Collin County Health Care Services has issued a health alert due to an increase in chickenpox (varicella) across the county. Chickenpox is an infection caused by varicella-zoster virus, leading to a fever and an itchy rash with spots all over the body.

Because it is highly contagious, chickenpox is a reportable condition in Texas and must be disclosed to the local health department. According to health officials, schools and childcare settings are high-risk environments for outbreaks. Prompt identification and exclusion of cases are critical to limiting transmission.

While chickenpox used to be a common illness in the United States, it has become much rarer due to the chickenpox vaccine which helps prevent the infection.

Cook Children’s Health Care System doctors know parents and caregivers may have questions about this, Laura Romano, D.O., a hospitalist at Cook Children’s and mom herself, addresses some concerns.

• I got chickenpox as a kid. Should I be concerned if my little one gets it?
  • One infection with chicken pox should give you lifelong immunity.
• How effective is the varicella vaccine?
  • Two doses give up to 98% protection and have decreased hospitalizations and death by over 97% since 1995!
• What if my little one only had one dose. What does that mean for them?
  • If your child has already had one dose of the chicken pox vaccine, they will most likely not need another one if they get an actual infection. Please talk with your pediatrician about this.
• What happens if someone is immunocompromised and is around someone who has varicella?
  • The most common complication is a skin infection caused by scratching at the lesions, which may require antibiotics to help treat. Other more serious complications include pneumonia, ataxia (difficulty walking), dehydration, or encephalitis (swelling of the brain). People who also have chicken pox are at risk for shingles later in life. Vaccination against chicken pox helps prevent against all these complications including the furture risk of shingles.
• What complications can arise from chickenpox?
  • The most common chickenpox complications are bacterial infections of the skin and soft tissues in children and pneumonia in adults.
• How do you treat chickenpox?
  • While there is not a single treatment for chicken pox, doctors focus on symptom relief. Doctors recommend Tylenol for fever, calamine lotion or oatmeal baths for itchiness. Lesions should go away in the 10-14 days. 

Symptoms of Chickenpox:

A mild fever may occur 1 to 2 days before rash onset, particularly in adults. In children, the rash is often the first sign of disease.

Seek immediate medical attention when your child:

• has trouble breathing
• has a severe headache
• is very drowsy or has trouble waking up
• has trouble looking at bright lights
• has trouble walking
• seems confused
• seems very ill
• has a stiff neck
• has a fever that lasts for more than 4 days
• has a bad cough
• has an area of rash that leaks pus (thick, yellowish fluid) or becomes red, warm, swollen, or sore
• is vomiting

March marks spring break for families and it is Poison Prevention Month. According to the 2024 Community Health Needs Assessment, one in two children live in homes where medications are not always locked up and four in seven children live in homes where cleaning products are not always stored in a locked area. 

“Unintentional poisoning can happen to anyone, at any age,” said Klaressa Broughton, poison prevention program coordinator at the Center for Community Health. 

In 2025, Cook Children’s saw an increase of poisoning encounters, with 1,031 compared to 818 in 2024. Broughton explains that the top poisoning for 2025 involved children of all ages from birth to 18 and were related to medication and unspecified non-drug poisonings.  

“By practicing Safe Dosing, Safe Storage, and Safe Disposal, you can create layers of protection for your household,” said Broughton. 

She adds having conversations with friends, caregivers and family can ensure kids stay safe while they explore someone else’s home. She suggests opening the conversation with: “Since the kids are at the “into everything stage”, do you mind if we double-check that medications and cleaners are out of reach?” 

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 

• DEA Drug Take Back Day is on April 25th from 10 a.m.-2 p.m.
• 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. 

 Related Stories:  

• Expert Tips for a Safe Spring Break: Car Safety

• Expert Tips for a Safe Spring Break: Water Safety
• Expert Tips for a Safe Spring Break: Aim for Safety

Summertime is the best time of year (in my opinion!). Schedules can sometimes be looser, we can be outside more and it’s great to have a break from schoolwork! It is common to be more relaxed with the bedtime routine.

As a parent myself, I am happy to let a strict bedtime for the school year fade away. However, a late bedtime and waking up late can end up being troublesome during this time of year when we know we have to return to a more regular schedule.

It isn’t “bad” for kids to go to bed late and awaken late, as long as they are getting the total number of hours of sleep recommended for their age. I have met a few kids that go to bed late but also wake up early so they are tired in the daytime, which can impact their behavior.

Our middle school kids are programmed to go to bed late and awaken late -- this change to the clock inside your brain is part of the pubertal process. Therefore, it can be hard to fight the return to an early morning wake-up in August.

How should you do it? Here is one method. Once a person has been going to bed late for a longer period of time, the brain becomes accustomed to that. So simply getting in bed early won’t mean that a person gets to sleep early.

It’s best to continue with the late bedtime, but get up a bit earlier (like 1 hour earlier) than usual. It’s hard to do but using sunlight exposure (sun to the face) and encouraging breakfast can help. Then kids will be naturally tired earlier the following evening since they arose earlier that morning. Some parents use melatonin (dose of 1-3 mg) given 1 hour earlier than the late bedtime to help with falling asleep as well.

