restrooms are the result of advocacy by dedicated parents whose needs for their children were listened to by decision-makers at Cook Children’s.”

The Cook Children’s HFAC: A Success Story

The Cook Children’s HFAC does an incredible job of highlighting the Hispanic perspective to bridge the gap between patients’ and families’ viewpoints and experiences and organizational decision-making.

Lucía and Liz agree that the council is so successful because each member has joined with the intention of learning about the Hispanic culture. They also praise their leader, Kelley, who they say opens doors for them.

“Vicki is a great leader who believes in us,” Lucía said. “She has introduced us to so many people. She trusts us. That allows us to really speak our minds and then work together to find solutions.”

Cook Children’s employees seek the council’s knowledge and perspective with an open mind and a willingness to improve practices.

In addition to providing insight internally, the FAC has traveled to conferences across the country to give presentations about how they got started and how they function. The HFAC emphasized the importance of institutions partnering with parents to learn about other cultures.

If you’re interested in making an impact by joining the Cook Children’s HFAC, or know of a parent from the Hispanic community whose child is a patient of CCHCS and would be interested in serving on the HFAC, please reach out to the Parents As Partners coordinator, Natalie Dorsey (Natalie.Dorsey@cookchildrens.org).

A Special Thank You

We are so grateful for each member of the Cook Children’s HFAC. Each member’s efforts have created enormous benefits for programs, other families, caregivers and staff, and especially the babies, children and teens who experience care at Cook Children’s.

Lucía Nájera-Gartman, Councilmember
Lizdelia Piñón Ed.D., Councilmember
Vicki Kelley, MS, CCLS, Director of Family Engagement
Anylu NerioGarza, Manager of Language Services
Jennifer Stephen, Ph.D., RN, CPN, Education Coordinator
Jan Crockett, Content Strategist
Anu Partap M.D., M.P.H., Physician Director of Health Equity

“Similar to what has happened with adults, Hispanic children have been most affected during the COVID-19 pandemic,” said Ana Maria Rios, M.D., infectious diseases pediatrician at Cook Children’s. “Hispanic people have the highest burden of all the races and ethnicities in the U.S. and they have the highest risk of contracting infection, and becoming severely ill.”

The Centers for Disease Control and Prevention (CDC) reports similar statistics nationwide. According to a report released in August, Hispanic children are eight times as likely to be hospitalized for COVID-19 as white children. For Black children, the risk is five times as high.

In Tarrant County, overall infection rates for COVID-19 have hit the Hispanic community hardest. This group accounts for 27% of all positive tests, which is the largest percentage across all races and ethnicities.

Why are Hispanic families being hit the hardest?

Out of the 181 children hospitalized with COVID-19 at Cook Children’s between March and October, 96 were Hispanic. But how can this be when white (non-Hispanic) people make up the majority of Tarrant County and surrounding areas?

One reason many experts point to is large numbers of Hispanic workers who are on the frontlines and considered essential.

“A lot of people don’t have the luxury of being able to work from home,” said Vida Amin, M.D., medical director of Cook Children’s Neighborhood Clinics. “It’s kind of the worst recipe. You have adults who have to keep working to put food on the table. You have kids who have to go to daycare or school. All of these factors go into play.”

She says another risk is that Hispanic families are more likely to have multiple generations living under one roof.

“We saw this in Italy early in the pandemic. I remember I was curious about why is this happening in Italy and I started to look at the literature. I saw many younger people, in their twenties and teens, were working in the city and they'd come back home where they were living with their grandparents,” said Dr. Amin. “I think it’s a very similar situation here.”

Bianka Soria-Olmos, D.O., a pediatrician at Cook Children’s office in Haslet, has been an outspoken advocate in the Hispanic community throughout the pandemic. After speaking on various Facebook Live events and news interviews targeted toward Spanish-speaking audiences, Dr. Soria-Olmos says getting information out has been critical.

