If you are concerned about your child, here are seven facts you need to know:

1. Monitor your child for cough, particularly if it is occurring in severe spells or they cough so hard that they vomit. The characteristic whoop of whooping cough occurs when the child is inhaling after their cough.

2. Older children and teenagers may have severe cough but usually do not have the whoop. Infants are very susceptible to pertussis and have an increased risk of hospitalization and death.

3. Be aware that the vaccination for whooping cough is not perfect. Even if your child is vaccinated, you should be on the lookout for symptoms, particularly if you live in the Grapevine-Colleyville area or know that your child has been exposed.

4. If you are concerned your child might have whooping cough, your doctor can run a test and start treatment with an appropriate antibiotic. (Even with treatment, the cough can last several weeks.)

5. Students who are diagnosed with pertussis should remain home until they have completed five days of antibiotics or until 21 days have passed since their cough started.

6. Those who live in the house of persons diagnosed with pertussis should receive treatment to prevent the infection as soon as the infection is confirmed.

7. Other close contacts (not in the house) that should receive treatment for exposure include: those at high risk for pertussis (infants and pregnant women in the third trimester), those with health conditions that put them at more risk (severe asthma or immunodeficiency), contacts of a case that have contact with a child less than 1 year of age and contacts who work in high risk settings (NICUs, childcare and maternity wards.)

If you have further questions, please contact your pediatrician.

Related articles:

• Let's Learn About Whooping Cough
• Measles, Pertussis Increase due to 'intentionally unvaccinated'
• 3 Reasons to Still Give Your Kids Whooping Cough Vaccine
• Newborns Depend On Rest of the Family To Protect Them From Whooping Cough

Ear pain can be caused by many different factors. Often kids just play with or point to their ears. If the child is otherwise cranky, sick or not sleeping well, parents will assume there is an ear infection. However, a study from 1998 showed that parents only identified 70 percent of their children with ear infections and when they suspected an ear infection, it was only present 50 percent of the time. (Translation-they could have just flipped a coin rather than trying to guess.)

This is why getting an antibiotic called in when your child has ear pain is a bad idea - whether it is from your doctor or from one of the new insurance nurse lines that many people are using. Every exposure to antibiotics is a potential risk for allergy or side effects. Unnecessary exposure is not worth it.

2. All ear infections have fever.

Studies are all over the place about what percentage of ear infections have fever. They generally fall between 1-2 out of 3. Regardless, that means a lot of kids with ear infections won’t have fever.

3. Having your child in the wind or under water causes ear infections.

The location of an ear infection is behind the ear drum way back in the inner ear. External exposure like wind and water don’t affect that area. Grandma will have to come up with another reason for their grandbaby to put on a hat when it is cold outside.

What are risk factors?

• Age (6 months-2 years)
• Family history
• Day care
• Not breastfeeding
• Smoke exposure
• Pacifier use (small effect)

4. You can’t go swimming if you have an ear infection.

Related to the previous myth, there is no reason to avoid swimming if you have an ear infection. Unless the ear drum has ruptured the space where the ear infection is located is walled off from the water. Don’t skip the swim party! If the child feels discomfort or pain while swimming, they can play in the shallow end or just have a snow-cone.

5. All ear infections need antibiotics.

Many children with ear infections will get better without antibiotic treatment. The latest treatment guidelines give the following advice for treating ear infections:

• Children of any age with severe pain, fever or ear drainage should receive antibiotics.
• Children 6 months-2 years with both ears infected should receive treatment.
• Children 6 months and up with 1 ear infected and with mild symptoms can be watched for 2-3 days to see if symptoms improve or worsen prior to starting antibiotics.

6. Amoxicillin is not strong enough for ear infections.

Many studies have looked to compare different antibiotic treatments for ear infections. The bottom line is this, there is nothing better at getting rid of infections than amoxicillin. Other antibiotics may work as well, but they are typically more broad spectrum - meaning they cover more different types of infections that those that typically cause ear infections. Because of this, we should reserve those antibiotics for those situations in which they are necessary. Amoxcillin is cheap, well tolerated by most kids and effective. Therefore, except in penicillin allergic patients, it should be used unless the child has been on the medication in the last 30 days.