Watching caffeine intake, aiming for calm play in the hours before bedtime and keeping lighting low can also help with resetting bedtime. Screen use (TV, phones, computer monitors, and video game consoles) should stop around 1 hour before the desired bedtime as well.

Remember that bright artificial light (from screens) can trick your brain into thinking it is daytime. Try not to allow afternoon naps, so kids build up their sleepiness- aiming for a reasonable bedtime.

Sometimes writing down the plan for bedtime/waketime change can help. Kids can be an ally here so involve them in the process.

Good luck with the new school year!

• Thistle the porcupine
• Nigel the Brazilian spectacled owl
• Laguna the American alligator
• Zuri the African grey parrot

Three little girls’ lives were changed when Save a Smile provided more than $11,000 in dental care to restore their smiles. Britani, Skarli and Ashley Ortiz were in so much pain from dental decay that they frequently went to the nurse’s office at school to ask for ice packs. The Save a Smile program at their school identified the Ortiz sisters because each girl had multiple abscesses and was in emergent need of dental care.

Save a Smile, which started in 2003, is in 21 elementary schools in Hurst-Euless-Bedford, Fort Worth and Keller ISDs. Save a Smile provides dental screenings at schools and identifies children who are in emergent need or pain. Save a Smile has provided over $10 million in dentistry to children in the community.

Depending on the severity of the problem, the age of the child, translation requirements and financial/insurance status, a referral is made to the appropriate volunteer dental provider. Dental care is given in the volunteer dentists' private offices, free of charge to the families. Children with CHIP or Medicaid are connected with a Medicaid/CHIP provider selected through their coverage.

The Ortiz sisters were identified as patients in the 2019-2020 school year, but some of their dental procedures were delayed due to the pandemic. After more than 15 appointments and procedures, the girls received their final appointments in June 2022. They are 5, 6, and 7 years old.

“I told my sister to be brave and to not be scared,” Ashley Ortiz, 6, said. “They are very nice people. I was happy to be in this place because they’re so nice.”

Tonya K. Fuqua, D.D.S., is the Director of Child Oral Health under the Center for Children’s Health, Children’s Oral Health Coalition and Save a Smile program. She was also the dentist who volunteered to provide dental care for the girls.

Dr. Fuqua knew the girls were afraid of going to the dentist since they had never been before. She noticed how brave they became by the last appointment.

“I got to see the transformation from dental disease to happy smiles, so I think that warms all of our hearts when we think of it that way,” Dr. Fuqua said. “When we think how the smile connects to the rest of the body, it does impact the child, from not being able to eat or to learn or to not be in pain.”

The Ortiz sisters were some of many children across the country who got behind on dental appointments and care due to the pandemic and dental office closures.

“These teeth that were just going to need fillings or stainless steel crowns now needed extractions,” Dr. Fuqua said. “Even one of the girls needed multiple extractions. That’s sad and that’s where COVID has taken us.”

The 2021-2022 school year was one of the first years that Save a Smile had well over 500 kids identified as a “class one, severe or urgent” category for needing dental care. Dr. Fuqua said that so many children have infections and abscesses. Usually, in previous years, there were 300 to 400 children considered class one.

Save a Smile has more than 86 volunteer dentists who provide children with comprehensive treatment as needed, whether it’s fillings, surgery, root canals, orthodontics, etc.

“We can’t do it without these private-practicing dentists saying yes, to opening up their doors to seeing hundreds of children for thousands of dental appointments and a ton of dental work being done,” Dr. Fuqua said. “We want to keep kids out of our emergency rooms at Cook Children’s and out of our Urgent Cares if we can – not for dental pain.”

Save a Smile community health workers will pick up students and take them to appointments if they don’t have transportation.

Jesusa Campos, Community Health Worker at Save a Smile, connects with families in need and met the three girls.

The girls’ parents were unable to attend the appointments, so Campos was there to coordinate between the parents and the dental offices. Sometimes within one week, Campos picked the girls up from school and drove them to multiple appointments.

She’s happy that the girls are doing better now and that they learned how to take care of their teeth.

“I love being able to help them to strive in life,” Campos said. “I can’t imagine having a toothache and having to go to school every day. I like helping them out and making sure they can continue healthy habits.”

At the event on Thursday, patients participated in arts and crafts themed around the “You Can Be Anything” Barbies that showcase different occupations and show that children can grow up to be anything they'd like to be.

After hearing about the tragedy, Mattel contacted Varghese Summersett Injury Law Group, which is representing Athena’s mother, Maitlyn Gandy.

Maitlyn and her legal team helped a six-person group from Mattel set up Barbies and toys for the patient event. Afterward, Maitlyn interacted with the patients as they came down to select a toy, have a snack, and complete crafts that focused on the children’s future and goals. 

“This was a special event in memory of my daughter,” Maitlyn said. “I’m grateful for everyone who helped make it happen.”

Nancy Molenda, Executive Director of the Mattel Children’s Foundation, said their purpose is to empower the next generation to explore the wonder of childhood and “reach their full potential.” 

“We are honored to be part of this event and to help bring the power of play to the patients of Cook Children’s,” she said.

As cases of the flu and RSV decline at Cook Children’s, we are experiencing an increase in positive cases of COVID-19. Families are encouraged to remain vigilant against respiratory illnesses and make sure their children have the latest COVID booster vaccines, especially as a new dominant subvariant appears to be more contagious.