“I think for some people, unless they've known someone who has been personally affected, they may not realize how dangerous and unpredictable the virus is, including the wide range of presentations it can cause from mild symptoms of a cold to life threatening illness that requires intensive care and in some cases even death,” said Dr. Soria-Olmos. “I also feel like the great things about our culture, like the importance of family and celebrations and the act of gathering, have been an Achilles heel for us.”

She says the most important thing for everyone to remember, not just Hispanics, is to be mindful of activities she calls ‘extracurricular.’

“It’s choosing not to do those things where you could potentially become exposed,” said Dr. Soria-Olmos. “The bottom line is leaving your house is a risk when you have transmission rates this high in the community.”

Tarrant County is currently averaging more than 1,000 cases of COVID-19 a day.

Why do Hispanic children end up getting sicker?

It’s important to remember that most children who contract COVID-19 have mild symptoms or are asymptomatic. In fact, overall hospitalizations among children remain low. However, Hispanic children are at the greatest risk of becoming severely ill and needing hospitalization. Experts believe higher rates of underlying health conditions in this population may play a pivotal role.

According to the CDC, obesity, chronic lung disease and prematurity are the most prevalent underlying conditions for children hospitalized with COVID-19. They report nearly 46% of Hispanic children have one or more of these conditions.

“I have to be honest with you that even though I am Hispanic, I didn't realize how much inequities we have in the medical system,” said Dr. Rios. “I think this pandemic is making everyone aware of the public health crisis we’re in. The silver lining is that public health has to be reinvented and we need to work harder in prevention.”

Another issue that can lead to children of any race or ethnicity becoming sicker is delaying medical care.

“I think it's really important that we ask families and schools to remain vigilant about any kind of severe symptoms that they may be noticing in children,” said Dr. Amin. “Don’t just ignore it because children are supposed to be safe from the virus. Some kids do get very sick and we need to be taking these cases seriously and seeking out medical care.”

Symptoms of COVID-19 in children include:

• Fever or chills
• Cough
• Nasal congestion or runny nose
• New loss of taste or smell
• Sore throat
• Shortness of breath or difficulty breathing
• Diarrhea
• Nausea or vomiting
• Stomachache
• Tiredness
• Headache
• Muscle or body aches
• Poor appetite or poor feeding, especially in babies under 1 year old

Dr. Amin adds, “As a clinician, I hope my families will recognize if their child is in a high-risk category, and that they take it seriously when their child becomes ill and seek out care early.”

What can families do to protect their children?

First and foremost, take COVID-19 safety precautions as seriously. This means wearing a mask in public, washing your hands frequently and using hand sanitizer when handwashing is not possible.

“Wash your hands every chance you get and wear a mask,” said Dr. Rios. “We now know masks work both ways. At first, we thought they would only protect others, but we now know masks make a big difference in the amount of virus that can get to us and make us sick.”

It’s also critically important to stay home from work and school when sick. If your child is exhibiting any symptoms of COVID-19, make an appointment with your pediatrician or a Cook Children’s Urgent Care. These visits can be in person or virtual from your phone or computer using a MyCookChildren’s account, which you can easily sign up for here.

“Not everyone is aware that we offer virtual appointments at our urgent care clinics and at our community based (Neighborhood) clinics,” said Dr. Amin. “For families who are working and juggling other things, signing up for MyCookChildren’s is a great way to schedule appointments and to make sure they can see a doctor quickly.”

Dr. Amin also urges parents not to skip well-visits and vaccines.

“These appointments are our chance to discuss their child’s health, prevent serious illnesses through vaccines and help them understand what to do in case their child becomes sick,” she says. “If anyone out there is wondering if they should get their child’s flu shot this year, they should know the influenza vaccine is recommended for all children over 6 months of age, with rare exception. Please discuss it with your primary care physician. As for our clinics, we have safety protocols in place to allow families to wait in their cars until they’re called in and have taken many other safety precautions as well.”

Another thing families can do to protect themselves and their children is to limit gatherings with people outside of their household, which can be increasingly difficult with the holidays in full swing.

“We realize how hard it is to say ‘We’re not going to get together this year,’” said Dr. Soria Olmos. “But we have to do our part to get the community numbers down. To do that, we need to keep our holiday celebrations to our households, and we hope that we will not have to do this ever again.”