7. If your child gets tubes, their ear infections are guaranteed to stop.

After a few ear infections, some parents are eager to move forward with placement of tubes. Tubes can be a life saver with kids who have had multiple ear infections and can prevent recurrence of ear infections, but they aren’t perfect. They are a surgical procedure and the inherent risk associated with anesthesia need to be fully explained to a parent. Continued ear infections occur in about 20 percent of children even after they have had tubes placed.

The AAP (American Academy of Pediatrics) and the Centers for Disease Control’s ACIP (Advisory Committee on Immunization Practices) stated, “Health care providers should not use live attenuated influenza vaccine (LAIV) in the upcoming 2016-2017 season due to poor effectiveness.”

The first thought that went through my head was this: my kids have to get the injectable flu vaccine next year AND I have to convince them that it’s a good thing. (I may be a pediatrician, but I’m still a dad.)

The committee looked at data from the last three flu seasons showing that the nasal vaccine had limited to no effectiveness for preventing flu.

Here are 4 facts you need to know:

1. Even in bad years, the flu vaccine continues to provide the best layer of protection against this deadly disease. Last year’s injectable flu vaccine was 50 percent effective in preventing disease which means thousands of people were protected.
2. Assuming there’s no new information or guidance, your pediatrician should not offer your child the nasal flu vaccine. Even if we hear something new, I would choose to do the injectable vaccine and I will do so for my kids.
3. The committee is hopeful that this early decision will help prevent any issue with the vaccine supply. However, there are flu vaccine supply issues nearly every year so I recommend getting in to get your shot early.
4. There’s a committee out there who is looking at this data and making the best recommendations possible based on the latest information. Is it frustrating that we were giving a vaccine that didn’t work? Of course. Am I glad that I won’t do it for another year? Definitely.

Stay tuned for more information about flu and flu vaccines as we get closer to September when flu vaccine supplies start arriving at your Cook Children’s pediatrician’s offices.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the fall of 2016.

Here are 4 reasons goat's milk is dangerous and could even be deadly:

1. It is usually not pasteurized which can lead to all kinds of bad infections (listeria most commonly).
2. It has more protein so baby's kidneys can't handle it well. This along with high sodium level can lead to strokes.
3. It doesn't have enough folate which can lead to anemia.
4. It doesn't have the same electrolytes which can lead to extra acids building up in the baby's body. This causes multiple downstream problems.

Breast is best. Modern formula is really, really good too.

Goat's milk is nothing to kid around with.

Watch the video below for five key facts about diarrhea that every parent needs to know in only a minute. 

In today's video, Doc Smitty explains:

1. What are the common causes?
2. How long can it last?
3. When are the symptoms more than a stomach bug?
4. When do you call your pediatrician?
5. What are the biggest risks?

Learn the answers to these questions. It only takes a minute.

When people think of homelessness, they commonly think of someone living in a park or on the street with no structure to sleep under but the effects of homelessness are felt by many in less dire circumstances. There are various classifications of homelessness which include homelessness without shelter but also include the following:

1. Homelessness with shelter - Living in a supervised private or public shelter.
2. Imminent homelessness - A chance that the primary residence will be lost in 14 days.
3. Youth/family instability

In survey data from 2012, the Cook Children’s Center for Children’s Health show than 7.5 out of 1000 kids in Tarrant and the surrounding counties had spent the night in an emergency shelter or with family/friends due to homelessness. Because of the nature of the study, my suspicion is that this number is likely understated. Despite the fact that it is more common in low socioeconomic areas, it is not restricted there. An example of this might include a child who is kicked out of the home for various reasons.

What are the effects of homelessness youth and children?

1. 97 percent have moved more than once in the last year.
2. Interrupted or ineffective school participation
3. 22 percent have been witnesses to domestic violence
4. 50 percent of homeless teenagers have depression or anxiety
5. More likely to have severe asthma, malnutrition, ear infections, exposure to toxins
6. More likely to have mental health and substance abuse issues
7. More like to engage in dangerous sexual activity leading to STDs and unintended pregnancies
8. 7 times more likely to be victims of violent crime

All of these issues can be categorized under the heading “toxic stress.” Toxic stress occurs when a child experiences strong, frequent and prolonged adversity. Studies show that these experiences can have significant effects on the development of the brain and other organs which can lead to increased risk for negative mental and physical health outcomes. These problems can persist well into the adult years, even when the stressful situations have resolved.

What can you do?

1. Be aware - One of the biggest problems with addressing homelessness is that many people are not aware that it is even an issue in their area.
2. Donate time - There are many programs available in our area where you can serve as a mentor to children in schools. Children going through toxic stress benefit greatly from having an adult who spends time with them and with whom they can process their experiences.
3. Donate financial resources - Many homeless shelters struggle to survive financially. They have a hard time providing healthy nutritional options and, certain times of year, even enough beds to house all those in need.

Learn more about homeless in Tarrant County here. 

They are not caused by holding (or kissing) frogs but, instead, are caused by viruses.

The virus that causes warts is contagious, but that does not necessarily mean that if your child touches a wart they will get one.

Warts will go away on their own without treatment (Say it with me now.). It never feels like that when it’s your own child, but I promise they will. It may take 6 months to 2 years but they will go away.

There are many strategies for taking care of warts at home. 

Over-the-counter (OTC) Meds

1. Bath or shower
2. Use an emery board to file the dead skin on the surface
3. Apply the topical wart remover
4. Cover the wart with a band-aid

Duct Tape

Place a strip (or ring if on the finger/toe) over the wart. This strategy may take weeks or months of coverage to work, but it does work (studies even show it)

Wart removal can be done, but I only recommend it for warts that are painful or in a location that makes activities (writing, etc) difficult. 

The most common types of removal are freezing and laser therapy.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Sweat was dripping off my shirt and I could not escape that feeling of needing to throw up, almost wishing I could, but not actually vomiting. It doesn’t sound all that inviting, but I was really interested in coming back the next day to try it all again.

Why?

Because my nurses had invited me.

Because they were getting up for their 6 a.m. boot camp every morning.

Because they were loving every minute of it and sticking with something to better their health (despite the fact that the schedule was crazy and the workouts demanding).

I would think that most people do not want to get up and work out at 6 a.m. (I think there was even a 5 a.m.class but…I’m not that crazy!). Those that do love it, could probably get up and work out on their own by running or lifting weights by themselves.

Why are programs like boot camps and Crossfit so successful?

I believe it is because of one main reason: they are SOCIAL CLUBS.

(Wait Crossfitters, don’t get mad yet.)

I certainly don’t mean that the people going to these workouts are sitting around drinking coffee and chatting. I’ve done a few of each type of workouts and I can guarantee they are working hard.

What is a social club?

1. People gathering around a common interest.
2. People attending to better themselves or increase their knowledge.
3. People encouraging one another.

People who gather together and workout get many benefits besides simply getting their workout in. They are motivated to show up because they provide accountability. “Where were you this morning?” They are encouraged to continue working even when things are hard. “Come on, just one more, you can do it.”

Unfortunately, there are not as many opportunities for our teens to have this type of experience, which is why I am advocating that we bring this mindset into our homes.

Here are some comments I frequently hear during my teenager visits:

“I try to get them outside but they just don’t want to.”

“All they want to do is sit around and watch TV.”

Yep, that’s right, that may be all they want to do. That is probably all they will do unless you make exercise social for them.

One of the major contributors to children’s physical activity is whether their friends are active. Friendships are often centered around shared goals or activities. If those shared interests are active, it is more likely that your child will be active. If those shared interest are passive, getting your child to be active may be more difficult. A study from 2012 in Pediatrics showed that even children as young as 5-12 years would increase their physical activity by 10 percent to match their friends.

But, it’s not just friends that influence your child’s activity level. Parents' activity level, but more importantly their encouragement, also have big effects on their child’s activity levels.

Here are some ways you could possibly make this work for you teenager:

1. Find a common activity the whole family enjoys- Maybe it’s just getting out and kicking a soccer ball around or playing catch. Maybe it’s something more intense, it doesn’t matter just do something together.
2. Set a family goal- Make it a goal to do something physical as a family 6 days a week. If you accomplish that goal, have a family cheat day where you get to watch a movie and have a special treat (or whatever reward would motivate your kids).
3. Run a 5K as a family- Set a goal to run a 5K sometime in the next 3 months. Find the race, sign up and start trying. There are plenty of Apps and online programs you can use to help work your way up to the distance. There is no goal for time or speed, just that everyone finishes.