From Dec. 25 to Dec. 31, Cook Children’s saw a COVID positivity rate of 9.2%, which has been increasing since November. From Jan. 1 to Jan. 7, the positivity rate increased to 11.2%.

As children return to school from the holiday break, there could be an increase in respiratory viruses and illnesses over the next two weeks and beyond, so it’s important to remain watchful and proactive. If your child is feeling sick, keep them at home from daycare or school and wear a face mask when in public to stop the spread.

Influenza A and B cases have declined since November. From Jan. 1 to Jan. 7, we had a positivity rate of 9.9% for Influenza A. This doesn’t mean that the flu season is over, it’s possible to see another increase in cases, so be sure to get vaccinated against the flu. The flu vaccine works to prevent you from catching the flu – or, reduce the severity if you do come down with the illness.

“It is very encouraging to see cases decline,” said Laura Romano, D.O., hospitalist at Cook Children’s. “However, this does not mean that RSV and flu season is over. There is a very likely possibility of a second peak occurring later this winter.”

Respiratory syncytial virus (RSV) cases are declining compared to high cases in October and November. We currently have a RSV positivity rate of 7%. There are limited treatments for RSV. Right now, there is no vaccine available to prevent RSV. Synagis, a monoclonal antibody, can be given to prevent severe infections but this is reserved for premature infants, etc. We are also seeing positive cases of rhinovirus and adenovirus in our patients.

COVID-19 Subvariant

The World Health Organization said that it’s concerned with how quickly the XBB.1.5 subvariant of COVID is spreading in the northeast U.S. The subvariant makes up 40% of submitted specimens to the national SARS-CoV-2 surveillance system. There's still a lot that is unknown about this subvariant.

“This subvariant may be able to slip past our immune defenses and might be more contagious, but it is not clear yet if it causes more severe disease or if the vaccine can effectively prevent severe infections from this strain,” said Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children’s. “We do know that masking and good handwashing will still be helpful to avoid infection.”

The Centers for Disease Control and Prevention tracks the community spread of COVID-19. For the week of Jan. 1, Tarrant County is rated “high” transmission spread.

Prevention & Precautions

The biggest thing the community can do to help is to take precautions against COVID-19, including masking indoors if you or your child feel sick, frequent hand washing, and getting the COVID-19 vaccine and booster.

Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If you or your child is sick, wear a mask in public.
• If your child is sick, keep them home from daycare or school. Make sure your child drinks lots of liquids, gets plenty of sleep and takes over-the-counter meds to alleviate symptoms.

Flu vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

There’s no guaranteed way to avoid the flu. But getting the vaccine every year can help. At Cook Children’s, we believe that flu vaccinations are the safest, easiest way to protect everyone age 6 months and older from serious flu symptoms. And a flu vaccination during pregnancy helps protect your newborn baby from flu for several months after birth.

Flu immunizations, COVID-19 immunizations and other services are available at Cook Children’s neighborhood clinics and primary care sites across Fort Worth and beyond. Find a location near you: Primary Care Offices/Neighborhood Clinics (cookchildrens.org)

For COVID, at-home tests and community testing locations are also great options.

Texas Country artist Josh Abbott visited patients and staff members at Cook Children’s Medical Center on Jan. 6 to share his music and to bring some smiles.

While at the children’s hospital, Abbott talked about his partnership with the Texas Dairy Queen Operators’ Council. In June 2022, Abbott was chosen to create a fresh new sound for DQ® restaurants in Texas with one of the most recognizable jingles in the Lone Star State, “That’s What I like About Texas.”

“I loved visiting Cook Children’s to meet the kids and the team caring for these incredible human beings,” Abbott said. “It was great to sing, laugh, and learn about the Life Zones where the kids can forget about why they are in the hospital for a moment. It also was fun to be interviewed for Cook Children’s internal television station, CLZ TV.”

Abbott is the voice for Texas Dairy Queen. Dairy Queen is a Children’s Miracle Network Hospitals  partner and many locations throughout our Fort Worth and surrounding areas participate and do national fundraising initiatives through CMN Hospitals (Miracle Treat Day, Point of Sale fundraising, Dip It for the Kids). 100% of the funds raised to through these initiatives in our fundraising market benefit Cook Children’s.

Abbott sang the iconic jingle as well as several of his songs for the kids and team. He talked about his music journey, the band and his family, which includes his wife Taylor, daughter Emery and son Luck.

“I love what I do, and I get to entertain people because I have a very supportive family,” Abbott said. “This visit was a wonderful opportunity to share music which can be therapeutic and healing.”

Before his departure, Abbott handed out Dairy Queen Dilly Bars for the kids and staff.

The Josh Abbott Band will play at Billy Bob’s in Fort Worth on Jan. 6 & 7.

Media partners may use this content for news stories and broadcasts with credit to Cook Children's.

Media partners may use this content for news stories and broadcasts with credit to Cook Children's.

Since 2017, Cook Children’s Emergency Department has treated more than 300 children and teens for gunshot wounds. One of those children, a 4-year-old boy, changed the life of Daniel Guzman, M.D., forever. While Dr. Guzman couldn’t save this child from his fatal injuries, he vowed to do everything in his power to save other children from the same fate.

