Texas spring is an early indicator of summer. While mornings may begin at a mild 60°F, temperatures often quickly rise into the 80s by midday. To ensure the community stays safe as the heat intensifies, Cook Children's Health Care System experts Viviana Esparza, program coordinator for community health, and Sharon Evans, trauma injury prevention manager, are urging families to stay informed.  Their goal is simple: preventing

“Never leave your child alone in a car, not even for a second,” said Evans.

The first hot car death in the nation this year was reported in late March. A 1-year-old in Florida was left in the vehicle while the outside temperature was 86 degrees.

“In just 10 minutes temperatures can rise 20 degrees in a car,” explained Esparza.

In 2025, Texas recorded eight hot car deaths, nationwide 31 hot car deaths were reported according to noheatstroke.com. Data from the Texas Department of State Health Services (DSHS) shows the state surpassed the number of hot car deaths in early July with four fatalities. These figures make vehicular heatstroke the second-leading cause of vehicle-related deaths for children under 15, trailing only car crashes.

“A child's body heats up about three to five times faster than an adult and so the heat really takes a toll on them,” explained Evans.

The data behind the danger

According to Kids and Car Safety, 52.9% of hot car child deaths occur when a child is forgotten. Parents or caregivers can suffer from exhaustion due to lack of sleep, stress, and changes in their normal routine. Any one of these can cause a parent or caregiver's memory to fail at a time when it’s least expected.

Additionally, 23.8% of these deaths are due to a child gaining access to an unlocked vehicle or a child getting the keys. Evans recommends teaching toddlers and preschool-aged children to honk the horn if they become trapped, enabling them to draw attention to the vehicle.

Esparza noted the third most common cause is knowingly leaving a child in a vehicle for a quick errand. DSHS emphasizes a cracked window does not protect a child or pet from heatstroke.

Prevention is Key

Evans and Esparza encourage families to remember the acronym ACT to prevent a hot car death.

• A: AVOID heatstroke and other heat-related injuries by never leaving your child alone in a car, not even for a minute. When the vehicle is at home, keep the doors locked and keys or key fobs out of a child's reach.
• C: CREATE reminders. Place an item you need in the back of your car or next to your child, such as a bag, wallet or cellphone. This is especially important if you're not following your normal routine. If your child is with a care provider, ensure vehicle-related procedures are in place, such as vehicle searches or locking vehicles when not in use. Use technology to your advantage and use apps or other communication methods with your childcare provider.
• T: TAKE action. If you see a child alone in a car, call 9-1-1. Emergency personnel want you to call, and they are trained to respond swiftly to these situations. One call could save a life.

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According to the Texas Department of State Health Services, about 7,000 people are bitten by venomous snakes in the United States each year. However, about half of all venomous snakebites are “dry,” meaning the snake does not release venom.

“Snakes are often in bluebonnets. You may want to reconsider sending your kids to sit or lay in them,” said Sharon Evans, injury prevention manager at Cook Children's Health Care System.

Snakebites are most common between April and October, with snakes typically most active in the morning and at dusk. Texas is known for two types of venomous snakes: pit vipers and coral snakes. North Texas is home to three species of pit vipers: copperheads, cottonmouths (also known as water moccasins) and rattlesnakes.

“If you are bitten go to the Emergency Department or Urgent Care Center for treatment and evaluation,” said Evans.

Once at the hospital, patients with moderate to severe envenomation may receive antivenom, which is readily available at Cook Children’s Medical Centers. Patients are closely monitored for symptom progression and may require hospital admission for observation and supportive care. 

Cook Children’s reported three snake bites as of March 2026. Last year, 25 snake bites were reported, the first one in April. In 2024, the first snakebite was reported in March. The system treated 27 snakebites that year.

Bluebonnets may not just be home to some slithery friends, but insects too. In cases of insect bites, such as fire ants, Evans suggests caregivers call the North Texas Poison Center.

“Be careful when your children are getting in there,” said Evans.

Evans shared advice for caregivers on how to enjoy the beautiful flowers, while avoiding a trip to the emergency department.  

Keeping safe:

• Look before you walk.
• Avoid walking in tall grass.
• Wear protective boots.
• Never attempt to touch or handle a snake, even if it appears dead.

 What to do if bitten by a snake:

• Do not try to capture, photograph, or kill the snake.
• Do not apply ice, tourniquets, or attempt to suck out venom.
• Immobilize the affected limb and keep it at heart level if possible.

 Signs of venomous snake bite:

• Blurred vision
• Convulsions
• Dizziness
• Excessive sweating
• Fainting
• Fang marks
• Fever
• Increased salivation
• Localized pain and burning
• Muscle contractions
• Muscle incoordination
• Nausea and vomiting
• Numbness and tingling
• Rapid pulse rate
• Skin discoloration
• Swelling in the bite area
• Thirst
• Tissue death
• Weakness

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In 2025, Cook Children’s Health Care System saw on average, 38% of children injured in a major vehicle accident were unrestrained or improperly restrained. 

“Many of these resulted in deaths or severe injuries,” said Sharon Evans, trauma injury prevention manager.

According to the National Highway Traffic Safety Administration (NHTSA). Texas law requires children under the age of 8 and those under 4 feet 9 inches should be in a child safety seat. A child must be 8 years old or taller than 4’9” to use a seat belt. Failure to properly restrain a child can result in a ticket of up to $250. NHTSA data shows more than 300 children under the age of five have been saved due to their car seat.  

What to know before hitting the road:

According to the National Safety Council more than 54 million vehicles on the road have an open safety recall. Almost one million cars have an open child seat anchor safety recall. The LATCH (Lower Anchors and Tethers for Children) is the built‑in anchoring system required in most vehicles since 2003, designed to secure child seats without relying on seat belts. These anchors keep child seats firmly in place.

• Drive alert: Avoid tired, distracted or impaired driving.
• Check for recalls: Visit the website Vehicle Recall Check by VIN or License Plate | Check to Protect to see if your car has an active recall.
• Secure every passenger: Make sure every passenger is secured by the correct car seat or seat belt on every ride.
• Take breaks: If your children are fussy, don’t let them out of their car seat or seat belt while the car is moving. Instead, stop at a safe location where they can run around and burn off energy.  
• Pack safely: Pay attention to how and what you pack.  Remember everything becomes a flying projectile in a sudden stop or crash.
• Use cargo tools: If you have an SUV, use the cargo cover or net to secure your luggage.

Know the Four Stages of Car Seats

Trauma Injury Prevention and the Center for Community Health share some tips on keeping your little one safe.

1. Rear-facing

Rear-facing car seats are the first stage of restraint for children ranging from newborns to preschoolers. This stage supports their head, neck, and back while riding in a vehicle until they meet the maximum weight OR height of their car seat. According to Evans, it is highly recommended by experts to keep your child in a rear-facing car seat for as long as possible, as it is the safest option available.

2. Forward-facing

Forward-facing is the second stage of car seats for preschoolers through school-age kids. Children should remain in a forward-facing car seat with a five-point harness until they meet the maximum weight OR height before moving to a booster seat.

3. Booster

Children must be at least five years old before transitioning into a booster seat. The booster seat stage is crucial for children who have outgrown a harnessed car seat, but do not yet fit safely behind a lap-shoulder belt. Still, booster seats are skipped over all too often. Evans said many kids between the ages of 4 and 8 get seriously injured due to being put in seat belts too soon.

4. Seat Belt

A seat belt is the final stage of restraint. The safest time to transition to a seat belt is when your child is at least 4’ 9”, or 57 inches tall. Though the law states children can transition to seatbelts at eight years old, Evans cautions that many children won’t reach 57 inches of height—and should therefore remain in a booster seat—until closer to 10 or 12.

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Keeping Warm and Having Fun

“If you are going to be outside, dress appropriately,” said Sharon Evans, injury prevention manager at Cook Children’s Health Care System.

Experts advise caregivers to dress little ones in several thin layers to keep warm and dry. Children are at more risk from the cold because their bodies lose heat more quickly. Insulated boots, mittens or gloves, and a hat are recommended.

Make sure children change out of any wet clothes as soon as they come indoors.

“While playing in the snow or “sledding” be aware of your surroundings, be careful to not run into trees or out into the street and mailboxes can be real dangers,” said Evans.

Know the Signs of Hypothermia 

According to the American Academy of Pediatrics, hypothermia, or abnormally low body temperature, "is a dangerous condition that can occur when a person is exposed to extremely cold temperatures." This is a medical emergency, and treatment should be sought immediately. 

 Symptoms of hypothermia include: 

• Blue skin
• Shivering
• A cool chest and stomach are signs that children may be dangerously cold.
• If you see these symptoms, take action immediately to get kids out of the cold. Seek immediate medical attention if you are not able to warm the body.
• Victims of hypothermia can include babies sleeping in cold rooms. 

 Warning signs for infants include: 

• Bright red, cold skin
• Very low energy 

 Warning signs for adults include: 

• Shivering, exhaustion
• Confusion, fumbling hands
• Memory loss, slurred speech, drowsiness 

Coats & Car Seats

While keeping kids warm is a priority during the winter, it should never come at the expense of car seat safety.

“Stay home and inside if possible. If you must be on the roads make sure everyone is buckled up correctly,” said Evans.

Bulky coats, such as puffy jackets, can create extra space between the child and harness straps or seat belt, which can increase the risk of injury in a car crash.  It is recommended to dress in thin layers and use a blanket or put the coat on backwards after the child is buckled in. 

If caregivers decide to start the car to allow it to warm up prior to entering the vehicle, it is important to make sure the car is in a ventilated area, such as an open garage, and that they lock the vehicle when they are not inside.  This will make sure that a child does not enter the vehicle unsupervised and become trapped in the vehicle.

Evans adds families should have snacks, water, and extra blankets in their car in case you get stranded. 

“If you are stranded and waiting for help on the side of the road, please make sure everyone stays buckled up,” said Evans, “often cars may slide/spin near you and hit your car.”

In addition, just as local officials advise people to stay off the roadways, if possible, ice can make dangerous driving conditions for ATV’s, Golf Carts and Go Karts.

 Safe Sleep

With winter weather, keeping infants warm is a priority for caregivers, and it is essential to do so safely.

“Caregivers often use extra blankets and hats for warmth, but these soft items can easily become a suffocation or entanglement hazard,” said Samantha St. John, program coordinator at Cook Children’s Center for Community Health.

A safer alternative is a sleep sack, also called a wearable blanket. A sleep sack provides warmth and comfort without risk because it fits securely around the baby's upper body and is sized so the fabric cannot cover their face, while still allowing plenty of room at the bottom for comfort and movement.

St. John suggests a general rule to follow dress a baby in one more layer of clothing than an adult would find comfortable in the same environment.  In winter months this could mean baby is in a long sleep fleece onesie with a wearable blanket/sleep sack. When dressing baby for bedtime or nap time during the extremely cold temperatures, it may be necessary to add socks, mittens, or hats to baby. Caregivers want to make sure that these items cannot come off during sleep and become a loose item in the crib.  It is also important to make sure baby is not going to overheat.  Signs of overheating can include sweating, a hot chest, or flushed skin.  

 Remember the ABCs of Zzzs:

• Alone: The sleep space should be clear of any soft items, such as blankets, stuffed animals, pillows, and bumper pads, leaving only a mattress with a tight-fitted sheet.
• Back: Babies should always be placed flat on their back for every nap and every night.
• Crib: A crib, bassinet, or portable play yard with a firm, flat mattress and a fitted sheet is the safest sleep surface. 

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Holidays often mean more car trips as families drive to visit relatives. Sharon Evans, trauma injury prevention manager for Cook Children’s Health Care System, explains that during the holidays, there is an increase in motor vehicle collisions and related injuries.

Texas law requires children under the age of 8 and those under 4 feet 9 inches to be in a child safety seat. Failure to properly restrain a child can result in a ticket of up to $250.  Despite these laws, NHTSA data shows that 46% of car seats are installed incorrectly.