I’ve made a decision that I’m no longer able to accept this:

“They just won’t get out and exercise.”

Without this:

“Are you getting up to do it too?”

One of the biggest stories centers around the suspension of Luis Suarez for biting an Italian defender.  It’s not the first time he has done it either.

I usually tell families that their kids will outgrow this problem, but I guess if you’re a world-class soccer player, that’s not always true.

What do we do when our child is the biter?

First off, this happens ALL THE TIME…

Your child is not the first child who has bitten and won’t be the last so let’s be calm.

There’s really just a few things you can and need to do in these situations …

When the bite has already happened

Separate biter and the bitten child.  This helps the “victim” feel safer and diffuses whatever frustration caused the biting in the first place.

Try to talk it out.  Often you are dealing with a pre-verbal child, but it is still important to try and talk about the situation that led up to the biting.  Usually the child who bit is just as scared as the child who was bitten.  You are typically dealing with young toddlers with limited verbal skills, but talking with them about their frustration/anger that led up to the biting can help them understand that there is a better way to express these emotions.

Preventing the Problem

The ultimate goal in helping with biting is to prevent the situation that leads to biting in the first place.  The key to this is: distraction, distraction and distraction.  Keep the frequent biters from their trigger situations or be prepared to intervene quickly before the frustration levels begin to rise.

Or, Just Bite Them Back

Of course, everyone has had a family member or someone tell them that this is the best way to get a biter to stop and while it may have worked for them in the past, I feel that this strategy is simply modeling the behavior you are trying to extinguish.  Toddlers learn best through seeing their parents’ actions and having your parent bite you only makes you think that is appropriate behavior.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his three young children, exercising, reading and writing about parenting and pediatric health issues.He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

I hope everyone had a great Father’s Day. I'm sure there were no fights between fathers and their teenage children.

Maybe, you had barbecue and ugly ties mixed with good feelings and love all around. But now back to reality.

Because of that, you can consider this a post for all the other weeks of the year when there might be more "disagreements" between fathers and teenagers. Most of you might be able to file this away under the Common Sense tab of your brain but I think it is a good reminder.

What is the best way for a teenager to resolve a fight with his/her dad?

Find someone else to support them through dealing with the conflict in a healthy way.

Jeff Cookston from San Francisco State University studied almost 400 families asking them questions about how they handled father-child conflict. He released a study in the March edition of the Journal of Research on Adolescence.  

The most common people that teenagers talked to were mothers, then friends and occasionally a stepfather or father (if conflict is with stepdad).

The study compared two positive ways the support person could discuss the problem with the teenager: giving an explanation for dad's behavior and assigning responsibility for the conflict.

So, to make the adolescent happy, just take his or her side and assign all the blame to the father, right? Actually, you may be surprised to learn that’s not true.

In fact, a real discussion about the reasons for dad's opinion and a fair assessment of the responsibility of the conflict left children feeling better about themselves and their fathers in the long run.

So, how does this play out in a real life situation?

Conflict #1:

"But, dad, I really want to go to this party and it won't even get started going strong until 11!"

"Sorry, it's just not going to happen this week."

Bad support:

"That's just how your dad is, he's always been overprotective."

Good support:

"I'm sure your dad is just concerned about you being safe and remember what happened the last time you went to a party and came home hours after your curfew."

Conflict #2:

“But, dad you can’t take away my Xbox!”

Bad support: 

“He’s just being dumb.  You can always play after he goes to bed.  I’ll try to convince him to give it back.”

Good support:

“I think he’s concerned because we’ve noticed that your grades have been dropping and you are having a hard time getting out of bed in the morning.  Maybe if you show him that you can show more responsibility, we can talk about getting it back.”

Give the father in your life the best gift you can give them this year, support your teenager in a way that helps them feel better about themselves and their Dad. (The ugly ties can wait until next year.)

Stop screaming in the car!

That's enough!

Just stop!

I'm the “out-of-home” worker in our family, while my wife is able to do her job mainly from the house. Therefore, I usually have:

1. brief periods of time alone with the 3 kids.
2. time at home when the duties are shared between my wife and me.

Because of Mother's Day Weekend, I got to spend more time alone with the 3 littles this weekend (all under 5).

As the weekend wore on, there were more moments of frustration.  I'd like to think they were just particularly crazy this weekend but I'm sure that would just be lying to myself and trying to justify my frustration.

Finally, on the way to get some tortillas for dinner Sunday night, after repeated attempts to get my kids in the car, listening to them scream at each other and seeing my 3 year old more or less punch my 5 year old in the face....

"Stop screaming in the car!

That's enough!

Just stop!"

I didn't REALLY yell at them. They weren't physically threatened. But, there were three pair of scared eyes looking back at me in the rear-view mirror.

Fortunately, a week before, I'd listened to Michael Hyatt's Podcast: 4 Difficult Sentences for Leaders.

In it, he outlines a four-sentence method for apologizing:

Sentence #1: I am sorry.

Sentence #2: I know that hurt.

Sentence #3: I was wrong.

Sentence #4: Will you please forgive me?

He also reminds us to avoid using terms like if and but...

So, I had the 5 minute drive home to think about it. The kids were quiet by now. They had either forgotten about it, they were too terrified to speak or Thomas the Tank Engine^™ just got much more interesting.

But when we got home, here's how it went:

"Guys, I'm sorry I yelled at you. I know that was scary. I should not have done that. Will you please forgive me?"

Some tips:

1. Apologize specifically for what you did, recognize how they felt, apologize again and ask forgiveness.
2. Don't use ifs or buts.  It was very tempting to say, "I'm sorry I yelled at you guys, but you should have come quicker and you shouldn't have been screaming and you shouldn't..."  But, then I'm not truly acknowledging the fact that I shouldn't have raised my voice.

There has been talk in the media and blogging world lately about how forcing your kids to apologize doesn’t actually teach them to apologize. I’ve seen this to be true in my family, they barely get the “I’m sorry” out before they are running off to do something else and very likely to come back and do the same thing two minutes later.

However, there are many reasons to apologize to your kids. First, modeling that one should apologize when they are wrong is a better method of teaching your children the power of apology. Another benefit is what it does for you. After apologizing, I was back in the right frame of mind to go back inside and parent more positively and with more patience rather than continuing to be angry and letting my kids suffer the ongoing consequences. It sure didn’t hurt that I heard this in return:  

5 yo: Of course, we forgive you.

3 yo: Yeah, we wuv you dad.

Almost 2 yo: Go, go; pway, pway; hungy!!

Well, 2 out of 3 isn't so bad.

"My mom used to say, 'When God closes a door, He always opens a window.' I have found that to be true many times in my life. My life as a pediatrician is a result of crawling through an open window when the door I thought I was supposed to walk through was closed to me."

Jason Terk, M.D., Keller, Keller Parkway

"Florinda Peak, the most amazing Mommy in the world, to 5 year old Dr Sandra Peak who did not want to practice reading… 'You have to learn how to read…because when you do the whole world opens up to you!'”

Sandra Peak, M.D., Lewisville

"The best advice my mother ever gave me was to give to others without expecting anything in return. (She also told me to never go outside with wet hair because I’d catch a cold, but medical school later disproved that. Sorry mom.)"

Diane Arnaout, M.D., Willow Park

"The best advice my mother ever gave me was, “never miss the chance to use a perfectly good bathroom” when you are out of the house."

Audrey Rogers, M.D., Fort Worth, Forest Park

Nicole Wineriter, M.D., Keller, HeritageTrace

"My mom told me to respect (be nice) to the nurses because they can either make or break your day."

Samuel Sheng, M.D., Arlington Neighborhood Clinic

"Encourage others. She always wrote notes to people for accomplishments, during sad times and just because."

Justin Smith, M.D., Lewisville

And finally, our favorite advice ...

"Marry Joan."

Tom Rogers, M.D., Forest Park. Dr. Rogers and his wife Joan have been married 59 years and today, she is a proud mother. "Joan worked to pay my way through medical school, gave me two great kids who are both pediatricians, and has allowed me to work without having to pay attention to small things like finances, maintenance of our house and yardwork. I couldn't be where I am today without her," Dr. Rogers said.

Happy Mother's Day from all of us at Cook Children's ...