Later that year, he launched the Aim for Safety program at Cook Children’s, which focuses on preventing gun injuries in children and teens. On this episode of Raising Joy, Dr. Guzman (who is a gun owner himself) explains how parents can protect their children, regardless of whether or not they have a gun in their home.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

Join us for the first LIVE recording of the Raising Joy podcast on Thursday, September 29 at the historic Downtown Cowtown at the Isis Theater in the Fort Worth Stockyards.

This event, which is being hosted in partnership with The Center for Children’s Health led by Cook Children's, will bring mental health leaders in the community together to hear an inspiring talk by author and renowned speaker Andrew Solomon, Ph.D. Solomon is a Pulitzer Prize finalist, National Book Award winner, TedTalk presenter, as well as a professor of Clinical Psychology at Columbia University.

Registration is required to attend. Click here to register! 

National Teddy Bear Day is Sept. 9.  We're celebrating in a BEARY special way for this patient tradition at Cook Children's.

In July, the Cook Children's Spiritual Care team called on the community to restock the prayer bear den. As of Sept. 8, the den has more than 3,200 additional prayer bears thanks to our generous community.

Prayer bears are a way to remind patients that they are not alone. The Spiritual Care team gives out over 300 bears per week at the Medical Center. These bears are given to patients who need encouragement or support after a painful procedure, during a lengthy hospital stay or during difficult times.

Many congregations and community organizations participate in the interfaith ministry's PrayerBear program. New toy teddy bears of all shapes, sizes and colors are blessed during worship services, then they are delivered to medical center chaplains. 

Would you like to get involved? All bears must be new, with no scent, and with no words/logos. Email prayerbear@cookchildrens.org or donate at giving.cookchildrens.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

As people gather and travel during the summer months, the COVID positivity rate continues to rise. The seven-day average positivity rate reported at Cook Children’s Health Care System is 21% as of Tuesday.

Many Cook Children’s primary care offices are offering COVID vaccines. Patient families can check MyChart for online scheduling options or call their pediatrician’s offices.

In June, the Centers for Disease Control and Prevention and the Food and Drug Administration cleared the way for children 6 months to 5 years old to get the COVID-19 vaccine.

Our health care providers and pediatricians at Cook Children’s strongly recommend that parents get their children vaccinated. Vaccines are the best way to prevent serious illness in people of all ages, including children.

The COVID positivity rate has slowly increased at Cook Children's.  

Rolling seven-day average positivity rate at Cook Children’s:

• May 5 - 3.5%
• May 16 - 3.3%
• June 5 - 8.4%
• June 20 - 10.6%
• July 6 - 21.6%
• July 11 - 24.5%

On July 6, there was one COVID patient in the ICU and two others in non-ICU beds at Cook Children's.

On Wednesday, Tarrant County Public Health moved the community spread level to High after 774 new COVID cases were reported in the county. 

Positive cases and hospitalizations are increasing across Texas, according to Texas Health and Human Services.

The biggest thing the community can do to help is to take precautions against COVID-19, including masking indoors, hand washing, social distancing and getting the COVID-19 vaccine and booster if eligible.

Not only will this help prevent COVID-19, but it may also prevent multisystem inflammatory syndrome in children (MIS-C), which has continued to affect kids throughout the pandemic.

It’s also important to avoid Cook Children’s urgent cares and emergency department for simple COVID-19 testing. These locations should be used for severe COVID-19 symptoms such as:

• Difficulty breathing
• Difficulty staying hydrated
•  High fever for more than four days

If you need a COVID-19 test for your child, please call your pediatrician’s office to schedule an appointment. At-home tests and community testing locations are also great options when available. Tarrant County’s website is a great resource for finding testing locations.

RELATED:

COVID Vaccine Authorized for Young Children (checkupnewsroom.com)

Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

The Fourth of July is a time for celebration and getting together with family and friends. Cook Children’s experts are sharing safety tips and information to remember as people gather this weekend. Keep in mind that drowning is the leading threat for children, especially during the Fourth of July holiday.

In the emergency room, drowning patients are seen the most frequently and drownings most often lead to fatal outcomes, said Corwin Warmink, M.D., medical director of Cook Children’s Emergency Department.

“Keep a close eye on your child any time there is water nearby,” Dr. Warmink said. “People are often in large groups and let down their guard thinking that someone else is watching the kids in or around the water. They should identify an official Water Watcher who is responsible for keeping track of everyone.”

DROWNINGS

In June 2022, there were 19 drownings treated at Cook Children’s, none were fatal. Seventeen of those children were 5 years old and under.

• In June 2021, there were 22 drownings, one was fatal.
• In June 2020, there were 8 drownings.
• In June 2019, there were 13 drownings.
• In June 2018, there were 16 drownings. Three were fatal.

While most patients survived these incidents, drowning injuries can result in severe effects, especially on a child’s brain development.

Many of the drownings so far in 2022 have occurred during unplanned swim time. This is when parents didn’t expect their child to be in or around the water.

Drownings can happen silently and quickly. A submerged person might not attract attention or appear to be in danger.

Drownings can occur even with many adults present. When there are children around water, always designate a Water Watcher, an adult who is in charge of watching all children without any distractions.