“There are more kids in the car than there are seatbelts and/or car seats, or the car is loaded with gifts and food,” said Evans. “So parents don’t make the child sit in their car seat, booster seat or wear their seat belt.”

Unfortunately, that leaves children unprotected in a crash and often results in severe injuries or death. 

“Don’t skip on safety over this holiday season,” said Evans, “make sure you and your children are buckled up correctly on every ride, no exceptions.”

A Child Passenger Safety Technician (CPST) can help ensure a child is safely and correctly secured in their car seat. Cook Children’s Health Care System has 66 CPSTs across North Texas.  

The Injury Prevention Collaborative offers free car seat checks with a CPST. Additionally, assistance is available to families who may need a car seat. To schedule an appointment, please call 682-885-2634 or click the link. You must have your child with you, unless you are an expectant parent.

Know the Four Stages of Car Seats

1. Rear-facing

Rear-facing car seats are the first stage of restraint for children ranging from newborns to preschoolers. This stage supports their head, neck, and back while riding in a vehicle until they meet the maximum weight OR height of their car seat. Experts highly recommend keeping your child in a rear-facing car seat for as long as possible, as it is the safest option available.

2. Forward-facing

Forward-facing is the second stage of car seats for preschoolers through school-age kids. Children should remain in a forward-facing car seat with a five-point harness until they meet the maximum weight OR height, then move into a booster seat.

3. Booster

Children must be at least four years old before transitioning into a booster seat. The booster seat stage is crucial for children who have outgrown a harnessed car seat, but do not yet fit safely behind a lap-shoulder belt. Still, booster seats are skipped over all too often. 

4. Seat Belt

A seat belt is the final stage of restraint. The safest time to transition to a seat belt is when your child is at least 4’ 9”, or 57 inches tall. Although the law states that children can transition to seatbelts at eight years old, Evans cautions that many children won’t reach 57 inches in height and should therefore remain in a booster seat until closer to 10 or 12 years old.

Firearm Safety

According to the 2024 Community Health Needs Assessment of households with guns in our eight-county service area, approximately 1 in 5 children live in a home with guns that are not always safely locked away.

Between 2022 and 2024, Cook Children's Health Care System in Fort Worth treated 179 individuals for firearm-related injuries. 10 were fatal and 169 were non-fatal. The majority of fatalities were from handguns and 136 were unintentional firearm injuries.  

The Aim For Safety program focuses on educating about firearm safety to decrease the number of youth injured or killed by a firearm.

The program shares these safety tips:

• Safe Storage
  • Store firearms unloaded and in locked locations, out of reach of children.
  • Use cable locks and gun boxes.
  • Secure ammunition separately.
• If You See a Gun
  • Stop.
  • Don't touch.
  • Run away.
  • Tell a grown-up.
• Safe Play
  • Ask the parents of your child's friends if they have guns in their homes and how they are being stored.
  • If you are asked about your guns, don't be offended.
  • Never aim BB guns or pellet guns at another person.

Poison Prevention

More than 800 children are treated at Cook Children's Health Care System every year due to accidental poisoning, and 65% of those poisonings are medication-related. According to the 2024 Community Health Needs Assessment, 1 in 2 children live in homes where medications are not always locked up and 4 in 7 children live in homes where cleaning products are not always stored in a locked area.

Tips for Poison Prevention

• Safe Medication Dosing
  • Follow the dosing directions listed on the medication by using the appropriate measuring items, such as a medicine cup or oral syringe.
  • Double dosing is NOT twice as effective, and in many instances can cause internal damage.
  • Adult medications may be too strong for children and should not be given in half doses. Only give medicine to your child that is intended for children.
  • Print the medication schedule to keep the right dosage for your family.
• Safe Storage
  • Many people leave medications on bathroom and kitchen counters as well as bedroom nightstands as a visual reminder to take them. Avoid unintentional injury and store medication up high, locked, and out of reach.
  • Hang purses and personal bags up high so children cannot reach prescriptions, vitamins, or other regularly used medications.
  • Remember, when visiting friends and family, it is ok to have an open discussion about safe storage.
• Safe Disposal
  • Visit a medication drop box at a local pharmacy. For more information on poison prevention, visit www.meddropbox.org.
  • The best disposal option is to find a drug take-back location, which may be found in retail, hospital, pharmacies, and/or law enforcement facilities.
  • Removing any unused or expired medication in the home can reduce the risk of access.

Safe Sleep

Each year in the United States, 3,500 babies die unexpectedly during sleep, according to the Centers for Disease Control and Prevention (CDC).  In Tarrant County, between 2018 and 2022, there were 124 deaths due to Sudden Unexpected Infant Death (SUID).

Sudden Unexpected Infant Death (SUID) can happen in any sleep environment, but it is less likely to happen if the baby is in their own crib, bassinet, or portable crib," explained Samantha St. John, safe sleep program coordinator at Cook Children's Center for Community Health.

Caregivers should remember the ABC's of Safe Sleep:

• Alone: The sleep space should be clear of any soft items, such as blankets, stuffed animals, pillows, and bumper pads, leaving only a mattress with a tight-fitted sheet.
• Back: Babies should always be placed flat on their back for every nap and every night.
• Crib: A crib, bassinet, or portable play yard with a firm, flat mattress and a fitted sheet is the safest sleep surface. 

The Texas Poison Control Network received 192 reports of kratom and other 7-OH products in 2025 alone, compared with 229 exposures combined in 2023 and 2024.

The agency reported 19 cases this year. Eleven of those cases required treatment at a health care facility due to significant health risks.

Written by Samantha Youngblood

The Texas Poison Center has reported 192 exposures involving kratom or 7-hydroxymitragynine (7-OH) this year. 7-OH is a chemical compound found in small traces in kratom, a tropical tree native to Southeast Asia. Kratom is known for its stimulant and opioid-like effects. Both 7-OH and kratom are often marketed as remedies for pain, anxiety or opioid withdrawal.

The U.S. Food and Drug Administration recommends “consumers avoid 7-OH products, including conventional foods, dietary supplements, and those claiming to treat an ailment or disorder.” Neither 7-OH nor kratom is FDA-approved for medicinal use, and has not been proven safe or effective.

The Texas Department of State Health Services issued a public health alert on the use of 7-OH, on Sept. 2. DSHS has found 7-OH in low levels of kratom products sold as liquid extracts, powders and gummies across the state.  

Klaressa Broughton, poison prevention program coordinator for Cook Children’s Center for Community Health, explains that the public health alert is intended to raise awareness of the dangers posed by 7-OH products due to the rise in cases and increased access to these products.

Broughton shares what parents should know about this public health alert and offers guidance on how to talk to their children.

How should parents talk to kids about 7-OH?

Create an open, honest and judgment-free environment. Parents should provide accurate information, encourage questions and reassure children that they have a trusted support system.

It is important for children to feel as though they have a support team and/or trusted adults they can go to for questions they may have. If needed, seek professional guidance to assist.

What does exposure look like?

According to the Centers for Disease Control and Prevention (CDC) and DSHS, Symptoms reported after harmful 7-OH exposure include:

• Nausea and vomiting
• Agitation or confusion
• Sweating
• Rapid heart rate
• High blood pressure
• Trouble breathing
• Drowsiness or loss of consciousness
• Seizures

What if a child consumes a 7-OH or kratom product?

Parents should seek medical attention immediately. If the child becomes unresponsive, parents are encouraged to administer naloxone, an over-the-counter medication that can temporarily reverse opioid-like effects. Naloxone is available at many pharmacies, including Cook Children’s Medical Center Pharmacy, and is often covered by insurance. Visit www.meddropbox.org for more poison prevention information.

Naloxone’s effects last 30 to 90 minutes, while 7-OH and kratom effects may last four to eight hours, making medical care essential.

Who can I talk to about 7-OH?

Consult a doctor or pharmacist before using any supplement, especially those marketed for pain, energy or mood.

• Talk to a health care provider about treatment for opioid addiction, anxiety, mood disorders or pain.
• Call the Poison Help Line at 800-222-1222 with concerns about 7-OH.
• Dial 911 immediately if someone is unresponsive or needs urgent medical attention.

How can I dispose of these products?

Visit a medication drop box at a local pharmacy. You can also participate in National Prescription Drug Take Back Day, organized by the U.S. Drug Enforcement Administration, on Oct. 25. Police departments across Texas will accept unwanted, unused or expired medications that day. This is a great opportunity to safely dispose of all unused or expired medications in your home, too.

Texans are encouraged to stay informed, talk with their health care providers, and take advantage of safe disposal options to reduce risks tied to 7-OH products.

“A drowning can occur in any body of water at any time,” said Jillian Mitchell, community health program coordinator at Cook Children’s Health Care System.

Mitchell explains that data shows infants have the greatest risk for drowning inside the home, while children ages 1-4 have the greatest risk for drowning overall. Cook Children’s has developed strategic partnerships and efforts to inform and educate families on water safety.

“After seeing that a majority of drownings were occurring during a planned swim time, it became clear that strong messaging around adult supervision is key,” said Mitchell.

Eighty-eight percent of drownings occur with at least one adult present. The “Lifeguard Your Child” program teaches parents how to create a safety plan for children anytime they are around water.

Those tips include:

• Designate an adult Water Watcher to ensure constant visual supervision of children in and around water.
• Implement 15-minute shifts for Water Watchers.
• No Distractions: The Water Watcher must have no distractions, including conversations, phones, reading, or consuming alcohol.

“We know that distractions are a key component of unintentional injuries around planned swim time, so sharing these messages are strong reminder that drowning-related injuries and fatalities are preventable with non-distracted supervision,” said Mitchell.

Swim Lessons

Learning to swim can reduce drownings by more than 80%. Cook Children’s recognizes there is a disparity in access to swim lessons and saw an opportunity to collaborate with swim schools in the community. As a result, free Water Safety lessons are provided in select areas in under-resourced neighborhoods through community partnerships.

“By committing to taking a multi-layered strategic approach, the goal is to encourage safer choices in and around open water activities,” said Mitchell.

It is not just pools but ponds and lakes where water safety is important, and life jackets can help. Cook Children’s has a partnership with the Brazos River Authority in Granbury and Possum Kingdom Lake to provide water safety education at local schools and camps. The efforts extend into more than a dozen counties with loaner life jacket stations that Cook Children’s has built and supports.

“We hope to instill the importance of choosing the safest floatation device for their child,” said Mitchell. She adds that life jackets are not a substitute for supervision.

Choosing the right life vest:

• If the lifejacket does not say “U.S. Coast Guard-Approved” or “USCG approved,” you can assume it is not safe. Always check the label.
• As your child grows, the lifejacket needs to meet their new weight.
• Get a new lifejacket if there are rips and tears or if the straps are fraying.
• Do not rely on floats or other toys to keep children safe.
•  Always assign an adult water watcher when children are swimming, even if they are fitted with a life vest.

Water safety is year-round

Mitchell adds that water safety continues well into the winter months.  Drowning can happen in only an inch or two of water, just enough to cover your child’s nose and mouth.  Last year, Cook Children’s saw an uptick in bath-related drownings.

“We know that bath-related drownings are 100% preventable,” said Mitchell. “Much of our education focuses heavily on behavior change around preparedness, 100% adult supervision, and general safety concepts.”

Bathtub safety tips:

1. Ensure an adult stays at the side of the tub within reach of the child throughout the entire bath. This is too big of a responsibility for siblings and other children, so don’t ask them to take over for you. 
    
2. Avoid multitasking. Preparing dinner, folding laundry, or any other housekeeping tasks can and must wait until after the bath is over.
    
3. Ignore distractions like the doorbell or cell phones. Stepping or looking away from your child for even a few seconds can put them at risk of drowning.
    
4. Be prepared. Keep a towel and bath supplies close at hand, so you do not need to get up and leave during bath time. 
    
5. Treat every bath as a time to relax and bond with your baby or toddler. Bath toys like foam letters, animals that shoot water, and waterproof books are a great way to make the bathtub more fun and teach your child new things at the same time! 
    