But these patches of darkened skin called acanthosis nigricans may also be a sign of something more serious, said Joel Steelman, M.D., an endocrinologist at Cook Children’s.

The exact cause for acanthosis nigricans appearance is not yet known, but current scientific research suggests over-growth in the outer layer of the skin lead to the darkened, rough, velvety patches of skin seen in the condition.

Common body areas where patches of acanthosis nigricans may be seen include the neck, knuckles, armpits, elbows and knees. It can be more widespread and impact areas like the face, chest or belly. In severe situations, it can even be seen in the lips or cheeks.

The condition appears equally between boys and girls and seems to be more common in Hispanics, African Americans and Native Americans, compared to other ethnic groups. One recent study found about five-fold higher likelihood of acanthosis in blacks or Hispanics, compared to whites.

Dr. Steelman said in an overall healthy child, the most likely cause of acanthosis nigricans is a higher level of the hormone insulin in association with obesity. Insulin helps the body grow and store energy from food. That growth effect from too much insulin is thought to be the reason in most obese children causing the skin to develop acanthosis nigricans.

“Since, the main cause for acanthosis nigiricans is linked strongly to obesity and a higher risk for diabetes, I recommend that parents first take steps at home to manage their child’s weight,” Dr. Steelman said. “These steps which include making improvements in the diet and encouraging more physical activity pay off in so many ways.”

The changes Dr. Steelman recommends should be something that the whole family does together. He says this will benefit parents, grandparents and others in the family. If there is a strong family history of diabetes or their child is considerably overweight, parents may want to bring their child to their pediatrician for a checkup. Labs may be ordered to search for higher risk findings for diabetes or metabolic syndrome. Also, more detailed kinds of investigation may be needed in children who don’t have the usual medical history seen with acanthosis nigricans risk.

The skin condition itself doesn’t usually cause too many problems for the child, other than causing the child to be itchy in a few cases. Topical treatments applied to the skin like moisturizers, bleaching creams, and exfoliating creams are used in situations where the person is bothered by the appearance of the acanthosis.

“But the main treatment begins with a talk about obesity and weight,” Dr. Steelman said. “I think the discussion has to be framed in a way to discuss the reward and minimize the negative. It may sound pretty trite, I know, but it really means a conversation about, ‘Let’s get healthy.’ Getting healthy means a lot more than just looking good. It means feeling better, achieving more, etc.”

Read more about acanthosis nigricans here.

- Credit to KidsHealth® for photo.

Get to know Joel Steelman, M.D.

Dr. Steelman is an endocrinologist at Cook Children's. He trained in endocrinology at the University of Colorado Children’s Hospital in Denver, where the magnificent setting turned Dr. Steelman into a lifelong outdoor sport enthusiast, with a strong desire to lead a healthy life. On his rare days off, he could be found skiing, mountain biking and trail running. He loves to go back to the Rockies as often as possible, and just a few years ago, he ran the Pike’s Peak ascent half marathon. He continues to run for exercise regularly. 

During his tenure in Colorado, where he met his future wife, Dr. Steelman trained at the internationally renowned Barbara Davis Diabetes Center, one of the world’s largest and most esteemed diabetes medical facilities for adults and children, specializing in type 1 diabetes research. Along the way, he discovered another strong research interest in the area of bone disorders, and Dr. Steelman began to treat children with osteogenesis imperfecta, or brittle bone disease-- a rare, crippling malady. After completing his training, Dr. Steelman left the West to enter academic medicine at Vanderbilt Children’s hospital in Nashville, Tennessee. Over the next seven years he focused on research projects and medical education.

As a self-described ‘techie,’ Dr. Steelman has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices. He still loves to write, and he is a regular contributor to Checkup Newsroom.

Three kids have been ejected total, with one child surviving. It probably doesn’t come as a surprise the cause of the tragedies – the children weren’t restrained properly or not at all in their car seat.

Since April 2015, Cook Children’s Trauma team has treated 13 children who were ejected from a car.

Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s, says it’s so frustrating because she has seen wrecks where one child who was properly restrained live and the other child not buckled in dies.

“Honestly, it’s just so infuriating,” Evans said. “These accidents are totally preventable. It’s because the adults in the car aren’t doing something that could save their child’s life. I don’t think people think it can happen to them. But it can happen to anyone. It just breaks my heart because these are deaths that shouldn’t occur if people would just place their kid in the proper car seat and buckle them up with a seat belt.”

Statistics show this is especially a problem for Hispanics in the community. Ninety percent of the ejections that have occurred since April 2015 were Hispanic.

“I think a lot of it has to do with our culture,” said Magdalena Santillan, Trauma Injury Prevention specialist at Cook Children’s. “These are people who love their kids and they want to hold their baby. A lot don’t want to hear their baby cry and so it’s easier to hold their baby in the car. They are showing love, but the consequences are too high. This can be a deadly mistake.”

According to the Centers for Disease Control and Prevention, car crashes are a leading cause of death among children ages 3 to 14. From 2002 to 2011, about 9,000 children under the age of 12 died in car accidents, the agency’s statistics show. Correctly using a child safety seat can reduce the risk of death by as much as 71 percent.

“We know that car seats are working,” Evans said. “Research shows that a properly installed rear-facing car seat is five times safer and can dramatically reduce the risk of head, neck and spinal cord injury if your child is involved in a crash.”

Call 682-885-2634 to set up a FREE car seat checkup to ensure your seat is properly installed.

According to the study, approximately 15 percent of 2-year-olds consume as much as 4 ounces of coffee daily. It’s a practice, health experts say, that comes with a dangerous dose of health risks.

The study followed 315 pairs of mothers and infants who were participating in an analysis of weight change during a child’s first week and its impact on body mass index at age 2. While examining diets, researchers found that 48 of the participating mothers were feeding their 2-year-olds coffee as part of their daily fluid intake.

Infants and toddlers of Hispanic mothers were more likely to drink coffee than those of non-Hispanic mothers, according to the study, but researchers did not examine further to determine why. Female infants were also found to be more likely to drink coffee than male infants.

Cultural practice may be one of the reasons some children drink coffee at younger ages, according to the study. In some countries, including Cambodia, Australia, and Ethiopia, children under 5 are given coffee.

“I think too much caffeine in childhood is a bad thing and worse in the case of a younger child,” said Joel Steelman, M.D., endocrinologist at Cook Children’s. “Coffee consumption by younger children is a big deal. I wouldn’t recommend parents start this practice. There are much healthier options. Caffeine could interfere with sleep – naps and bedtime. Overconsumption of caffeinated drinks could lead to symptoms of dizziness, headaches, mood changes and seizures.”

The U.S. Federal Drug Administration (FDA) has not provided guidelines on coffee consumption for children, but previous studies suggest there are potential negative health impacts, including Type 2 diabetes, depression, obesity and sleep disturbances. The American Academy of Pediatrics (AAP) recommends against the inclusion of caffeine in a growing child's diet.

Deborah Schutte, M.D., cardiologist and medical director of Cardiology at Cook Children’s, said her chief concern regarding toddler coffee consumption is the cardiovascular effect, particularly increased heart rate and high blood pressure.

“It boggles my mind why any parent would give a toddler caffeine. Toddlers are wired enough, why would anyone want to add to that?” Schutte asked. “My concern with caffeine and toddlers is more about tachycardia and arrhythmias. Caffeine can cause the heart to pump at an unnatural pace, resulting in palpitations.”

Schutte also points out that giving toddlers coffee could lead to dehydration, particularly since caffeine is a diuretic.

A 2013 study found that 2-year-olds who drank coffee or tea between meals or before bedtime were three times more likely to be obese in kindergarten.

“Just because there are no guidelines, doesn’t make it OK,” Schutte added. “What people don’t consider is that there is caffeine in drinks and food that we don’t always realize, such as chocolate and coffee- flavored ice cream, so caffeine levels can sneak up on you.”

According to the FDA, the average American adult consumes approximately 300 mg of caffeine each day - the equivalent to between two and four cups of coffee.