Drownings on July 3 and 4:

• 2018: one drowning on July 3 and two on July 4
• 2019: four drownings on July 3
• 2020: one drowning on July 4
• 2021: one drowning on July 3 and one drowning on July 4

None of these drownings listed above were fatal, but parents and caregivers must remain vigilant.

Parents can also put barriers in place to help prevent a child from accessing the water or make it more difficult to access when an adult is not present. Barriers – such as locks, alarms and fencing – can help keep unsupervised young children from getting into swimming pools.

For more information and resource, including Water Watcher tags, visit: LifeguardYourChild.org

HEAT SAFETY

There are other threats during the Fourth of July holiday that can lead to severe injuries.

“Boating, jet ski and watercraft accidents are very frequent and often very tragic injuries. Burns from fireworks and cookouts are also very common,” Dr. Warmink said. “Snake bites and other bites are also common because a lot of people are outdoors along with very severe sunburns and heat exhaustion.” 

With the highs in the upper 90s and triple-digits, be sure to keep these heat safety tips in mind.

“Sunscreen is important and it should be reapplied every few hours. Drinking plenty of water and hydrating drinks throughout the day,” Dr. Warmink said.

Wear appropriate clothing: Choose lightweight, light-colored, loose-fitting clothes. Wear a hat to shield yourself from the sun, until you feel yourself getting warm. Then remove any items covering your head that can trap heat close to the body.

Schedule outdoor activities carefully: Heatstroke can occur in less than an hour when you are participating in a strenuous activity on a hot day. Try to limit outdoor activity to when it’s coolest, like morning and evening hours. Rest often in shady areas so your child’s body has a chance to recover.

Hydrate: Drink plenty of water during the day, especially if you are engaged in any strenuous activity. Be sure to drink water or a sports drink before, during and after any strenuous activity.

Wear sunscreen: If you got outside, use sunscreen, wear a wide-brimmed hat, and sunglasses, and put on sunscreen of SPF 15 or higher 30 minutes before going outside. Continue to reapply according to the package directions.

FIREWORKS

Severe injuries from fireworks can be harmful and painful to a child. Even sparklers can heat up to more than 1,200 degrees and are dangerous for young children.

“Kids should not shoot off fireworks and they should be shot off in a ‘kid-free’ zone," Dr. Warmink said. "Keep kids away from grills and bonfires also.”

ATV SAFETY

Though often thrilling for children, off-road motorized vehicles — including all-terrain vehicles (ATVs), ATV mules, go-karts, and even golf carts — can be extremely dangerous for them to ride, especially if they don’t use safety measures once they get on board.

To prevent such injuries among children, the American Academy of Pediatrics (AAP) recommends children under 16 do not drive or ride as passengers in two- and four-wheeled off-road vehicles.

ATV Safety:

• Always wear protective gear such as:
• o Helmet
• o Eye Protection
• o Boots, gloves, long pants, jacket
• Do not ride an ATV at night
• Take an ATV safety course
• Never ride on public roads
• Perform ATV safety checks

Melatonin overdoses in children are rising at an alarming rate, according to a new study where researchers found a 530% increase in the annual number of pediatric melatonin ingestions over the past 10 years. The number of children hospitalized as a result increased, too.

Most ingestions were unintentional and in children younger than 5, with the biggest jump in numbers occurring during the pandemic. Researchers believe the spike may be linked to an increase in melatonin use as a result of stress and anxiety-related sleep disturbances during the pandemic. Melatonin sales in 2020—the height of the pandemic—topped $821 million, up from $285 million in 2016.

It’s easy to see how it might happen. With schools and activities shuttered, kids had more time and opportunities at home to find and ingest what some may think is a harmless dietary supplement. But doctors say the misuse of any substance, even those that can be purchased over-the-counter, can be dangerous.

“Physicians often recommend melatonin which makes kids and parents think it is benign and, most of the time, it can be very helpful for those struggling with sleep,” said Artee Gandhi, M.D., medical director for pain management at Cook Children’s Medical Center. “However, large amounts of melatonin may cause drowsiness, agitation, nausea, headache and dizziness. Very large doses have effects on the reproductive system but there are no long-term studies about this in pediatrics.”

Melatonin is a hormone released by the brain in response to darkness. It signals to the body that it’s time to sleep. Short-term use of melatonin supplements may be helpful in cases of jet lag, sleep disorders and anxiety before and after surgery. The supplement can be purchased over-the-counter and comes in both pill and gummy form for adults and children.

Therein lies the danger. Gummies look and taste like candy, which can be particularly attractive to young children. Also, what’s listed on the label may not be what’s actually in the bottle.

“In the United States, melatonin is considered a dietary supplement so it is less strictly regulated by the Food and Drug Administration (FDA) than a prescription or over-the-counter drug would be,” Dr. Gandhi said. “Therefore, some melatonin supplements may not contain what’s listed on the product label.”

Symptoms of a melatonin overdose may include:

• Drowsiness
• Increased bedwetting or urination in the evening
• Headache
• Dizziness
• Agitation

About 83% of melatonin-ingestion cases reviewed in the study did not show any signs of distress. Those who did mostly reported symptoms related to the gastrointestinal, cardiovascular and central nervous systems. More than 4,000 children were hospitalized, with as many as 287 requiring intensive care. Two children—a baby and a toddler—died in their home as a result of a melatonin overdose.

Medications and dietary supplements, whether prescription or over-the-counter, should always be kept out of sight and reach of children. Talk to your child’s pediatrician before giving them melatonin or any dietary supplement.

If you believe your child has unintentionally ingested melatonin, or taken too much, contact Poison Control at 1-800-222-1222.

March 28, 2022, was coming to a close like any other ordinary day for the Chavez-Llanas family. Salvador and Laura Chavez-Llanas were upstairs bathing their youngest of three sons while their older two were playing video games downstairs. In a moment, their peaceful evening turned to chaos.

A cry for help rang out from downstairs. It came from Salvador and Laura’s middle son. Laura rushed to check on him, only to find her oldest, 8-year-old Santiago, on the floor. He was conscious but drooling, and unable to stand up or move the right side of his body. His speech was slurred, and one side of his face drooped.

Laura yelled for her husband’s help. He called 911, and an ambulance arrived within minutes to carry Santiago to the emergency room at Cook Children’s Medical Center. That’s where Laura met Rachelle Herring, M.D., a pediatric neurologist.

“Santiago was pretty severely impaired at that point,” Dr. Herring explained. “He had a dense hemiplegia, which means he really could not move the right side of his body at all. He had very slurred speech but, fortunately, he was alert and understood everything that was going on.”

Santiago quickly underwent imaging tests of his brain. They confirmed he was having an ischemic stroke. This type of stroke occurs when a blood clot blocks the flow of blood in a vessel in the brain, cutting off oxygen and disrupting the function controlled by that part of the brain.

“We were just playing our Nintendo Switch and that's when my controller fell," Santiago said. "I started reaching for it, but then I felt like I was getting weak in my right side so I tried even harder to get it and then I fell down.”

Santi, as his mother calls him, has always been a healthy, active boy who loves playing basketball, swimming and riding bikes with his family. Never did his parents imagine their son would be one of the 5 in 100,000 kids each year ages 1 to 18 to have an ischemic stroke. It’s more common in newborns, occurring in 1 in 2,500 full-term infants during their first month of life.

“It was pretty shocking,” Laura said. “Your world as you know it just disappears. It’s so hard.”

Time was of the essence. With stroke, recovery is directly related to how quickly treatment can be administered. But stroke in children is so rare that the drug considered the gold standard treatment for adults has not been studied enough in kids to be approved for use in pediatric cases.

The medication, called tissue plasminogen activator, or tPA, breaks up blood clots. It’s administered through an IV with the goal of dissolving the clot within the vessel and restoring as much blood flow as possible. To be most effective in reversing damage, it must be administered within 4 ½ hours of the onset of stroke.

Although it’s considered off-label to use tPA to treat children, some hospitals administer the drug to pediatric patients after carefully weighing the risks and benefits.

“That’s what we did in the case of Santiago,” Dr. Herring said. “He came in very quickly after the stroke and I reached out to Dr. Marcela Torres, our hematologist who specializes in blood clots, about giving tPA. We’re basing our decision on the adult data that when the patient comes in within 4 ½ hours of an ischemic stroke, we think tPA can help restore the blood flow to the affected area of their brain."

Dr. Herring explained the risks of using the powerful drug to Santiago’s mom.

“At that point, I couldn’t say no,” Laura said. “Because I want to have my kid with me.”

It was the right call. Not long after receiving the drug Santiago’s symptoms began to resolve, and he was transferred from the ER to the pediatric ICU for monitoring. Because tPA is a blood thinner, patients are at risk of bleeding and must be watched closely. The stroke team also wanted to keep an eye on his neurological status and run tests to determine the cause of the stroke. 

Images of Santiago’s brain showed inflammation of the blood vessels consistent with a condition called cerebral vasculitis.

“We don't know exactly what caused the vasculitis,” Dr. Herring said. “It could have been triggered by some type of prior infection. The body's immune system goes a little haywire and can cause irritation to the blood vessels in the brain.”

Santiago spent two weeks in the hospital, all the while making a remarkable recovery. By the time he was discharged he had only a mild facial droop and had regained all of his movement. He’s on medications to reduce inflammation in his blood vessels, as well as blood thinner to prevent more strokes, and will undergo more imaging tests in the future to make sure his vessels return to normal.

In the meantime, Santiago is enjoying being back home with his family and back to school part time.

Looking back, Laura recalls a few things her son told her that may have signaled something was wrong. A few days before the stroke, Santiago complained of not feeling well. He said he felt like he was going to pass out at school. When questioned in detail by his mother, the only word he could find to describe how he felt was “weird.” Now, Laura wants parents to know to listen to their kids and know the signs and symptoms of stroke.

“Look at your kids,” she said. “Look at how they're behaving, and if they tell you something hurts, pay attention to every single different thing.”

To spot the signs of stroke, remember the acronym BE FAST:

Balance - Is there a sudden loss of balance or coordination?

Eyes - Is there blurred or lost vision?

Face - Is one side of the face drooping or numb?

Arm - Is there weakness, numbness or loss of movement in the arms, legs or one side of the body?

Speech - Is speech slurred?

Time - If you or someone you know is experiencing any of these symptoms, call 911 immediately.

“The most important thing to know is that stroke happens in children,” Dr. Herring said. “If something is different or off about your kid, do not discount it. It could be something serious. Seek emergency care because even if they're not a candidate for tPA, sometimes they're a candidate for other therapies. The sooner we're able to see that patient and try to figure out what's causing the stroke, the better off their prognosis is going to be.”

As the mother of three boys, I’ve seen the inside of an urgent care center and emergency room a time or two. I’ve learned not to panic at the first sight of blood. But when I saw my 13-year-old passed out on the living room floor after doing nothing but getting up off the couch, my heart rate soared. I was terrified. My mind raced with questions.

Is he breathing? Is he having a seizure? Do I call an ambulance? Is something wrong with his heart?

Fortunately, the fainting spell didn’t last long. A few seconds in and he came to. One minute he was out, the next minute he was fine, albeit a little confused as to why he was on the floor. Of course, off to his pediatrician we went.

An exam showed no signs of anything other than a little fluid in one of his ears. His bloodwork was normal and everything checked out from a neurological standpoint. The diagnosis was narrowed down to a few possibilities — dehydration, orthostatic hypotension or just a random case of syncope.

Unbeknownst to me, it’s not uncommon for pre-teens and teens to experience syncope. That’s the medical term for fainting. Determined to learn more, I talked to a few physicians at Cook Children’s Medical Center — a pediatrician, a pediatric cardiologist and a pediatric neurologist. They helped me understand what to look for if it happens again, and the signs that indicate it could be something more serious than a random case of syncope.

“Fainting is a lot more common than people think,” said Diane Arnaout, M.D., a pediatrician at Cook Children’s Pediatrics Forest Park.

About 20% of all children will experience at least one fainting episode during adolescence, according to a study published in Paediatrics & Child Health.

“Thankfully, most of the causes are benign,” Dr. Arnaout said. “It’s so scary, and we tend to think the worst when fainting happens. But a thorough visit with your primary care doctor should be able to assess whether it’s caused by common or more scary causes.”

What can cause children to faint?

The most common form of syncope is called vasovagal syncope. It’s caused by a sudden drop in heart rate and blood pressure. Several things can trigger it, like fear, emotional stress, the sight of blood, dehydration, getting overheated or standing for too long with your legs locked. Some kids faint when having their hair combed or styled because of sensitive nerves in their scalp. Yes, that’s really a thing. It’s called hair grooming syncope.

Fainting can also be the result of orthostatic hypotension. That’s when you stand up from a sitting or lying position and your blood pressure bottoms out. The next thing you know, you’re passed out on the floor. Dehydration can lead to orthostatic hypotension, especially in teens who tend to be under-hydrated.

“The most common reason for kids to faint is relative dehydration,” said Deborah Schutte, M.D., a pediatric cardiologist at Cook Children’s. “They’re not getting enough fluids. Another common thing is that they don’t drink much until late in the day, right before athletic practice and games, or after they get home from school. I always encourage them to start their day with a glass of water and continue to drink throughout the day.”

What to do if your child faints

The first thing you should do if your child faints is checking their airway. Make sure they are breathing and have a pulse, but don’t try to pick them up or raise their head.

“If it’s a ‘simple faint’ they should be breathing comfortably with a regular pulse and should arouse within a couple of minutes,” Dr. Schutte said. “If the child does not arouse, or there are concerns related to breathing or pulse, call 911.”

Other red flags include a sensation of a fast or irregular heartbeat before fainting, a history of congenital heart disease, fainting during exercise or recurring episodes. If your child experiences any of these, it would be wise to consult a cardiologist.

Watch for how quickly your kid rebounds, especially when it comes to their neurological status. If they are like mine — out one minute and back to normal the next — it probably doesn’t warrant emergency care but, rather, a visit with their pediatrician.

“Any episodes where a child has altered mental status and they’re not coming back to baseline quickly, or if there are signs of seizure during the event such as stiffening or jerking movements, those issues should be checked out by a neurologist,” said Rachelle Herring, M.D., a pediatric neurologist at Cook Children’s.

Also, know that kids can have a stroke, and any stroke-related symptoms warrant a call to 911. To remember the signs of stroke, think BE FAST.

Balance - Is there a sudden loss of balance or coordination?

Eyes - Is there blurred or lost vision?

Face - Is one side of the face drooping or numb?

Arm - Is there weakness, numbness or loss of movement in the arms, legs or one side of the body?

Speech - Is speech slurred?

Time - If you or someone you know is experiencing any of these symptoms, call 911 immediately.

As unsettling as the incident with my son was, I feel better knowing it’s not completely out of the ordinary for someone his age. I’m paying closer attention to how much water he’s drinking throughout the day, and I’m now armed with the vital information I need to better, and more calmly, assess the situation if it ever happens again.

I remember scrolling through a Facebook group for physicians a few years ago, and a popular post rolled onto my screen, written by a confused pediatrician.

“What the heck is up with all these moms wanting their baby’s tongues cut?”  It was followed by hundreds of comments of confusion and agreement from other physicians.

I chuckled a little because the tremendous pressure on parents to have their baby’s tongue evaluated is something I literally talk about every day now -- and I hardly talked about it at all when I started my career.