6. Safety proof your home to prevent young children from accessing the bathroom without an adult. The more barriers in place, the safer your child will be.
    
7. If you absolutely have to leave during bath time, swaddle your child in a towel and bring them with you. 
    
8. Remove all toys and drain the tub immediately after each use.

The Community Health Needs Assessment provides valuable insights from parents, caregivers and community leaders across our eight county service area – Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant and Wise Counties. These assessments help Cook Children’s identify community health needs and develop and implement strategies to address them.

On June 3, Cook Children’s shared those findings and subsequent calls to action. The health topics discussed during session two were mental health, caregiver support, injury prevention and oral health.

The full assessment can be found here, including demographic breakdowns, responses by county and caregiver, community leader, and expert quotes. See more tools for result breakdowns at the interactive data dashboard.

Mental Health
Across the eight-county service area, community leaders interviewed reported mental health care or counseling for behavioral/emotional concerns as the most needed health service in their community.

Nearly two in seven children (about 237,000) in our eight-county service area have at least one of the four most commonly diagnosed mental health conditions. The top two diagnosed mental health conditions were anxiety and ADD/ADHD.

Of the approximately 269,700 school-age children who needed mental health treatment or counseling, nearly half (48%) have a caregiver who had difficulty accessing needed mental health care for children. Families with an income under $50,000 in particular were more likely to report having difficulty accessing mental health treatment.

Caregiver Support
Caregivers’ challenges can contribute to adverse childhood experiences, or ACEs, which are potentially traumatic events that occur during childhood and can have lasting effects. The summit highlighted the prevalence of ACEs among children in our area and the impact those experiences may have.

About 18% of children in our service area (about 216,600) had two or more ACEs, according to the survey. The most common ACEs included having difficulty covering basic needs, like food or housing, and caregiver divorce or separation. Nearly 36% of under-resourced families reported it was hard to cover basic needs on the family’s income.

In the eight-county service area, more than half of caregivers (57%) said they are coping very well with day-to-day demands. However, that leaves about 43,100 children with caregivers who report they are not coping well.

Cook Children’s can continue to support families through the creation of parent and family community support groups and collaboration with existing programs. One particularly vulnerable population is people who have just given birth; the first 12 weeks after birth is a crucial time for caregiver support and child development. Cook Children’s can continue to support access to critical resources such as postpartum mental health support, treatment, and programs to meet the needs of families during this time.

Injury Prevention
Unintentional injuries, also known as accidental injuries, are the leading cause of death for children in the United States, according to the Centers for Disease Control and Prevention (CDC). Nearly one in five children (about 233,300) in our service area received emergency care for an accidental injury. The most common type of unintentional injury varies by age.

The most common unintentional injury for infants is suffocation, mostly due to unsafe sleep environments.

For children ages 1 to 4, drowning (fatal and nonfatal) is the most common unintentional injury. From 2021 to 2023, Cook Children’s Medical Centers in Fort Worth and Prosper treated 224 drowning-related injuries that happened in bathtubs, open water, and pools or hot tubs, according to Cook Children’s Health Care analytics. Of those, 85% were pool/hot tub related, and overall, 8% were fatal.

In 2022, firearms were the leading cause of death among children and teens ages 1 to 19 in the United States, according to the CDC. From 2021 to 2023, according to Cook Children’s analytics, Cook Children's treated 23 patients for firearm-related injuries and 44 patients for injuries related to other gun types (i.e., bb guns, airsoft guns). Of households with guns in our service area, about 1 in 5 children (about 120,300) live in a home with a gun that is not always safely locked up.

For young kids and teenagers (ages 5 to 17) the leading cause of death in the U.S. is car accidents in the United States, according to the CDC. The risk of severe injuries and deaths in car crashes can be greatly reduced when kids are correctly secured in car seats, booster seats or seat belts that are appropriate for their age and size.

Accidental poisoning is another common danger, often from medication or chemical products. The survey revealed more than half of children live in homes where cleaning products and/or medications are not locked away.

Some ways in which Cook Children’s combats accidental injuries include educating caregivers about these dangers, providing resources and prevention tools and advocating for public policy changes.

Oral Health
The last portion of session two focused on oral health.

Two out of seven children (about 328,300) in our service area do not have “excellent” or “very good” oral health. In our service area, 57% of children (about 651,000) received at least two or more preventive dental visits aligning with American Academy of Pediatric Dentistry recommendations. Community leaders said some of the obstacles families face are a lack of providers and affordability of dental care. Others may not know the importance of oral health on growth and development.

Awareness and education are our most important tools to help families with oral health care. About 62% of children (about 726,200) have a caregiver who is unaware that a child should have their first dental visit by age one.

Since children visit pediatricians more frequently than dentists, collaboration between medical and dental professionals improves overall health outcomes for children through screening and education. In the eight-county service area, nearly 2 in 3 children had a medical professional recommend regular dental checkups for preventive care, and nearly 1 in 3 children were advised to visit a dentist for a dental problem. 

Recordings and slide decks from both sessions will be available on the Center for Community Health website.

If you are interested in learning more or have questions about the data, please email CHNAFeedback@cookchildrens.org.

“Hiding a gun under a mattress, in the closet, or on a high shelf is not safe storage,” Gonzalez explains. “Guns must be stored unloaded and locked away outside the reach of a child or teen.”

Gonzalez adds that safe storage can greatly contribute to reducing unauthorized use of firearms and gun violence among our youth.   

Cook Children’s Medical Center-Fort Worth treated 40 gun-related injuries in fiscal year 2025 (October–September). During the fiscal year 2024, Cook Children treated 62 gun-related injuries.

June 6 marks National Gun Violence Awareness Day and the beginning of Wear Orange Weekend, a time dedicated to raising awareness about gun violence prevention and honoring victims.

“Summer especially is a great time to practice the 3 T’s of gun safety: Talk, Teach, and Take Action,” Gonzalez said.

Gonzalez and Dan Guzman, M.D., a pediatric emergency medicine physician and Medical Director of the Aim For Safety® program, work together to educate the community, primarily focusing on preventing unintentional gun injuries by encouraging safe gun storage. Dr. Guzman has seen and treated an unfortunate number of children injured or killed due to firearms. As a gun owner and parent, he understands the importance of safely securing firearms.

“I don't want to watch another child die as a result of a firearm,” Dr. Guzman said.

He emphasizes that the initiative is not about advocating for or against gun ownership; the focus is on providing people with the tools and resources to be safe around guns.

The Aim For Safety® program has provided education and resources to thousands across the Dallas-Fort Worth Metroplex.

“We highlight how safe storage greatly reduces the risk of unintentional injuries, as well as how it contributes to keeping children safe during mental health crises and reducing the risk of use for gun violence,” Gonzalez said.

Between October 2024 and April 2025 alone, the program provided 252 gun safes and 206 gun cable locks to the community. This is in addition to almost 1,000 gun cable locks provided to families in the emergency department over the last year.

“That’s a total of 458 families which now have tools to keep their families safe,” Gonzalez said.

Gonzalez explains that safety extends beyond firearms such as handguns and also includes air-powered guns such as BB, pellet, and paintball guns.

“Guns should never be used without a guardian’s permission and should only be used while an adult is supervising,” Gonzalez said.

Open Dialogue: Talking to Other Parents about Gun Safety

• Keep the conversation focused on safety, not on whether someone should or should not own a gun.
• Simply ask if there are firearms in the home and if so, are they properly stored (unloaded and locked with a cable lock or in a gun safe).
  • If not, visit the Cook Children’s Aim For Safety website for tips on how to keep guns safely stored or for resources that we can offer to assist in safely storing the gun.

Aim for Safety in the Community

Aim for Safety will be out in the community throughout the summer:

• Defenderpalooza on July 12
• Fort Worth’s Premier Gun Show on August 23-24
• Scheels Great Outdoor Expo September 6-7
• If anyone is interested in a presentation, please reach out to  eric.gonzalez@cookchildrens.org

Lives Impacted by Gun-Related Injuries and Prevention Efforts at Cook Children's

• In FY 2025, Cook Children’s Medical Center-Fort Worth has treated 40 gun-related injuries
• In FY 2024, Cook Children’s Medical Center-Fort Worth treated 62 gun-related injuries
• Most non-fatal injuries were caused by air-powered guns (BB guns, airsoft guns, paintball guns, etc.), while most severe or fatal injuries were caused by handguns.
• Between October 2024 and April 2025 alone, we provided 252 gun safes and 206 gun cable locks to the community through various events.

Sophia Price, with Cook Children's Trauma and Injury Prevention says Cook Children's Medical Center in Fort Worth reported its first snakebites of the season in late April and early May, including its first copperhead bite in May. In 2024, the Cook Children's Health Care System treated 30 snakebites, with the first reported in March.

Jay Pearson, P.A., a physician assistant with Cook Children’s Trauma Services, offers crucial advice for parents on keeping children safe from snakebites. Price recommends avoiding walking in tall grass and wearing protective boots. She also warns that at night, snakes may rest on warm surfaces like driveways or sidewalks. Price emphasizes that individuals should never attempt to touch or handle a snake, even if it appears dead.

North Texas is home to three species of pit vipers:

• Copperheads
• Cottonmouths (also known as water moccasins)
• Rattlesnakes

A snakebite can cause localized pain and swelling that may spread as venom progresses. Other symptoms can include nausea, vomiting, and an increased heart rate. In severe cases, patients may experience difficulty breathing, low blood pressure, or bleeding disorders.

If a snake bites a child, seek immediate medical attention at the closest emergency department.

What to do if bitten by a snake:

• Do not try to capture, photograph, or kill the snake.
• Do not apply ice, tourniquets, or attempt to suck out venom.
• Immobilize the affected limb and keep it at heart level if possible.

How snakebites are treated at Cook Children's:

Once at the hospital, patients with moderate to severe envenomation may receive antivenom, which is readily available at Cook Children’s Medical Center.

Patients are closely monitored for symptom progression and may require hospital admission for observation and supportive care. 

“I dropped off Avyee and asked my dad if I could go one more ride,” Wyatt recalls.

Jimmy agreed. Wyatt drove to a new subdivision, where many of the homes were still being built or were vacant. The road was unpaved. Wyatt hit loose gravel while making a sharp turn, causing his golf cart to tip over. The cart landed on his foot, causing severe injuries.

“I was yelling for help,” said Wyatt.

The accident happened in front of a home where a family had just moved in that day. The mother there picked up Wyatt and rushed him to his home. As the unfamiliar car pulled up with Wyatt, Avyee rushed inside to tell April.

“I got outside and just saw this stranger holding Wyatt like a baby, and Jimmy wrapping his feet in a swim towel,” April said.

Jimmy sprang into action, grabbing his car keys and rushing him to the local emergency room, where Wyatt was stabilized and transferred to Cook Children’s Medical Center-Fort Worth.

The 11-year-old’s innocent evening stroll ended with scattered road rash along his side, three broken bones, and two ripped tendons.

April shares that it was not until the next day, when they met with the plastic surgeon, that they realized the severity and trauma their family had endured.

“I realized this is our new reality right now,” April said. “We’d have full days of surgeries, with doctors and nurses constantly in and out.”

During the first few days, the Hatchers were overwhelmed with friends and family pouring in to tend to their two youngest children at home. Their youngest was just 8 months old and breastfeeding. It was then that she realized the trauma affected her whole family.

She recalls one moment in the hospital where she was caring for Wyatt and his baby brother, Bodynn. April explained to Wyatt that while the trauma happened to him, it affected everyone.

She told him, "You must be patient versus expectant. We are all learning new things."

“It was a hard lesson for him, and just a beautiful opportunity to remind him that he was the one in the hospital bed, but it was changing all of our lives,” April said.

In the two years since the accident, Wyatt has undergone 11 surgeries and one tendon release. Wyatt's last tendon release surgery with a podiatrist will be when he is 18.