Canadian guidelines recommend no more than 45 mg of caffeine for children ages 4-6. This is equivalent to one 16 ounce can of soda.

If parents are already giving their toddler coffee, it’s possible to wean their child off the caffeinated beverage, Steelman said. He recommends parents talk to their pediatrician about a weaning off caffeine schedule.

Dr. Greenspan, a pediatric endocrinologist, offers insight on medical reasons for earlier puberty in girls. The co-author, Dr. Deardorff, a psychologist, offers insight into the behaviors and emotions in early puberty.

The book draws on the experiences of  two ongoing research studies and has almost a decade worth of scientific observation with some startling statistics and impacts.

By age 7, breast development was seen in:

• 25 percent of African-American girls
• 15 percent of Hispanic girls
• 10 percent of Caucasian girls

Some of the worrisome impacts of early puberty on girls highlighted by the book included:

• Higher risk for depression or anxiety
• Higher eating disorder risk
• Higher breast cancer risk

Puberty is a normal process in life that eventually happens in the life of every child. It can be an uncomfortable challenge though for a girl who experiences puberty much earlier or much later than her friends. Earlier puberty is a challenge perhaps more for girls because of more visible changes. Emotional changes that accompany puberty occurring early may also be distressing to many girls and their families.

Some key medical challenges in investigating puberty from a medical standpoint include determining the difference between normal early puberty versus abnormal precocious puberty. The authors give parents some guidelines to help guide them on when to see their pediatrician for a check-up.

Clear reasons to schedule an appointment include:

1. Breast development at 7 years old or younger

2 .Pubic hair development at 6 ½ years old or younger

3. Bad acne, moodiness and having an abnormal growth spurt

4. Menstrual periods starting before age 10

Perhaps one of the greatest challenges for me and other pediatric endocrinologists is figuring out the cause of early puberty. There are definitely situations where there is a clear reason for early puberty, but these situations are often rare, leaving the task of finding an answer a difficult one. The book authors tackle the tough question of what causes early puberty. They offer three theories.

1. Obesity effect

2. Endocrine disrupting chemicals

3. Social and/or psychological stresses

Obesity has the longest history as a known association with early puberty. Higher body fat may change the hormone balance in a girl’s body causing the adrenal gland to activate early and produce hormones which cause body odor and pubic hair growth. A portion of estrogen is made by fat in the body; therefore, a higher amount of body fat may lead to higher estrogen levels and drive earlier breast development.

Exposure to estrogen or estrogen-like chemicals has effects on puberty. There is now a lengthy research on natural estrogens, called phytoestrogen. Tea tree oil and lavender oil both have estrogen-like effects and have been linked to breast development in some children. More concerning though than phytoestrogen exposure is the possible effect of endocrine disrupting chemicals (EDCs) on puberty. EDCs are chemicals that have hormone-like effects in the body, including estrogen-like effects.

The authors discuss the unknowns of EDC impact on developing girls, at what dosages, and during which time points might effects be seen? Recent research examining various chemicals in personal care products also adds concern about possible effects on puberty of these exposures.

It is already a sad reality that some children grow up in chaotic homes, and many are exposed to the early images of violence whether in real life or in media. The information offered by the authors on the effects of stress on brain chemistry leading to early puberty was perhaps the most shocking to me.

The book not only explores the why of early puberty, but also gives tips on what parents can do. A whole section is devoted to strategies to avoid or minimize EDC exposures. Practical tips include developing emotional closeness early to aid in talking about puberty and dealing with the rapidly changing moods of puberty.

Early puberty presents challenges both on the part of parents and physicians. Especially with early puberty, the dividing line between normal and abnormal is blurred making choices of investigation and management harder to make. I just purchased the book and am looking forward to the new insights, which will help me better care for the physical and emotional health of girls dealing with early or precocious puberty.

To learn more about precocious puberty, please read  my three-part  series I wrote in 2011:

• Part 1
• Part 2
• Part 3

About the author

 As a self-described ‘techie,’ Joel Steelman, M.D., has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices.