Jamye Coffman, M.D., medical director of the Child Advocacy Resource and Evaluation (CARE) Team at Cook Children’s, says if we don’t talk about the issue, change won’t ever occur.

“Children are dependent on adults so it’s up to us to make sure they are protected and taken care of, regardless if they are our children or not,” Dr. Coffman said.

Today, we discussed abuse and neglect with Dr. Coffman to learn more about the types of abuse our children face and what we can do about it.

What are the types of services the CARE team provides?

The CARE team is made up of board-certified pediatricians and advanced practice nurses trained in the treatment of child abuse. Our team is involved in providing assessments, education and medical evaluations of the child.

What are the different types of abuse seen at Cook Children’s?

I think when people hear  the word "abuse" they think of sexual or physical abuse. But we also see kids for neglect.

Would you mind explaining neglect a little more to us?

The most common form of child maltreatment is neglect. We see different types of neglect, which is defined as a failure to provide adequate food, clothing and shelter. Children who are neglected are often underweight and/or unkempt. They may beg for food or eat out of a trashcan at school, or they may be dirty, have dirty clothes and have a bad odor. For infants, underweight or malnourished, unbathed and dirty or severe diaper rash can all be signs of neglect.

What is the impact that neglect can have on a child?

Neglect, especially in children under the age of 3, can cause the same long-term chronic health problems as being physically or sexually abused.

Primarily for younger children, babies, we see a lot of failure to thrive cases. Usually, these are kids under 2 or 3 years of age, who can’t get food for themselves. It may be because the parents are impaired with substances and are not paying attention to the needs of a child most of us take for granted like feeding the child or changing his or her diapers.

When the child gets older, we see school-aged kids who appear to be malnourished. The only meals they are getting are at school and they get breakfast and lunch. But during the weekends or summer when school is out, these kids are looking in the trash outside for food.

Another form of neglect is parents simply not watching their kids. That’s where we see bathtub drownings or a child left alone in a car.

Sometimes it’s about knowledge and awareness. It doesn’t always mean a criminal act. Sometimes the parents need to be educated and learn they can’t leave their child alone in the tub or in a car for even a short period of time.

What can the public watch for when it comes to child abuse and neglect?

For neglect, people should watch for a child who is extremely underweight or malnourished. They may beg for food or always have dirty clothes or a bad odor.

Any bruise on an infant is concerning because they are not mobile enough to bruise themselves, so if a bruise occurs it’s more than likely that someone else had to have had a part in it. Any unexplained injury of a young child. Infants under 6 months of age should not have bruises.

For older children, the concerning bruises are ear bruises, bruises on the padded parts of the body or the cheeks, and anything from the hips to the shoulders, on any side of the body (excluding the hip bone). If the child has bruises on the bony prominences such as forearms, shins, elbows, knees, forehead, nose or chin, those could all come from normal play that the child engages in and are not as concerning.

Other things to be looking for are pattern bruises anywhere on the body, which means anything that looks like an object such as a belt, switch or spoon. Similar to this are burns. If there is an emersion type burn on a child as if they had put a whole body part into hot water, that is also concerning. This is different from an accidental burn. Those types of burns, such as pulling a pot of hot water off the stove, would have a splash pattern from all the places the water went, whereas an emersion burn has a distinct pattern that usually looks like a glove or sock pattern. This means that their body was placed into hot water and was forced to stay there long enough for severe burns to form.

Sexual abuse can be difficult to detect because it doesn’t have many specific symptoms or behaviors. Some physical signs of sexual abuse, however, could include trauma or damage to the genital or anal areas, sexually transmitted diseases, or pregnancy.

Children may act out with sexual or inappropriate behavior that is beyond their expected developmental knowledge. This may indicate the child has witnessed or experienced the sexual behavior.

If someone does suspect a child is abused or neglected, how should they go about reporting the situation?

You should call the Texas Department of Family and Protective Services at 1-800-252-5400. If the child is in immediate danger, call 911.

I know it’s difficult to be involved. But these children are at increased risk of long-term poor health and early death. It’s our moral responsibility to act now and put our children first and get involved.

It’s also important to do what you can before things escalate. We have to watch out for one another. If you know someone, whether it’s a family member or close friend, offer to be a resource for them.

Step in and offer to babysit if you see a parent is struggling.

That doesn’t mean you don’t call if you see abuse though.

We all have to work together to do better and care enough to work together to improve the future of our children.

Cook Children’s has brought in visiting dogs for decades as a way to help patients and their families cope with their situations, but it was one of the first hospitals nationwide to realize the value in having dogs as badge-yielding staff members.

“People wouldn’t have pets the way they do and treat them like family members if there wasn’t something to that,” said Facility Dog Program Coordinator Kizzy Marco.

Just over three years ago, Ralph and Chanel became the first dogs to join Sit...Stay....PLAY, the facility dog program at Cook Children's.

“We are pioneering something really new,” said Marco. “The majority of hospitals in the country have animal-assisted therapy or dogs that visit routinely and that’s wonderful, but having them here as residents and as employees makes such a difference.”

As facility dog program coordinator, a large portion of Marco’s job involves handling Ralph, answering referrals and working one-on-one with patients and their families.

“I feel like people moved mountains to make these dogs available for our patients and families,” said Marco. “I’ve always loved working at Cook Children’s, but that was the moment I realized how much this place cares, probably beyond words, about the emotional well-being of its patients. Of course health care exists to take care of people physically, but we also have a responsibility to take care of people emotionally and these dogs are doing that.”

When Ralph comes in contact with a patient, the atmosphere changes immediately.

“I’ve seen kids at their very sickest,” said Marco. “I’ve seen kids at the end of their lives light up to see Ralph.”

Stephanie Myers witnessed the power of dog therapy first-hand when her 4-year-old daughter Baylee was introduced to Ralph after being diagnosed with stage 4 neuroblastoma.

“She hadn’t walked or gotten out of bed in about a week,” said Myers. “Kizzy brought Ralph in and I saw a light in Baylee’s eyes I hadn’t seen in a while. She instantly wanted to sit up and then stand so she could pet him.”

Ralph brought normalcy and softness to the situation with Baylee, as he does with so many others.

“Anytime Baylee has needed a little push, Ralph has been there to guide her through it,” said Myers. “He is such an amazing therapy dog and has given our daughter strength and a smile when we thought she might be out.”

“What our dogs do for patients is deep. A patient once vulnerably told me that he loved Ralph because he knew Ralph would never judge him. That says it all right there,” said Marco.

Because of the large number of both inpatient and outpatient cases, therapy dogs are not able to sit on every child’s bed or walk the halls with them or get ready for surgery with them.

However, many patients, families and staff members get the experience of seeing one of the dogs in passing walking down the hallway or in the cafeteria, which Marco considers a therapeutic encounter.

“You don’t know what people are carrying emotionally when they’re walking through the hallways,” said Marco, “so adding this goofy, smiling, prancing, fluffy, handsome Golden Retriever to the environment is so important. If you never knew a single patient story, if you never knew how much of an impact these dogs make, just knowing that is huge.”

When Ralph does have the opportunity to work one-on-one with a patient, they form a bond so strong that every child thinks Ralph is their best friend. When they see him and start calling his name, his tail starts to wag, he squints his eyes and starts shaking around with excitement.

“It’s almost like he remembers every kid he’s ever met,” said Marco.

While the dogs are a friendly face for children at the medical center, they really do serve an important role in the physical and emotional well-being of these patients.

Whether giving a dog a syringe of water mixed with juice to get a child to take medicine or taking him for a walk to get kids up and moving, these animals are trained to relate to the patients and their difficult experiences in a way that normalizes their environment and gives them something else to focus on.

Using dogs as a means of reducing anxiety in patients is especially true for Child Advocacy Resources and Evaluation (CARE) Team, which assesses cases of child abuse.

“When you’re talking about abuse and really difficult subjects with these kids, having a dog there can really ease their anxiety and help them voice what happened to them,” said Jamye Coffman, M.D., a child abuse pediatrician at Cook Children’s. “When you reduce the anxiety in a child, it reduces all the stress hormones so you don’t have any of the effects of stress on the child that can contribute to illness.”