He says it was the words of an anesthesiologist that helped him face those surgeries head-on.

“He said, ‘When you face a challenge, you have to meet it, greet it, and then defeat it,’” Wyatt recalls.

Camp RISE

The family came to know their Cook Children’s child life specialist well. She suggested they attend Cook Children’s Trauma Support Group. Through the group, they learned about Camp RISE, a camp focused on families who have experienced a traumatic event. The camp helps families build coping skills, process trauma, and meet other families, all while taking part in fun activities like zip lining.

“It was an escape from the city life,” April said. “Being out where the stars are so numerous and it's just an oasis, and it’s just such an excitement.”

As the Hatchers arrived for their first day of camp, they were greeted with cheers and welcomed to their private cabin. Avyee, Bodynn, Wyatt, Jimmy, and April were excited for the experience.

Wyatt admits his favorite part of camp was archery, but during his second year, he felt compelled to encourage other children through their trauma. He credits Matthew 17:20-21 for finding that courage.

“If you have faith, faith the size of a mustard seed, you could tell a mountain to move and jump,” Wyatt recites.

To Wyatt, it was about giving hope to someone else.

“This is never going to be normal, but it will become a new normal, and it's going to be okay eventually,” said Wyatt.

After two years at Camp RISE, the Hatcher family graduated in 2024. April said it was a bittersweet moment. The family received a book signed by all the Trauma Support Group staff.

“The ripples were extensive, in what they had us do,” April said. “It’s just a scaffold to bring such healing.”

Just two weeks after the accident, wound vac and all, Wyatt used the anesthesiologist’s wise words to conquer any fears or hesitation he had about getting back in the golf cart. His dad placed him in the seat and gently drove him around the front yard, eventually taking him on the road.

Two years later, at 13, he shows his scar without hesitation. He openly shares and explains the accident with maturity.  

 For Wyatt’s 13^th birthday, he wanted to see starfish and swim with the dolphins. It was being with the dolphins that captivated him. He now has aspirations of becoming a Marineland dolphin trainer.

During that birthday adventure, April says Wyatt found his voice. On his own, while his parents watched, the 13-year-old had to explain to employees and the dolphin trainer why he wears a scuba sock on his injured foot. A scuba sock was something dolphins had never seen before. The trainer told Wyatt he would teach the dolphin what the sock was.

"It was the coolest moment for our kid," April said. "He just walked away with so much more confidence."

That statistic comes from Up and Away and Out of Sight, a platform that raises awareness of the danger of overdoses that happen accidently. Prescription medications, over-the-counter medications, vitamins and supplements can all be harmful if they aren’t used as intended.

March 16-22 is National Poison Prevention Week, a chance to educate parents and caregivers about the importance of keeping children and teens safe from ingesting substances that can be dangerous. Poison prevention at Cook Children’s falls under the scope of injury prevention along with gun safety, drowning prevention, safe baby sleep and vehicle safety through the Center for Community Health.

Schools, clubs, libraries and organizations such as North Texas Poison Center work in partnership with the Center for Community Health. The center’s poison prevention program distributes medication lock boxes, cabinet locks and kits for disposing of unused medications.  

“Education and resources are shared at each level to help influence safer practices while the messaging stays consistent,” said Klaressa Broughton, program coordinator. “We use social media ads, trainings, parent group presentations, local community events and health fairs for the greatest reach and overall impact.”

Three Key Points

You can help prevent accidental overdoses with these layers of protection:

1. Safe dosing – Follow a medication schedule checklist to make sure your child gets the right amount at the right time. Set an alert on your phone to remind you when it’s time for another dose. Measure accurately using an oral syringe, dosing cup or dropper. Follow the instructions on the bottle.

2. Safe storage – Keep medications in a locked cabinet that children can’t access. According to the Cook Children’s 2024 parent/caregiver survey covering an eight-county service area of North Texas, about 570,400 children live in homes where medications aren’t always locked up.

3. Safe disposal – Remove any unused or expired medication from the home by taking it to a designated drop box. Don’t flush them down the toilet or pour them in the sink.

Medication safety can be an extra challenge, Broughton said, when families are traveling or when houseguests bring medications into your home. Good communication is needed if a child stays with multiple caregivers.

“A common mistake is double-dosing,” she said. “Similarly, it’s important to not take a medication that is not prescribed to you or for your age range. It may be very harmful.”

Ask Your Pediatrician

Karen Evans, M.D. points out that medications for children are usually calculated based on weight. When writing a new prescription, she explains the dosing instructions with the parents of her patients at Cook Children's Pediatrics Parkwood in Frisco while in the office.  

“That opens the door for the parent to ask questions,” she said, adding that pediatricians and pharmacists are happy to answer those questions.

From her experience as a mom with three kids, Dr. Evans offered a tip: If your child is sick, have a syringe or dosing spoon washed and handy in case your child wakes up with fever in the middle of the night. Review the dosing instructions ahead of time. Making a plan for dispensing medication can help prevent mistakes when you’re exhausted.

Never try to trick a child by saying medicine is candy, Dr. Evans advised.

She also emphasized the risk of teens sharing medication with other teens. Parents should talk with their teens about taking medications only from trusted adults. Even if a friend at school offers what appears to be a familiar brand of pain reliever, you can’t be sure what the substance is, Dr. Evans said.

Warning signs of potential overdose include change in the child’s behavior or awareness, vomiting, choking, trouble breathing, seizures or not responding. Call 911 and get medical help right away.

Contact the Texas Poison Center at 1-800-222-1222.  

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Cook Children's Sees Increase in Emergency Care for Marijuana Ingestion

Friday night lights are beaming bright in high school football stadiums all across the country. Players are suited up, taped up and ready to rumble in an inherently unpredictable game where anything can happen. A turnover that shifts the momentum. A missed tackle that gives up a touchdown. A Hail Mary that wins the game. In football, only one thing is for sure — the risk of injury to players.

Among all high school sports, football ranks No. 1 in injury rates, according to a study published in the Orthopaedic Journal of Sports Medicine. It’s no surprise given the nature of the game, says Dan Guzman, M.D., an emergency medicine physician at Cook Children’s Medical Center – Fort Worth.

“It's a violent sport, and we know players are trained to go out and get that ball and hit hard,” Dr. Guzman said. “So we're going to, unfortunately, have injuries as a result of that aggressive play.”

In some cases, the results are tragic.

In 2023, the National Center for Catastrophic Sports Injuries reported 16 football-related deaths in its Annual Survey of Football Injury Research. Five deaths were at the college level, seven in high school, two in middle school and two in youth league. Three deaths were directly related to football and a result of a traumatic brain injury. Ten fatalities were classified as exertional/medical fatalities, which includes sudden cardiac arrest and heatstroke, that occured during football-related activity. 

In August, National Public Radio (NPR) reported that at least seven high school and middle school football players died during that month from head injuries or suspected heatstroke.

Tackling Trauma

Dr. Guzman has seen his fair share of football-related injuries in Cook Children’s Emergency Department. Most players visit the ER for orthopedic injuries of upper or lower extremities. Dr. Guzman suggests recent efforts to protect the head and neck from traumatic injury are leading to an increase in shoulder and arm injuries. Although these injuries can be serious and lead to loss of playing time, the trade-off is necessary to decrease the risk of traumatic brain injury or concussion, and to protect more critical areas of the body. 

“Coaches are teaching kids to not use their head and neck to initiate contact and, instead, use their shoulder, so I think we've seen a slight increase in the number of shoulder and clavicle injuries and shoulder separations,” Dr. Guzman said.

Not all injuries warrant a trip to the ER, but can have just as significant out of activity implications as their more serious counterparts. Bruises, sprains and strains are some of the most frequent injuries seen in football, according to Jeffrey Bass, MS, ATC, LAT, OPE-C, a licensed and board certified athletic trainer at Cook Children’s Orthopedics and Sports Medicine Walsh Ranch. Bass is also a football medical observer in the Big 12 Conference and a regular on the sidelines at high school football games, where he’s often referred to as “Doc” while he works to protect young athletes from injury.

“It’s a term of endearment based on the fact that the athletic trainer’s work can parallel that of a physician and because they can fill many roles, especially in rural areas,” he said. “The good news is I’ve never been confused with any of our local doctors, and I’ve never been asked to operate on anyone or deliver a baby.”

With 46 years of experience in the industry, Bass knows what makes a good football program, and a focus on player safety is at the top of his list.

“We know that about 95% of participants involved in competitive athletics are going to have a time loss injury,” Bass said. “It’s not a matter of if, it’s just when.”

With the risk of injury in competitive athletics so high, especially in a full-contact sport like football, it’s important that parents know that their child’s football program is ready and equipped to respond to an injury, be it minor or severe. We asked our experts to tell us what’s most important when it comes to player safety so parents can worry less and focus more on cheering their athlete into the endzone. 

What are the most important safety elements of a football program?

Be Prepared
Texas Senate Bill 82 outlines safety regulations for public school extracurricular activities. It mandates safety training for all coaches or athletic event sponsors, along with an emergency drill incorporating this training. It also requires that student athletes be provided training in recognizing symptoms of catastrophic injuries, such as head and neck injuries, concussion, heatstroke, and more. 

The University Interscholastic League (UIL) advises that schools have a detailed emergency action plan to respond to player and spectator medical emergencies during sporting events. Having a plan is the single most important element of a safe football program, according to Bass.

“It’s about having a plan in place, knowing that the likelihood of injury is going to be well above 50% to at least one player,” Bass said. “Do I have the necessary equipment? Do we have splints? Does someone have a phone to call 911? Do we have an AED? Who will make sure gates are unlocked for the ambulance? Do I have the processes in place to deal with an emergency? If we don't have EMS on site, how is that going to change our approach to the need of care and transport? If I'm trying to do it on the fly when everybody's excited, that is not the ideal time to be discussing these things.”

Prioritize Professionals
“Whether it's basketball, football, baseball or any other sport, parents need to know, not just assume, that in the event medical care is needed, there is somebody there that's qualified to care for their child,” Bass said. “We realize there are differences, obviously, between the larger public schools with more established programs and smaller or private school programs, but it’s still full-contact tackle football, and it doesn't make any difference what level that it's played at. You still need to know who is there to care for your child if they are injured.”

In addition to physicians, board certified athletic trainers like Bass often serve as a team’s chief medical professional both on the sideline and in the locker room. Athletic trainers are allied health professionals who specialize in injury prevention, assessment, diagnosis, care and rehabilitation for athletes.

But not all schools have the resources to have a physician or athletic trainer on the sideline for every game. In this case, someone trained in basic CPR should be present, Dr. Guzman says.

“That's the most lifesaving part of this entire conversation,” Dr. Guzman said. “If a player goes down who's unresponsive for whatever reason, then someone can start and initiate CPR within seconds.”

As a Project ADAM partner, Cook Children’s is helping more that 530 schools in North Texas become “Heart Safe” by training school staff and coaches on CPR, how to use an automated external defibrillator (AED) and how to create an emergency plan.

What can parents do to help protect their athletes?

Stay Informed
Ask questions and communicate openly with coaching staff about their protocols in the event of an injury. With a concussion, for example, understand how your player will be evaluated on the sideline. Who and what will determine if they are or are not ready to go back into the game? Going back too soon, Dr. Guzman says, can lead to a traumatic brain injury.

“It’s really important to have that open door communication with the school and coaching staff, " Dr. Guzman said. “Make sure that all those things are in place to keep our kids safe. Don't just think that it's being taken care of. The state of Texas does a pretty good job of making sure that there are lots of protocols in place to keep kids safe, whether it's in the school or at these events, but I think we still need to be a part of that conversation as parents.”

Stay Alert
Kids don’t always speak up when they are hurt for fear of being benched or considered weak. Committed players will often try to tough it out, and that’s not always best for their health. Playing with an injury can lead to a more serious complication that ultimately increases an athlete's time away from the game.

“Parents have to watch for those subtle changes in their children,” Dr. Guzman said. “Whether they're walking a little differently or they're not picking up their backpack the same way.”

Bass says part of his role as an athletic trainer is to educate players about what their body is telling them, and to help them understand the process for getting them through that injury and back in the game.

“I tell them it’s how we deal with injury that ultimately determines the character of what kind of player we’re going to be,” Bass said. “So if we have something that is swollen, that is uncomfortable and just doesn't look the way it should, that's something we need to have evaluated.”

When an injury does occur, the John and Tracy Sellers Sports Complex at Cook Children’s Orthopedics and Sports Medicine Walsh Ranch, helps young athletes get back in the game with training and rehabilitation services. The Sellers Sports Complex also offers injury prevention programs and sport and position-specific training led by certified athletic trainers.

For more on this and health and safety tips for young athletes, click on the links below.

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“While we are ecstatic that children are finding ways to get exercise and enjoy being outside, we want to remind parents to make sure that kids are protected while having fun,” said Kara Starnes, D.O., medical director of Urgent Care at Cook Children's.

Helmets are a Must for Fun on Wheels

ATV and dirt bike crashes are a common occurrence during summer. Over Memorial Day Weekend, the emergency department in Fort Worth saw 10 injuries related to motorcycles, dirt bikes, ATVs and skating.

Always ensure your child wears a properly fitted helmet to avoid head injuries. Adult supervision is essential when a child is riding any motorized vehicle, and children should never ride on ATVs or dirt bikes designed for adults.

“Please supervise your children on motorized vehicles,” Taylor Louden, M.D., medical director of Pediatric Emergency Medicine at Cook Children’s Medical Center – Fort Worth said. “They should always be wearing their seat belt and appropriate safety gear. The start of summer is a great time to check your kids’ safety gear and make sure helmets fit appropriately and are in good condition.”

A helmet that fits correctly will feel snug but not uncomfortable. 

A few other key points:

• Helmets that passed federal safety standards in testing will say “U.S. Consumer Product Safety Commission certified” on the label.
• Helmets should be worn in a level position just above the eyebrows.
• If the helmet rocks backward and forward or side to side, adjust the straps. No more than two fingers should fit under the buckled chin strap.    
• Never ride without a helmet.

Water Safety: A Constant Vigilance

Drowning is the leading cause of accidental death for children ages 1 to 4, and the second leading cause for kids 1-14 in Texas. Drownings can happen silently and quickly. A submerged person might not attract attention or appear to be in danger. These tragedies highlight the importance of constant supervision around water.

Sharon Evans, trauma injury prevention coordinator at Cook Children's, emphasizes, "There's no off-season for drownings. A moment of inattention can be devastating."

Unplanned swim time is a major culprit, with roughly 70% of drownings at Cook Children's occurring when parents weren't expecting their child to be near water.

Layers of Protection: Keeping Curious Toddlers Safe

Multiple safety measures, known as "layers of protection," can significantly reduce drowning risks. Fencing around pools with self-latching gates, preferably 5-feet high, is crucial. Door and window alarms can alert you if a child exits the house unsupervised. Remember, young children are naturally curious, so removing pool toys and floats when not in use minimizes temptation. For above-ground pools, make sure to remove the ladder when the pool is unsupervised. Consider using a pool surface alarm for added security.

Cook Children's has developed the "Lifeguard Your Child" campaign to raise awareness about childhood injury prevention. Through this initiative, you can find resources like free swim lessons, safety videos, and loaner life jacket stations at lakes across North Texas. Visit lifeguardyourchild.org for more information.

Sun Safety: Protecting Young Skin

Sunburns are not just uncomfortable; they can increase a child's risk of skin cancer later in life. Zinc oxide-based sunscreen is best whenever your child is outdoors. Covering skin with SPF is another way to protect your child’s skin. Apply sunscreen generously 30 minutes before sun exposure and reapply every two hours, or more often after swimming or sweating. Protective clothing, hats with wide brims, and sunglasses that block UV rays offer additional defense.

Hydration: Keeping Cool and Healthy

Dehydration can lead to nausea, dizziness, headache, or even heat stroke. Encourage frequent sips of water throughout the day, even if your child doesn't feel thirsty. Avoid sugary drinks that can worsen dehydration.

Your child’s urine colors can range from clear to dark yellow to orange, depending on how hydrated they are. To tell if your child is dehydrated, read this article from Celina D. Cepeda, M.D., a nephrologist at Cook Children’s Medical Center – Prosper.

Fishing Fun Without the Hooks

Fishing is a popular summer activity, but fish hooks can pose a safety risk. Teach children to handle hooks with care and supervise them closely while fishing. Consider using barbless hooks to minimize injury if a hook snags on skin.

RELATED:

• A Cautionary Tale: The Misadventures of Summer & Top Injuries Seen at Cook Children’s
• Should My Child Ride ATVs? Cook Children's Experts Weigh In 
• Sunburn Relief at Home, When to See a Pediatrician 
• Pediatrician Shares Top Beach Vacation Health Tips 
• Heads Up: Helmet Tips for Safer Bicycling 
• Teen Driver? What to Know Before They Go This Summer 

Toys gifted during the holidays are meant to bring joy and adventure. But toys can also pose risks for choking, head injury and other dangers.

A curious toddler might swallow a Barbie shoe or stick a craft bead up their nose. Older children might crowd onto the trampoline or shoot a Nerf gun at someone’s face. Teens might want to ride their bicycles and scooters without a helmet.

That’s why the safety experts at Cook Children’s urge parents to implement the best practices to help keep kids of all ages from getting hurt with toys. January is the time to set intentions for the new year … a fresh start for rules when it comes to how your family members use toys and put them away. 

“Injuries prevent fun. We want to be able to have fun with our toys, and in order to do that, we have to be safe with them,” said Ashley Pagenkopf, MS, CCLS, Child Life Specialist at Cook Children's Emergency Department (ED). “Safety produces fun.”

National statistics from the U.S. Consumer Product Safety Commission show an estimated 209,500 toy-related injuries were treated in hospital EDs across the country in 2022. Cuts and abrasions accounted for 41% of those ED visits. Almost half were injuries to the patient’s head and face.

At Cook Children’s in the year between October 2022 and September 2023, our ED saw patients with injuries stemming from: 

• 15 in bicycle collisions with automobiles
• 52 on bicycles
• 27 on scooters
• 25 on skateboard or hoverboard
• 20 on skates or rollerblades
• 106 on trampolines

The data from the Cook Children’s ED also included 93 injured ATV riders, including five fatalities. Additionally, the ED treated 29 patients hurt on go-karts and golf carts in the 2022-2023 year.  

Sharon Evans, trauma injury prevention coordinator at Cook Children’s, said parents need to understand the risks and be vigilant about teaching and enforcing rules for safe use of toys. She especially emphasizes the need to wear a helmet on any toy with wheels.

“Kids need to be taught the importance of using a helmet on EVERY ride, how to look for cars pulling in and out of driveways and on the street, crossing only at intersections,” Evans said. “They don’t learn all this by one parent lecture. You have to be with them and model this behavior until they are able to reproduce it on every ride.”

What’s most important for parents to remember? Here are key tips:

1. Get rid of the packaging right away when a new toy is unboxed. Plastic bags, bubble wrap and packing peanuts can be hazardous for a young child.  
2. Read the warning labels and instruction manuals. Show your child how to use the toy properly.
3. Follow the age range listed by the toy manufacturer. If it says 4+, then it’s not appropriate for a 3-year-old. And be mindful of your child’s maturity and any developmental delays that could affect their readiness for a particular item. Just because your child is 4 years old, they might not be suited quite yet for a toy labeled 4+. “As a parent you have the ability to say ‘We’re going to put this up for a while,’” Evans said.
4. If assembly is required, finish the job completely and correctly. A screw only partially screwed in can wind up in a child’s mouth.
5. Watch for magnets and batteries in toys. If swallowed, they can cause a fatal injury or serious harm to the throat, stomach and intestines.  
6. Be aware of recalls issued for toys identified as potential choking or fire hazards, containing unsafe amounts of lead, or other concerns.
7. Make sure older siblings keep things out of reach. That includes game pieces, mini LEGOs, makeup kits etc. Evans recommends finding a place and time when babies and toddlers aren’t nearby. “There may have to be rules where the older child can play with the small toys only when the younger child is asleep. Or put the toys up on a table or counter where they are out of the younger child’s reach,” Evans said.
8. Pick up after playtime. Plastic bins and secure lids from the dollar store are smart and affordable ways to contain your family’s toys.

Parents should set the expectations and then give their kids frequent reminders to help them stick to the family rules. Children might push back on the limit of two jumpers at a time on the trampoline or the requirement to wear a helmet on the scooter or bicycle. But it’s important to be consistent. And be ready to follow through with consequences if a child breaks the rules.

Pagenkopf said parents should reinforce again and again the conversations about putting away the toys that are risky for a little brother or sister. It’s also important to model the habits you want to instill, she said. For example: Parents should always wear a helmet when riding their bikes, so that kids understand that safety rules apply to everyone in the family.

Another tip is to praise your child for using and storing toys properly. “Say ‘Hey, thanks for having your helmet on.’ ‘Thanks for putting your toys away,’” Pagenkopf said. “Kids are so responsive to positive reinforcement.” They’ll repeat the praised behavior.  

Not all toy-related injuries can be prevented. But when a family makes safe habits the norm, they reduce the odds of a severe injury that requires a trip to the ED. It takes consistent practice by children and parents.

“There’s an intentionality and a mindfulness in it,” Pagenkopf said. “Not being safe is what steals fun away.”

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It’s a big milestone for parents of young children to turn their car seats to face forward. Some may wonder, when is the appropriate time to do so? Is it when the child wants to look out the window? Is it when the parent wants to see the child? This milestone should be delayed for as long as possible because safety is the top priority. Keep your child rear-facing to help prevent severe injuries during a crash.

“Keep them rear-facing until they reach the maximum weight and height of the car seat,” said Sharon Evans, trauma injury prevention coordinator at Cook Children’s. “Rear-facing is the safest way they’ll ever travel.”

Car crashes are a leading cause of injury and death in children ages 1 to 13. Every year children are rushed to the emergency room to be treated for car-related injuries.  

Check your car seat’s manual -- the most important piece of information will be determining the maximum weight and height limit of their rear-facing car seat. Most car seats will go to 40 pounds rear-facing so your child could be 3 or 4 years old before you turn them around.

Keeping your child rear-facing also protects their spinal cord in the event of a car crash. When they’re rear-facing during a crash, the impact will cause the car seat to dip, protecting their spine and neck.

“You’re keeping their head, neck and spine all in alignment,” Evans said. “The majority of the crash forces are taken on the back of the car seat and less of the crash forces are not transferred to the child.”

Parents may worry that their child’s feet are touching the vehicle seat when the car seat is rear-facing.

“You would think that there is a chance that they would be more prone to having a broken leg, but what we found through research and the American Academy of Pediatrics says that there is no increased risk,” Evans said.

If a child is facing forward during a crash, that is a lot of force to put on a child’s spine and neck.

“If you have that sudden stop, the pressure and force put on their neck can cause severe spinal cord injuries,” Evans said. “During that stop, their head and their arms are all going to come forward and that force can cause broken arms and legs.”

Check the harness straps are at or just below their shoulders and the retainer clip always needs to be at the armpit level, Evans said. Make sure the straps are snug with the pinch test.

After outgrowing a rear-facing car seat, children will move to a forward-facing car seat until at least age 5 based on the weight and height limit for the car seat.

The next seat is a booster seat, which is used until the seat belt fits properly, usually around ages 9 to 12, according to the Centers for Disease Control & Prevention.

FREE CAR SEAT CHECKS

Parents and caregivers can bring their vehicle and car seat for a free car seat check with the Cook Children’s Center for Community Health at 682-885-2634 or go online to freecarseatcheck.org.

Certified technicians will inspect your car seat free of charge and show you how to correctly install and use it. Some locations now offer virtual inspections.Top of Form

The National Highway Traffic Safety Administration maintains a directory of many inspection stations.

Always refer to your specific car seat manufacturer’s instructions (check height and weight limits) and read the vehicle owner’s manual on how to install the car seat using the seat belt or lower anchors and a tether, if available.

More information & resources:

• Car Seat Safety (for Parents) - Cook Children's (kidshealth.org)
• Register your car seat and sign up for recall notices to receive safety updates
• Car Seat and Booster Seat overview from the NHTSA
• Car seat recommendations from the NHTSA
• Child Passenger Safety | Injury Center | Centers for Disease Control & Prevention
• Child Passenger Safety | Pediatrics | American Academy of Pediatrics (aap.org)

Cook Children’s Medical Center has seen 30 infant deaths linked to unsafe sleep situations since January 2022, more than the number of fatal gunshot wounds and drownings combined.

That’s why safety advocates at Cook Children’s are sharing the risks that pillows, loose garments, blankets and other objects can pose in an infant’s sleeping environment.

The majority of unsafe sleep deaths in 2022 and so far in 2023 involved co-sleeping with at least one parent or caregiver, who awoke to find the child unresponsive. Trauma records at Cook Children’s list a variety of other circumstances too, including babies placed on a pillow with a propped bottle, in the crib with a blanket or pillow, in a recliner or on the couch next to a sleeping adult, or wearing a loose T-shirt that covered their face. By the time these infants arrived at the medical center, they were in cardiac arrest or respiratory failure.

Sharon Evans, trauma injury prevention coordinator, said the number of unsafe sleep deaths in the past 15 months is at the highest peak since she started in her role at Cook Children’s in 2008. Demographic data shows the group with the highest unsafe sleep deaths were Black boys from 2 months to 6 months old.

Infant deaths linked to unsafe sleep from 2022-2023

Candle Johnson, APRN, CPNP-PC at Cook Children’s Renaissance Neighborhood Clinic in south Fort Worth often talks about Safe Sleep with her patient families. As a Black nurse and Certified Pediatric Nurse Practitioner, it’s important to her that all patient families, including Black families, receive education and know that she is passionate about keeping their baby safe.

“Unless it hits home, it doesn’t really resonate. We want them to understand this is a very preventable situation,” Johnson said. “Let’s be proactive today, so we don’t have to be reactive tomorrow. If a fatality happens, then how do we go forward when we could have prevented it from the beginning?”

Sometimes patient families share with Johnson that co-sleeping is a generational habit and give her pushback. While those conversations can be tough, Johnson knows it’s important to break through those misconceptions. She shares why it’s important that the baby sleeps separately on a flat surface, like a crib or bassinet.

“It seems to be so much easier to co-sleep when breastfeeding,” Johnson said. “I do advise against that because even though it may be easier, it’s not safe. No one can control their body function once they’re sleeping. When you’re in a deep sleep and your infant is next to you, you’re not able to say ‘I won’t roll over on them.’”

An infant can get wedged between the headboard and mattress, suffocate under blankets, or come under the adult’s body if they’re sleeping together, Johnson said.

She discussed barriers that could increase the risk of an infant being fatally injured from unsafe sleep situations. Those challenges might include a lack of education about safe sleep, distrust of medical advice, young maternal age, and inability to afford a separate crib or bassinet, Johnson said. In a crowded one-bedroom residence, she said, everyone in the household might sleep in one bed due to space constraints.

Data from Cook Children’s on unsafe sleep deaths in 2022-2023 show that the infants were in sleeping positions or circumstances that contributed to their deaths, not to be misidentified as SUID, sudden unexpected infant death. SUID describes the sudden and unexpected death of a baby in which the cause was not obvious; SUID cases are not all preventable. 

According to the U.S. Centers for Disease Control and Prevention (CDC), about 3,500 sleep-related infant deaths occur each year in the United States.

When it comes to sleep risks, the message is just as critical as the safety rules for other potential hazards such as swimming pools and riding in a vehicle. Parents know to buckle their children into lifejackets and car seats. Safe sleep also involves precautions:

• Always place your baby on their back to sleep. Side and stomach sleeping are not safe for infants who can't roll over.
• Use a firm, flat mattress or sleeping surface with tightly-fitted sheets. The surface shouldn’t be sloped.
• Share a room but not a bed with your baby. Babies should sleep in their own cribs or bassinet.
• Clear your baby’s sleep area of blankets, pillows, bumper pads and soft toys.
• Sleep sacks are recommended instead of swaddling, especially after your baby is able to roll over. 

Parents want to do their best, but they’re often exhausted by midnight feedings and other aspects of caring for an infant, Evans pointed out. They might decide impulsively to lie down beside their sleeping baby in an adult bed for just a few minutes, leading to a tragic outcome.

“Nobody intentionally does it,” she said. “I don’t think any of the parents who are co-sleeping feel like there’s any danger.”

Evans encourages parents and caregivers to consistently follow the evidence-based guidelines for safe sleep. Even if the baby’s fussy. Even if co-sleeping makes it easier to breastfeed. Even if you grew up co-sleeping as the family norm, put the baby in a crib or bassinet every night and for every nap.

Daniel Guzman, M.D. treats patients in the Cook Children’s Emergency Department (ED). It’s particularly heartbreaking to see infants needing emergency care for injuries that happened while they slept, he said. “You always hear ‘I never thought it was going to happen to me.’ The amount of pain that you see these families go through is just horrific. It hurts me every single time.”  

Dr. Guzman, who is a father of three, empathizes with moms and dads who are worn out by the demands of parenting an infant. He starts conversations whenever he hears parents in the ED report they sleep in the same bed as their baby. “I’m quick to say, ‘Let’s talk about this. What can we do to make you guys safer?’”

The Safe Baby Sleep Council, led by Cook Children’s helps provide sleep sacks and pack-and-plays to families. Reducing the number of unsafe sleep deaths will require greater public awareness plus resources, Dr. Guzman said.

“Cook Children’s is here to make that difference and provide not only the education and the information, but the tools that make us safer,” he said. “If we get one person to hear the message and have a shift in their mindset, we’ve already done our job. But we want to do more and we’re going to continue to do more.” 

Anu Partap, M.D., M.P.H., Physician Director of Health Equity at Cook Children's, said many dynamics factor into sleep-associated infant deaths, including financial hardship and housing arrangements. Input from community leaders is key, Dr. Partap said.

“We need to engage the communities who are losing their babies at higher rates and work with them to figure out what we can do to stop loss of life. Communities who are affected are our partners in protecting their children,” she said. “Learn from them and share with them what we know. We have to work together to solve this and we can.”

Kaitlin Bates and her three young sons heard a loud pop while walking on a nature trail one day last summer. 

At first, Kaitlin thought their stroller ran over something, maybe a snake. Then her 18-month-old son Jace started screaming. Kaitlin was shocked to see blood flowing from a hole in Jace’s knee. The toddler, seated in the stroller, had been shot.   

The Bates family’s trip to a nature center in Wichita Falls on Aug. 11, 2022, turned tragic because someone fired a gun. Was the shooter aiming at the boys and their mom? Or was Jace randomly hit by a stray bullet? No one knows.

Whether or not the shooter intended to cause harm, the consequences were serious. The bullet tore through cartilage, ligaments and tendons, and also chipped off a bone fragment from his tibia. Jace required surgery – followed by months of physical therapy to regain the use of his left leg.

“Jace is so resilient,” Kaitlin said. “It slowed him down for awhile and he had a lot of pain for awhile while, but I think Jace has the beauty of ignorance because he’s so young. He never knew what happened. He didn’t know it was a gunshot.”

Jace was one of 42 children and teens treated at Cook Children’s Medical Center for gunshot wounds in 2022. Most of those patients were ages 11 or older, although some were babies or preschoolers. Five died from their injuries.

Hospital data show that handguns accounted for almost half of the gunshot wounds treated at Cook Children’s last year. Traumatic injuries also resulted from shotguns, BB guns and airsoft guns, which use compressed gas to launch pellets.

In an effort to reduce injuries and fatalities from firearms, the Cook Children’s Aim for Safety® program promotes awareness and responsibility to help protect kids from accidental shootings. The program emphasizes three basic steps:

1.     Safe Storage – Keep firearms unloaded and in locked locations out of reach of children. Use trigger locks and gun safes. Secure ammunition separately.

2.     Safe Children – Teach your child don’t touch if they see a gun or someone aiming a toy gun at others. Teach them to run and tell an adult.

3.     Safe Play – When non-powder guns are in use, remember to never aim BB guns or pellet guns at another person. Wear safety glasses when using a paintball gun, gel bead gun, water bead gun or soft foam gun. Before a playdate at a friend’s house, find out if guns are kept in the home and how those guns are secured.

Daniel Guzman, M.D. understands the Texas hunting culture; he’s a firearm owner himself and respects the Second Amendment. But as a physician at the Cook Children’s Emergency Department, he also knows the danger. Dr. Guzman started Aim for Safety® in 2017 after the upsetting experience of treating a 4-year-old shot on accident by a sibling. The child died from the injuries.  

“No one is here to talk about keeping a gun from anybody, but there are definitely things that we can do to help minimize the injuries,” Dr. Guzman said. “The number one thing that comes with gun ownership is safe storage and responsibility.”   

In Jace’s case, maybe the shooter hit the boy on purpose. His parents think the more likely scenario was carelessness … the shooter pulled the trigger without knowing what or who could be in the bullet’s path. Aim for Safety® wants to keep such tragedies from happening.

Jace can once again walk, ride a tricycle and romp around with his big brothers. Kaitlin and Justin Bates are thankful for their son’s recovery but don’t know if the injury will impact his growth or cause complications when he’s older. Here’s a closer look at events and the care Jace received at Cook Children’s.  

Bullet out of the Blue

The bullet came in at a downward angle, entering through the inner leg and protruding like a knot on the outside of his knee. Kaitlin unbuckled Jace and ran with him in her arms the short distance back to the nature center. She yelled for help.

“There was blood everywhere. Jace’s leg was just pouring blood,” Kaitlin remembers. “I was just looking at him and trying to assess what had happened. I saw a perfectly round hole in his leg.”

Two of Kaitlin’s former schoolmates happened to be there. They comforted the older Bates brothers, who were scared and crying. Someone called 911. Another guest offered a first aid kit, and Kaitlin sat Jace on the counter in the restroom. The two women made a tourniquet and applied pressure with paper towels. But the bleeding didn’t stop.

“Jace was kind of starting to pass out,” his mom said. “He had lost a lot of blood and he had quit crying. He was very still at this point.”   

The ambulance rushed Jace and Kaitlin to a local hospital, where doctors put his leg in a soft cast and lined up transport by helicopter to Fort Worth. Kaitlin knew it was a bad injury, and she wanted to go to pediatric specialists at Cook Children’s. The Emergency Department was ready and waiting to give Jace a scan and pain medication to get through the night.

In surgery early the next morning, two incisions were made to remove the bullet and to flush the wound of residue that could cause infection. Jace was put in a cast from his groin to the toes on his left foot. He went home the next day.

The cast prevented Jace from putting any weight on his leg. Normally a rowdy fireball of energy, the boy couldn’t stand up when the cast came off a month later.

“He couldn’t bend or straighten his leg. It was frozen in that position,” Kaitlin said. “It has been grueling. He's had a lot of pain. and even still, if I pick him up in a weird position or if I'm rocking him and I hold his leg funky, he still will reach down and grab his leg and start crying.”

Physical therapy sessions twice a week in Wichita Falls provided stretching and climbing practice to help Jace improve his strength and range of motion.

Cook Children’s will continue to monitor Jace, who limps when he’s tired. Doctors don’t know how the growth plates in his knee might respond to the injury. Arthritis could potentially be another long-term complication. 