Dr. Coffman has handled Kitty since she came to Cook Children’s nearly a year and a-half ago. Kitty stays with the CARE Team and is trained to jump up on the couch with patients when they are being interviewed to help relax them and their parents, making the environment feel less like a doctor’s office and more like a home.

But there is also an art to the things that dogs can do innately, the things that cannot be taught.

Not long after Marco and Ralph began working as a team, they were asked to visit a patient with a severe developmental delay. Marco was admittedly nervous because this patient was unpredictable in her movements and she was not sure how Ralph would react.

Without hesitation, Ralph walked up to the patient, looked her in the eyes and put his head on her lap while he sat there and let her do whatever she wanted.

“That’s the true gift of our dogs is that they don’t see any differences,” said Marco. “We know patients whose illness or treatments make them look or behave in a certain way. We know the ones that have especially great challenges, and hopefully it doesn’t alter how we interact with them, but Ralph doesn’t even know those things.”

For that child and her family, interacting with Ralph was a completely normal experience and there was nothing atypical about the situation.

“That’s an innate art that is something that we as a health system found a way to provide. It had never been provided to our patients and their families before,” said Marco. “It is very humbling to know that our dogs can make moments like that happen for families.”

It's important to remember that Ralph is only one dog out of five at Cook Children’s, making up only one-fifth of the program. Our most recent addition is a 2 year old Golden named Lulu who started working in inpatient psychiatry and partial hospitalization program just about a month ago.

Every day these dogs have encounters like this one, and every day they are doing something to make the hospital a better place for patients and their families.

The impact that these dogs have made and the moments they have shared with people in the time they have been at Cook Children’s is remarkable.

“It is profound that they know and have the ability to mourn with people who are mourning, to celebrate with people who are celebrating and to play with people who are playing,” said Marco. “I think there is a bond or intuition that connects them to people exactly where they are, and to watch that is amazing."

How to Help

The generosity of donors helps make it possible for Cook Children's to bring programs like Sit ... Stay ... PLAY to our patients. To support our dog therapy program and other programs like it, please call 682-885-4105 or donate online by clicking here. Learn more about Sit ... Stay ... PLAY by clicking here.

A recent study in the Journal of Pediatrics found that the teenage moms who participated are aware about sleep-safe habit recommendations, but ignore what they were told.

The most common reason given for co-sleeping was that “babies sleep better and were safest in bed with them.”

“We see this a lot with teenagers and risk taking behaviors,” said Jamye Coffman, M.D., a child abuse pediatrician and medical director for Cook Children’s Advocacy Resource and Evaluation (CARE) Team. “Their frontal lobes aren’t fully developed and they don’t think the bad outcome will happen to them. It is difficult for them to fully understand the potential consequences of their actions.”

Many investigations have tried to pinpoint the reasons why apparently healthy babies die during sleep, but one cause may be the increase in adults sleeping in the same bed with their.

In almost 200 years of research, no single cause of sudden unexpected infant death (SUID) has been found. It is now thought that there are a number of possible reasons why apparently healthy babies die unexpectedly. SUID is now broken into two categories:

• SIDS where a cause of death isn’t identified after a thorough investigation.
• Accidental suffocation and strangulation.

Of the two types of SUID, accidental suffocation and strangulation is the most common and most preventable cause of sudden unexpected infant death. In rare true SIDS deaths, about 25 percent of deaths are due to a heart rhythm defect, 5 percent are due to metabolic problems, and the rest are due to a combination of factors that likely includes an abnormality in the brain’s breathing center.

Here are the recommended ways to reduce the risk of SUID:

1. Babies should sleep flat on their back for every sleep time.
2. Babies should have their own sleep surface with a firm mattress and tight fitting sheet.
3. Room-share without bed-sharing.
4. Breastfeed exclusively for 6 months.
5. Offer a pacifier at every sleep time.
6. Keep blankets, pillows, bumpers, stuffed animals, mobiles, monitors and other humans or animals out of a baby’s sleep environment
7. Do not use infant positioners such as wedges or pillows. These items are a suffocation hazard and they make reflux worse.
8. Baby should sleep in a footed onesie or sleep sack.
9. Swaddling is not necessary and could be harmful. If you must swaddle, make sure you completely stop before your baby is 8 weeks old.

Jamye Coffman, M.D., a child abuse pediatrician and medical director for Cook Children’s Advocacy Resource and Evaluation (CARE) Team, advises parents to monitor their nanny or babysitter at all times.

“I would set up cameras in my home,” Dr. Coffman said “We’ve had nanny cam videos brought to us and we’ve seen what can happen when the nanny or babysitter gets frustrated. They many not leave physical injuries or bruises, but we’ve seen some awful and abusive behavior that would not have been discovered without the cameras.”

The nanny, who has pleaded not guilty, is charged with trying to smother a baby boy in her care. Police say they have video from a hidden nanny cam of Moriah Gonzales, 20 years old, pressing her hands against the 3 month old untl he went limp. She has been charged with felony child abuse likely to cause great bodily harm.

So how do you avoid this kind of thing happening to you? Dr. Coffman says parents should start with research.

The Texas Department of Family and Protective Services provides a list of licensed child care centers and licensed or registered child care homes.Learn more about reporting abuse by clicking here. The Texas Abuse Hotline number is 1-800-252-5400.

Once you’ve selected the child care for you, Dr. Coffman says go visit it yourself. Also, make sure two adults are in the room with the children at all times. Ask about the visitation policy. If parents are discouraged to check in, find another place for your child’s care.

And most importantly, Dr. Coffman says to trust your gut.

“Even if you do all the research sometimes an incident hasn’t been reported and may have occurred,” Dr. Coffman said. “If you think something is off about where your child is being cared for, you don’t want to risk sending him or her back until something does happen. If you have that gut instinct, look for another day care.”

If you take your child to an in-home day care provider or you have a nanny at your home, similar rules apply. Dr. Coffman says she always prefers two sets of adult eyes on the child, but if that’s not possible, make frequent drop in visits. Any day care operator should welcome the opportunity for you to check in on your own child.

Click the following link for more information: Did you know only 7 percent of licensed child programs in Tarrant County considered quality? Click to read more.

The problem is these apps simply aren’t for children under any circumstance and can lead to tragic consequences.

On Feb. 11, a 44-year-old Arlington man was arrested of sexually assaulting four students in the Keller ISD.

Reports say the man met the girls through a website called Seeking/Arrangement.com. Other sites parents should be concerned about include Grindr, Tinder and KIK.

“The problem with these message apps is that it’s really hard to find the perpetrators after they use them,” said Jamye Coffman, M.D., pediatrician and medical director for Cook Children’s Advocacy Resource and Evaluation. “That information is difficult to find. So it can be very anonymous. It’s very dangerous for teenagers because they don’t really know who is on the other side.”

With the GPS devices on the apps of these sites, your teenage kid could give a complete stranger the location of your home. They may come into mom and dad’s home without you even knowing it. 

Coffman said that the reason for the bad judgment can be directly related to basic science.

“Teenagers and younger-aged children just aren’t able from a developmental standpoint to really grasp the consequences of what they are doing,” Coffman said. “Their frontal lobe of their brain hasn’t finished developing. Their impulse control is not very good. It’s up to the parents to know what their kids are up to. They have to know what’s on their child’s phone. Parents need to look at their phones and see what apps they’re using and talk to them about it.”

And with kids becoming more tech savvy in elementary school, the need for conversations about predators and sex must begin at an earlier age than ever before.

“The goal is to get them to adulthood, right? Where they can learn and make their own decisions,” Coffman said. “They do have to have natural consequences. That’s the only way they are going to learn. So you do have to let them have some consequences but you don’t want it to be something that’s either life threatening or life altering. As a parent, you can’t allow that to happen. It’s hard as a parent to talk to your kid about sex and the dangers out there. It’s really hard to have those open, non-judgmental conversations. It may be your pediatrician, if you aren’t able to have that conversation. But someone has to talk to them. It’s too important to just ignore the issues facing our kids these days.”

Parents, want to keep your children away from predators? Then be a snoop.

That’s the advice of Dr. Coffman, who is not just talking as an expert in caring for and knowing the signs of abused children, she’s speaking as a mom.

“Parents need to be nosy,” Coffman said. “Your kids may say, ‘It’s my phone.” But you’re paying for it. It’s what I used to tell my kids growing up. If you live in my home, there is no supposition that you are going to have privacy. There is no privacy if I’m paying your bills. I have the right to go in your room. I have the right to look at your phone. I have the right to look in your backpack. I have the right to look in your mattress and in the ceiling tiles and anywhere else you might hide stuff because it’s my house. I think parents are hesitant to take that role. They are so conflicted in what’s Ok and what’s not Ok for their child’s privacy. It’s just a concern for safety. If it’s something that’s a safety issue, you have a right to know.”

Jody Hawkins, Information Security Officer at Cook Children’s, seconds Dr. Coffman’s sentiments regarding privacy of children. In presentations that he gives to parents, Hawkins cautions parents to lay down the rule early.

“This is my phone, on my plan, and I pay the bills,” he said. “If you do not follow my rules, then I stop paying for the phone you are borrowing from me. If I stop paying, the phone stops working. It’s as simple as that.

Hawkins encourages spyware to be installed on children’s phones by the parents. He asks parents, “Would you allow your child to take a stranger into the bathroom, lock the door and have no worries? They usually answer, ‘No.’ I then tell them that if they allow the child to take the phone into the bathroom with no monitoring, they could very well be doing it all the time.”

It’s the world we live in today. If you want to protect your children parents, be a snoop.

The Texas Education Agency (TEA) reported 188 cases of suspected teacher misconduct in 2015, causing state lawmakers to launch an investigation into what can be done to curb this alarming trend. An investigation by the TEA shows 19 of those teachers were cleared of wrongdoing. Still, the TEA says reports of student-teacher relations are up 53 percent over the past seven years. One website claims Texas leads the nation as far as sheer number of student-teacher relationship cases.

This has raised concern and placed a greater emphasis on the training of school employees. Another point of emphasis is the amount of teacher-student social media contact.

But what about at home? What do your kids think about this issue?

After all, TV shows like Pretty Little Liars, which features an affair between a student and teacher, seem to normalize the issue.

With so many mixed messages, how do you talk to your own children about this issue?

“I think the conversation begins with a general one about healthy relationships,” said Jamye Coffman, M.D., medical director of the Center for Prevention of Child Maltreatment and CARE Team at Cook Children’s. “If a relationship is very unequal, such as a big difference in maturity such as a minor with an adult or one partner has a position of authority over the other, it’s not a healthy relationship. Also, there needs to be a discussion about the law. This is wrong and the adult, will be prosecuted (not persecuted) and most likely face jail time.”

As a parent herself, Dr. Coffman says parents should be concerned if a teacher or coach is paying excessive attention to a child, is spending time with the child outside of professional responsibilities or gives the child a gift.

Dr. Coffman also says it makes no difference if the perpetrator is male or female. She says there’s still the same emotional/maturity and power inequalities involved.

“It usually starts with flirtation and gradually progresses to sexual intercourse,” Dr. Coffman said. “It’s important to remember, even as teens, they are children. Their frontal lobes haven’t developed where they can think all this through so they may not really appreciate the consequences. Really, they are being taken advantage of by older people.”

So what can parents do? Follow these tips:

1. Be your child’s advocate. A parent or coach shouldn’t want to spend time with your child. Decline any gifts. At no time, should a child have a slumber party with an adult.
2. Establish your home as a no-secret house.
3. Don’t tell a child he or she misinterpreted a behavior.
4. Don’t question any further if you think something is wrong.
5. Report any concerns to CPS or law enforcement.
6. Do not confront the perpetrator. Let the authorities do this.

Photo from Pretty Little Liars Facebook page.

For more information

Child maltreatment, sometimes referred to as child abuse and neglect, includes all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child's health, development or dignity. Within this broad definition, five subtypes can be distinguished - physical abuse; sexual abuse; neglect and negligent treatment; emotional abuse; and exploitation. Read more at the child maltreatment prevention resource page. 

Irving Police said the boy admitted to choking to death his ex-girlfriend, but his unsolicited confession came before he had his rights read to him.

Although the story is sad and shocking to us, it’s all too common.

When it comes to relationships, teens are the most common age group to experience dating violence, and dating inexperience is often to blame.

“Many teens in danger don’t realize their relationships are unhealthy or that certain behaviors are inappropriate,” said Jamye Coffman, M.D., medical director of the Cook Children’s CARE (Child Advocacy Resource and Evaluation) team. “Abuse doesn’t always involve physical assault, and many inexperienced teens and young adults view threats jealousy and controlling behaviors as signs of love.”

An estimated one in three teenagers is in an abusive relationship.

Because abuse is common in teenage relationships, it’s important for parents to talk with their children about the signs of abuse and the components of a healthy relationship before teens start dating. Parents should also model respectful behaviors in their own relationships.

“Explain that partners should respect and support one another and maintain safe boundaries,” Coffman said. “If you are worried, you can say, ‘I’m concerned about our current relationship, and I want to make sure this is a healthy one for you.’ By maintaining a healthy, respectful relationship with your teenager, you can keep communication open.”

Unfortunately, many of these relationships by teens are carried over into adulthood.

If teenagers are in an abusive relationship and want to break up, support from family and friend is essential. According to Dr. Coffman, teenagers should always carry a cell phone so they can call for help if necessary. They should also never end an abusive relationship when they are alone.

If teens attend school with their significant other, the school needs to be aware of the situation to prevent retaliation from occurring during the school day.

“The break-up period is the most dangerous time for abuse to occur or escalate,” Dr. Coffman said. “Parents need to help their children develop a plan, which should include ways to maintain safety. It’s also important for parents to recognize that girls are not the only ones at risk for abuse, and abuse doesn’t only happen in heterosexual relationships.”

Identifying Abuse

The following signs indicate teenagers may be in unhealthy relationships:

• Checking their significant other’s email, text messages or voicemail without permission.
• Jealousy.
• Mood swings.
• Offhand comments intended to degrade or put down, which are often written off as joking or teasing.
• Withdrawal from friends, family and favorite activities.
• Unexplained bruises or physical injuries.

The best thing a friend can do is help a woman suffering from domestic violence to connect with people who can get her out of her situation so she can develop a safe plan to reclaim her life. If you are in the Fort Worth area, contact One Safe Place to learn more about domestic violence, support victims, or to receive help. Nationally, call the National Domestic Violence hotline at 1-800-SAFE (7233).

But it doesn’t make her any less infuriated by the actions of an adult taking away the innocence of a child. Dr. Coffman said parents need to take certain steps to teach their children how to protect themselves:

1. Educate your children. Most importantly, educate your children about the dangers of predators. “The main thing is to educate your child and let them know what is not appropriate. What’s not OK,” Coffman said. “For children, young adults reading this, it’s not OK to be touched inappropriately. I don’t care who it is. Mom. Dad. Grandma. Grandpa. A family friend. A pastor. A police. A coach. It doesn’t matter who the authority figure is. If you are being abused, tell a trusted adult. If they don’t believe you or do something about it, keep telling an adult until someone does something.”
2. Start at a young age, making children aware of what is and what isn’t inappropriate touching. Dr. Coffman said at around 2 or 3 years old parents can use certain teaching moments to inform children on inappropriate touching. “When you are bathing your child that’s a good opportunity,” she said. “Make sure to name their body parts. I don’t care what you call it, just make sure your children know what their privates are called. During a bath or while they are using the potty, use that opportunity to teach them the difference between caregivers performing necessary child care during bathing or toileting and inappropriate touches. Let children know if someone else makes them feel funny or uncomfortable by touching them, to let you know.”
3. Let your children know it’s OK to talk to you. Generally speaking, Dr. Coffman said pedophiles don’t usually start out being extremely aggressive. They usually start with more generic touching and gaining the child’s trust. Dr. Coffman said that’s why it is extremely important to let your children know that they need to be able to come to you, as a parent, and let you know of anything that’s inappropriate. They also need to be assured that they will not get in trouble if they tell you they are uncomfortable about anything.
4. Communicate and report abuse. Let your child know to tell someone. Just letting someone know and reporting the crime can prevent a whole lot of tragedy.