Jace’s parents aren’t anti-gun. In fact, they practice safeguards at home because Justin owns a firearm.

“Being a responsible gun owner myself I never would’ve imagined that someone’s negligence would affect my family in this way,” Justin said. “It is paramount that firearm education is taught in our communities with the understanding that a firearm is a tool that should be operated, maintained and stored responsibly.”

His parents suspect the bullet that hit Jace came from a handgun fired blindly from a neighborhood or city park outside the grounds of the nature center. As of January 2023, the shooting remained unsolved.

“Maybe someone was just shooting up into the air and didn't realize that what comes up has to come down,” Kaitlin said. “I really don't know. There's a lot of yuck in this world, and so maybe someone did it intentionally. But overall, my husband and I really are on the page of somebody shot a gun not knowing what was behind him, which is just as stupid as doing it intentionally.”

Jace getting shot was one of the scariest things his parents have ever faced. They don’t want other families to go through what they experienced. But they rely on faith and see blessings throughout the ordeal. Kaitlin points out that if she had pushed the stroller one step further on the trail, Jace could have been shot in the head or heart instead of the knee. He could have been killed.

“We are constantly praying that the Lord would use this to bring about a mighty testimony in all of our lives, especially Jace’s,” she said. “We pray that Jace would come one day to know how much God loves him and protected him and that Jace would spread that love to all those he encounters in his life. No matter the circumstances, God is still good.”

Access and Risk

As medical director of Aim for Safety®, Dr. Guzman works to spread the three-point message of Safe Storage, Safe Children, and Safe Play through presentations at schools and community events. He and the program have reached thousands of families, provided hundreds of locks and safes for safe storage, and distributed more than 3,000 education and awareness resources.

In 2022, he made presentations to eight elementary schools and six community events in the Fort Worth area. The program also includes online classes offered through the Cook Children’s Center for Children’s Health.

“I wanted to get out there and talk to families and remind them of the importance of storing firearms safely – unloaded and locked in a safe,” Dr. Guzman said. “I’m not here to make a political statement. I’m here to educate families and keep our children safe!”

His goal is to help people understand the risk of gun ownership – similar to the risk of drowning that homeowners can proactively reduce by installing fences and locked gates around a backyard swimming pool.

Frequent conversations with your child are vital. Teach them never to touch a gun they might come across in a purse, nightstand drawer, vehicle or other location. But families also need to put barriers in place to limit access. Dr. Guzman estimates that Aim for Safety® has given away 175 gun safes and more than 1,000 gun locks in the past two years. 

The national Gun Violence Archive website lists 314 fatal shootings of U.S. children ages 0-11 in 2022. Unintentional shootings can be prevented, Dr. Guzman pointed out. He never wants to hear another grieving mother in the emergency room say she didn’t think it would happen. 

“I know my kids like to explore. They’re curious about things. They’re going to play hide and seek and play with things they may across,” he said. “Again, it’s not about browbeating anybody. It’s just about keeping our kids safe.”

Cook Children’s Aim for Safety® presents a non-political educational approach to keeping everyone safe when guns are in a home, The program emphasizes responsibility through three steps: Safe Storage. Safe Children. Safe Play. It doesn’t debate whether guns are right or wrong. It's about protecting our children.

For more information or to register for an online firearms safety course, go to Gun Safety (centerforchildrenshealth.org)

From Aug. 22 to Aug. 28, Cook Children’s treated five patients who were struck by vehicles in separate incidents.

As the new school year gets underway for many districts across North Texas, it’s crucial that drivers look out for children, especially in school zones.

Injuries treated:

• 3 patients (pedestrians) struck by vehicles
• 1 patient (pedestrian) struck by an ATV
• 1 patient (bicyclist) struck by a vehicle

Drivers should eliminate distractions and pay attention to their speed, especially in school zones. Always look out for pedestrians and don’t text and drive.

Dan Guzman, M.D., pediatric emergency medicine physician with Cook Children’s Medical Center, says that it’s important that parents also teach their children safety precautions for walking near a road, including paying attention, using sidewalks and crosswalks, and always looking both ways before crossing a street.

“It’s really important to teach your kids and make sure they understand that we need to pay attention because this is your life, there’s only one you and there’s no way to get this back if something bad were to happen,” Dr. Guzman said.

Dr. Guzman says the emergency department sees more children this time of year as kids walk or ride bikes to school and are, unfortunately, struck by vehicles.

“We want our children to be safe and no one wants to hurt a child,” Dr. Guzman said. “We all need to slow down close to school zones and neighborhoods. Make sure we take care of our kids.”

Elementary school children are very active and impulsive. Although they’re learning and growing, school-age children 10 and younger still need guidance and supervision when playing and walking near traffic, according to the National Highway Traffic Safety Administration.

Pedestrian tips:

1. Children less than 10 years old should not be crossing the street without an adult.  All kids are different, but developmentally until they are about 10 years old they don’t have the cognitive ability to judge the speed of an oncoming car.
2. Don’t be distracted while walking.  Stay off your phone and if you HAVE to use headphones, only use one. You have to be aware of your surroundings!
3. Look left, right and back left again before crossing the street. 
4. Only cross at the light, corner or crosswalk. Never cross the street between parked cars.
5. Walk on the sidewalk. If there isn’t a sidewalk walk FACING traffic.
6. Be alert for cars pulling into parking lots and driveways as well as cars backing up.
7. When there is a car approaching or even stopping, make eye contact with the driver and wait for them to motion for you to cross the street. Often times you may think the driver is looking at you but they may be in a “daze” and not truly see you.
8. More than 80% of pedestrians die when hit by a car going 40 mph or faster, and less than 20% die when hit at 20 mph or less. As a driver, SLOW DOWN.

School Zone tips:

1. Slow down and follow all speed limits.
2. Pay attention and look out for pedestrians.
3. Cell phone use is prohibited.
4. Obey crossing guards.
5. Stop for school buses.

Tips for Drivers:

1.  Always stop for pedestrians.
2.  Yield to pedestrians in crosswalks and stop well back from the crosswalk to give other vehicles an opportunity to see the crossing pedestrians so they can stop too.
3. Yield to pedestrians in crosswalks and stop well back from the crosswalk to give other vehicles an opportunity to see the crossing pedestrians so they can stop too.
4. Never pass vehicles stopped at a crosswalk. There may be people crossing where you can’t see.

Media partners: If you are interested in telling this story, please contact Public Relations Manager Kim Brown at Kim.Brown3@cookchildrens.org or at 682-885-1080, 817-266-3728

That’s the simple message that the folks at Cook Children’s who watch out for your kids’ safety wants you to know.

From March 14 to April 10, 2018, five children were rushed to the Emergency Department for drowning, with one resulting in death.

“There is no amount of time that it’s safe to leave your child alone in the tub,” said Magdalena Santillan, Trauma Injury Prevention specialist at Cook Children’s.

Drowning is the leading cause of unintentional injury-related death in children ages 1 to 4 years old and the second leading cause of unintentional injury related death for ages 1 to 14.

“Safety begins in the home,” said Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coalition. “Bath time is not only a good time to bond with your baby, but a dangerous time in and around water. Support safe habits with adult, not sibling, supervision.”

SafeKids Tarrant County, led by Cook Children’s, gives these facts:

• Drowning is quick and silent.
• Children can drown in as little as one inch of water.
• Irreversible brain damage occurs in as little as 4 minutes.

To protect your child from drowning in the tub:

1. Never leave your child unattended in the water.
2. Put the cell phone away. Give your child 100 percent of your attention.
3. The job of supervising a child in the pool is for adults only and not siblings. A child or even a teen should not be held responsible for supervising a child in the bathtub.
4. If you have to answer the door or the phone, take your baby out of the water and hold him or her while you do so.
5. Fill the tub only with enough water to cover the infant's legs.
6. Once the bath is over, immediately drain the tub.
7. Don't rely on bath rings or seats to keep a baby safe.
8. Store empty tubs, buckets, containers and wading pools away after use. Store them upside down and out of a child’s reach.
9. Keep doors to bathrooms and laundry rooms closed.
10. Learn CPR for infants.

Learn more at safekids.org.

Does your child wear a helmet while on a bike?

If not, statistics say you may make a visit to an Emergency Department near you very soon.

A report from Safe Kids Worldwide and Nationwide’s Make Safe Happen program found that nearly 40 percent of the 1,600 parents surveyed admitted their child doesn’t always wear a helmet while on wheels.

That’s despite the facts that more than 426,000 children – nearly 50 every hour – visited an emergency department in 2015 due to a wheeled sports-related injury.

• Serious head injuries, including concussions, internal injuries and fractures, made up 11 percent of those ED visits across the four-wheeled sports.

• Fractures to shoulder, arm, elbow, wrist or hand were the most frequent diagnosis for hospital admissions.

• 19 percent of hospital admissions for scooter injuries to children in 2015 were because of a head injury.

While head injuries are a concern, the majority of ED visits for wheeled sports in 2015 were for fractures, contusions and abrasions.

Less than 1 in 5 parents of children who scooter and less than 2 in 5 parents who kids skate said their kids always wear knee or elbow pads. Parents of children who skateboard reported less than 1 in 3 of their children always wear knee or elbow pads and less than 1 in 5 reported always wearing wrist guards.

Safe Kids says, “Between 2005 and 2015, the number of ED visits for bike- and skateboard-related injuries decreased, but visits for skate- and scooter-related injuries increased significantly. In fact, scooter-related injuries shot up by 40 percent over the 10-year period. Worryingly, the survey found that parents were least likely to make children wear a helmet while scootering at only 57 percent.”

From 2010 to 2013, less than 10 percent of patients seen at Cook Children’s for bike injuries had a helmet on and 0 percent of the patients on skates, skateboards and scooters wore a helmet.

Numbers have improved from 2015 to 2017 thanks to community education from groups like Peaks and Ladders, a collaboration between Cook Children’s, the Fort Worth Fire Department and Fort Worth Firefighter Charities.

During the past two years, 25 percent of children admitted for bike injuries wore helmets and it’s up to 10 percent now for kids on skates, skateboards and scooters.

“Those numbers are still too low, but we’ve made some progress,” said Sharon Evans, Trauma Injury Prevention coordinator at Cook Children’s. “It’s so important for kids to wear their helmets at all times. Even if they are taking a spin around their block, they need to wear a helmet. Injuries can occur anywhere, even when cars aren’t around. We’ve admitted children who have been injured in their driveways. Even little spills can result in concussions and broken bones.”

Evans said a great way to encourage helmet use is to let your child pick out the helmet and decorate it with stickers and markers to his or her liking. Then, make sure you set the example by wearing your helmet too.

Among parents who say they always wear a helmet, 86 percent say their child also does. However, among parents who say they never wear a helmet, only 38 percent say their child always does.

“With warmer weather ahead, your child will be spending more time on wheels – which means more opportunities for kids to get hurt,” Evans said. “The most important way you can teach your child to be safe is to always wear a helmet."

Safe Kids offers the following tips to help protect your child:

· Wear properly-fitted helmets, which are the best way to prevent head injuries and death, for every ride.

· Ride in safe locations like sidewalks, bike paths or bike lanes whenever possible.

· Follow the rules of the road.

· Check all equipment at the start or end of every season.

· Ride together until kids are comfortable enough to ride on their own.

For more information:

• Child Safety Center
• Bicycle Safety
• Safe Kids Worldwide

According to noheatstroke.org, 32 children have died in the U.S. as a result of being left in a car. In all of 2015, 24 kids died. 

On Sept. 21, 2016, a 7-month-old baby died in a hot car in Huntsville, Ala. The temperature was 94 degrees. The following day, a 4-month-old child died in Geronimo, Okla. The temperature at the time was 96 degrees. 

As anyone who lives in a state like Texas can attest, summer-like temperatures can occur even in winter. But it doesn’t take a scorching hot day for a child to be in danger. Heatstroke deaths have been recorded in 11 months of the year in nearly all 50 states.

“It truly doesn’t have to be a ‘hot’ day in Texas for a death to occur,” said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County coordinator. “The temperature inside a vehicle can quickly climb over 20 degrees hotter than outdoor temperature. So even a cool day in Texas can become dangerous very quickly. Since children’s body heat rises three to five times faster than adults, it’s important to know that temperatures can become deadly any time of year.

Heatstroke, also known as hyperthermia, is the leading cause of non-crash, vehicle-related deaths for children. It occurs when the body isn’t able to cool itself quickly enough and the body temperature rises to dangerous levels.

Young children are particularly at risk as their bodies heat up three to five times faster than an adult’s. When a child’s internal temperature gets to 104 degrees, major organs begin to shut down. And when that child’s temperature reaches 107 degrees, the child can die.

Because of this, and because cars heat up so quickly – 19 degrees in 10 minutes – tragedies can happen faster than you think. Symptoms can quickly progress from flushed, dry skin and vomiting to seizures, organ failure and death.

“We still have to get the word out that there’s never a safe time to leave your child in the car,” said Sharon Evans,Trauma/Injury Prevention coordinator at Cook Children’s, said. “We’ve seen children die in February. We hope people will take extra precaution in never leaving a child in the car.”

Safe Kids Worldwide says that heatstroke is the leading cause of non-crash, vehicle related deaths for children and that young children are particularly at risk as their bodies heat up three to five times faster than an adults’.

It’s hard to imagine someone forgetting a child is in the car, but human error, and people make these mistakes during their busy day-to-day lifestyle. Safe Kids recommend the “ACT” method to prevent tragedy to your child or to a child you see left in a car:

• A: Avoid heatstroke-related injury and death by never leaving your child alone in a car, not even for a minute. And make sure to keep your car locked when you’re not in it so kids don’t get in on their own.
• C: Create reminders by putting something in the back of your car next to your child such as a briefcase, a purse or a cell phone that is needed at your final destination. This is especially important if you’re not following your normal routine.
• T: Take action. If you see a child alone in a car, call 911. Emergency personnel want you to call. They are trained to respond to these situations. One call could save a life.

In 2015, five children were seen at Cook Children’s for lawn mower related injuries. Ages ranged from toddlers to teens and all five were run over by the lawn mower. Already in 2016, two kids have been involved in lawn mower accidents.

Each year approximately 10,000 children are seen with injuries caused by power mowers are treated in emergency departments across the nation.

Lawn mowing injuries can be severe, including amputations, broken and dislocated bones, burns and eye injuries.

“Lawn mower injuries are easy to stop, just don’t let children be outside if the mower is on, said Sharon Evans, Cook Children’s Trauma Injury Prevention/Outreach coordinator. “If the child is young there needs to be an adult inside the house supervising them. If the child and/or adult has to go outside there should be the rule that they signal, call or whatever to get the rider’s attention and then the rider turns off the mower as soon as possible before anyone approaches it. The rule should be the same for older children too.”

To prevent lawn mower injuries to children, the American Academy of Pediatrics recommends the following:

1. Use a mower with a control that stops the mower from moving forward if the handle is let go.
2. Children younger than 16 years should not be allowed to use ride-on mowers. Children younger than 12 years should not use walk-behind mowers.
3. Make sure that sturdy shoes (not sandals or sneakers) are worn while mowing.
4. Prevent injuries from flying objects, such as stones or toys, by picking up objects from the lawn before mowing begins. Use a collection bag for grass clippings or a plate that covers the opening where cut grass is released. Have anyone who uses a mower wear hearing and eye protection.
5. If the lawn mower is on, make sure all children are not outside and are safely inside.
6. Start and refuel mowers outdoors, not in a garage or shed. Mowers should be refueled with the motor turned off and cool.
7. Make sure that blade settings (to set the wheel height or dislodge debris) are done by an adult, with the mower off and the spark plug removed or disconnected.
8. Do not pull the mower backward or mow in reverse unless absolutely necessary, and carefully look for children behind you when you mow in reverse.
9. Always turn off the mower and wait for the blades to stop completely before removing the grass catcher, unclogging the discharge chute, or crossing gravel paths, roads, or other areas.
10. Do not allow children to ride as passengers on ride-on mowers.

Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children’s, knows that guns will be a popular gift this holiday season for not only children, but for adults too.

According to the journal Injury Prevention more than one-third of American adults own a gun. Last year, Cook Children’s saw 10 total injuries related to shootings of a gun (ranging from a BB to rifle). Since 2009, Cook Children’s has seen 104 shootings and three deaths.

Dr. Warmink asks parents to explain to children that BB guns can be dangerous, with harm ranging from severe eye damage to liver and kidney injuries.

Dr. Warmink says it’s important that parents educate their children about gun safety and make sure kids know to leave the area if another child, or someone other than their parent, has a gun.

“We live in Texas and I know many kids are raised hunting and have guns in the home,” Dr. Warmink said. “But if you give your child a gun for the holidays or if the adult in the house is given a gun, it’s important to take the proper precautions. The thing we want parents to remember is to keep guns locked, unloaded and separate from ammunition”

1. Lock the gun and keep it out of reach of kids. Hiding the gun is not enough.

2. Unload your gun. Take all ammunition out of the firearm.

3. Store the keys for the gun in a cabinet or safe different from your household keys. Keep the keys out of the reach of children.

Along with guns and replica firearms, such as airsoft guns that use hydraulics to shoot pellets, Dr. Warmink lists these gifts as dangerous and even life threatening:

• Ripstik Casterboard, Skateboards, roller skates …
• Pull toys with strings over 12 inches
• Trampolines
• Backyard playground equipment
• Hard plastic swords

Sharon Evans, Trauma/Injury Prevention coordinator at Cook Children’s, knows that owning a bike or scooter is part of growing up. But she encourages parents to take the proper precautions before placing wheeled gifts under the tree.

“Parents, please don’t forget a helmet for all riding toys,” Evans said. “Make sure the helmet is on properly and read the instructions.”

For younger children, Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coalition, warns parents to be aware of any small parts or potential choking hazards from their own toys or perhaps older siblings.

“The holidays can be an especially dangerous time for the little ones,” Walraven said. “Pick out toys and activities that will be appropriate for their age. On Christmas, designate an adult to supervise the children. It’s surprisingly easy to lose track of small children and with just a little planning we can keep choking hazards away from them. When it comes to young children, preparation is key.”

Last year, the Cook Children's Trauma team saw 22 children, either biking or walking, who were hit by cars from August through the month of October. Eight children were hit by cars in September and 10 in October. 

But with school already started, so are the dangers of kids and cars.

Already, a teen was hit in front of a high school in Crowley. The injuries seem to be minor, but it places an emphasis on how vulnerable children are near or even in front of schools.

More children are hit by cars during September than any other month of the year, according to Safe Kids Worldwide.

“Children do not have the cognitive skills to be crossing streets safely alone until at least age 10,” said Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s. “They haven’t yet developed the depth perception or the ability to maturely judge the speed of an object.”

Kids age 10 and younger should not walk or ride bicycles, scooters or skateboards alone to school because they:

• Are easily distracted by friends and toys.
• Can’t determine the direction of sounds. Some children may be listening for sounds and may not realize that some newer model electric/hybrid may not make much of a sound at all.
• Can’t judge the speed or distance of a moving vehicle.
• Don’t understand how long it takes a vehicle to stop.
• Have too narrow a field of vision.

Even when kids reach age 10, it’s still best for parents to accompany them to school whenever possible.

Teaching Your Child Pedestrian Safety

“When I visit children who have suffered pedestrian injuries, the most common thing they tell me is that they thought the driver saw them,” explained Evans. “It’s important to teach your children that just because they see a driver, it doesn’t mean the driver sees them. They need to make eye contact with the driver and wait for the driver to stop and signal to them before attempting to cross the street.”

While teaching your children to ride their bikes or walk to school, don’t forget to tell them to cross only at crosswalks; look left, right and then left again; and to watch for cars that are turning or backing up. The best way to teach your child pedestrian and bike safety is to be a good role model yourself. It’s also a good idea to encourage your children to wear bright clothing and reflectors when they’re walking before dawn or after dusk.

"It’s important for parents to remember they are the most important models of proper pedestrian behavior for children," said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County Coordinator. "Parents should also make sure they follow the rules when they are driving in school zones, including going the speed limit at all times through the zone and not texting or talking on the phone."

Safe Kids recommend teaching your kids these safe behaviors:

• Look left, right and left again before crossing the street. Cross when the street is clear, and keep looking both ways while crossing. Walk, don’t run.
• Understand and obey traffic signals and signs.
• Walk facing traffic, on sidewalks or paths, so that you can see oncoming cars. If there are no sidewalks, walk as far to the left as possible.

Practice safe behaviors:

• Don’t allow a child under age 10 to cross streets alone as he may not be able to fully appreciate the speed of cars on the road.
• Require children to carry a flashlight at night, dawn and dusk. Add retro-reflective materials to children’s clothing so that a child can be seen by motorists, even in the dark.
• Don’t let kids play in driveways, unfenced yards, streets or parking lots. Drivers may not see or anticipate children playing.

Interactive Infographic: How to not get hit by a car - Safe Kids Worldwide

With an average of 44 kids getting hit while walking every day in the U.S., it’s time for action. HOW TO NOT GET HIT BY A CAR is a fun new interactive infographic that guides walkers through seven common ways kids get hit by cars, and seven ways to avoid it. Parents and kids alike give it great reviews; not only do they think it’s fun to experience the action, they can usually relate to it. Try it out and see if you make any of the common mistakes when you cross the street.

Try the interactive infographic from Safe Kids

For more information

Whether it is the correct use of a child passenger seat, drowning prevention education in the schools, or providing a better awareness of poison hazards to new moms, we are working to create safe homes and communities for children.

• Bicycle safety
• Car safety
• Safe Kids Tarrant County
• CARE Team
• Drowning prevention
• Human trafficking
• Oral health prevention
• Poison prevention
• Sexting
• TV and furniture tip-overs

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.

• 2 deaths to begin the month of July
• 26 non-fatal drownings from June 1 to July 1, 2015
• 43 non-fatal drownings from Oct. 1, 2014 to July 1, 2015
• 4 fatal drownings during that same time frame

And now we head into the July 4^th weekend where people will be throwing pool parties at their house or apartment or going out to area lakes … and at many of those parties there will be drinking.

So what’s left to say? Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s, admits to being tired, frustrated, sad and even a little angry that no matter how much the message is delivered, kids drown.

“I feel like a broken recording at this point,” Evans said. “But I don’t know what else to do. We have to keep telling people. We have to keep getting the word out. Tell your friends. Tell your neighbors. Tell your other family members. Kids are dying.”

And then Evans collects herself to deliver the message again.

“I don’t think people know how quickly it happens,” Evans said. “It’s just seconds and it’s a silent killer. Kids died silently. You can’t just let your kids go. Water is dangerous. It scares me because now we are headed toward the July Fourth weekend.”

If nothing else, Evans wants to make sure everyone reading this gets this point.

“It can happen to you,” Evans said. “I can say it, but I don’t think people really realize it. It can happen to you. Don’t take your eyes off of your child. You have to hold on to his or her hand sometimes. The most important thing is to be there for your child. And my God, whatever you do, you can’t let your kid go swimming or to the water alone. You have to have adult supervision.”

Evans speaks strong, but you can hear the pain and heartbreak in her voice. She’s seen a lot of this in her career and twice the amount of drownings over the last month as she saw last year. And what troubles her the most is that she knows no matter how much she speaks about drowning prevention, she will see more again.

“I wish I had a better line, a better solution,” Evans said. “I don’t know what else to say. I just know it’s preventable, if we take the right precautions.”

Click to read the following information for those precautions:

• Drownings double from a year ago 
• Be a water watcher. Adult supervisions saves lives.
• Is your baby ready for swim lessons?
• Drowning tragedy - 'I can't believe this happened to me.'
• Cook Children's drowning prevention page