One study showed that from 1997 to 2012 the incidence of tongue-tie diagnosis went from 3,900 to 32,000 – a nearly 10-fold increase -- in a matter of 15 years! This might be because more moms are choosing to breastfeed compared to a few decades ago.

So what’s up with tongue ties? And when should you think about getting your baby’s tongue tie cut (frenotomy)?

Tongue ties are a hard thing to write about, as it is a topic that can be pretty controversial. Depending on whom you talk to, the advice you get will change. That’s because we’re still lacking large, sweeping studies that prove one way or another that the procedure helps more than harms. Also, a gentle reminder that some folks who perform the procedure make very significant income because of it – thus creating biased advice in some ways, I think.

Clipping a tongue tie comes with risks: infection, tongue ulceration, bleeding, tongue damage, and salivary duct damage are all possible.

What is a tongue-tie?

Tongue-tie, or Ankyloglossia, means the tongue has a tight band of tissue underneath it that restricts the tongue’s movement. The tongue typically can’t be stretched upwards very well, beyond the lower teeth or lips.

The existence of a “tongue-tie” and merely HAVING a tongue frenulum (a small fold of tissue that secures the tongue to the floor of the mouth) are not the same thing!

There are different types of tongue ties – some attach to the front of the tongue, some to the middle area, and some to the back.

All tongues have some portion of tissue tethering itself down to the floor of the mouth. Just because you see a thin band of tissue underneath your child’s tongue doesn’t mean it necessarily needs to be cut. But let’s explore when to worry.

When writing this, I decided to phone some trusted friends, because a well-rounded approach is vital. There’s a lot of information here, but I hope it gives you food for thought in making this important decision for your child.

A dentist: Drew Jamison, D.D.S., with Fort Worth Children’s Dentistry (“D”)

A Speech-Language Pathologist: Sara Adams with Cook Children’s (“SLP”)

A lactation consultant (and fellow pediatrician): Andrea Wadley, M.D., with 127 Pediatrics (“LC”)

An Ear-Nose-and-Throat (ENT) physician: Kristen Honsinger, M.D., with Cook Children’s (“ENT”)

What trends are you seeing when it comes to tongue ties?

D: There is certainly an increase in inquiries about tongue-tie in our office. I would estimate at least double the number of inquiries in the past eight to 10 years. Most of these come from new mothers looking for a solution to difficulties nursing. A majority are feeling stressed and feel like they have reached a dead end. Most have also already worked with a lactation specialist and treating the tongue-tie is a "last-ditch effort". We don’t offer this procedure in our office. I have always worked to practice evidence-based dentistry. I'm waiting for more data. I want to make certain that the procedures we provide are in the best interest of our patients. We are certainly open to including these procedures in the future, just not quite yet.

SLP: In our speech therapy and feeding evaluations, parents have questions about if the tongue-tie needs to be clipped or not. They have often received different recommendations or opinions from their different healthcare providers about “to clip or not to clip.” Parents are concerned not only about a baby’s ability to breastfeed or bottle-feed, but they also have questions about if a tongue-tie will cause speech sound differences. For speech sound concerns, the evidence we have says that tongue-tie is not directly related to articulation (speech sound) disorders in most situations.

LC: The trend that I am seeing is that the diagnosis of “tongue-tie” is the explanation for a lot of breastfeeding problems in the community. Tongue, lip and now cheek ties are "en vogue" diagnoses to the point where some will refuse Vitamin K administration, but be upset that I decline to do an elective tongue-tie clipping on their child due to the bleeding risk.

ENT: In the ENT world, we’re seeing more people referred by lactation specialists, speech therapists and other non-physician providers. Previously, most of the referrals came from pediatricians. Another trend we are seeing is referrals for speech issues/concerns related to ties. To date, there have been no good quality research studies linking tongue-tie with any kind of speech delay, speech issues such as articulation problems, or feeding issues besides breastfeeding problems. There is good quality research suggesting that tongue-tie release in babies may improve maternal pain with nursing and may improve latch and therefore breastfeeding outcomes.

Are all tongue ties “bad”?

D: No. We have a large number of patients that could be diagnosed as "tongue-tied" that we simply monitor. Most of these patients thrive. If they ever have concerns that involve speech or other issues, we try and work with speech pathology to discuss diagnosis and treatment.

SLP: Not necessarily, some children have tongue ties and can drink, eat, and talk with no difficulties. This is why it is important to have the child evaluated by a medical professional that is familiar with tongue ties and can help look at those functions.

LC: Not all tongue ties are bad. As the baby grows, often the "tie" or frenulum will stretch and grow over time. Occasionally, ties will need to be corrected later in life, but often kids get by just fine without having them repaired. If the baby has a visible tongue-tie but is transferring milk well from the breast or sucking well from the bottle, I often leave these alone and follow up over time.

ENT: It’s normal to have a frenulum or “tie” under the tongue -- most babies (and adults!) do and it’s a normal part of the anatomy. An evaluation by a qualified specialist is necessary to determine whether or not the frenulum is restricting tongue movement or causing other difficulties, however.

When do you think it’s a good idea for parents to seek out frenotomy (tongue-tie clipping)? Are there any patterns you watch for or anatomical problems you notice in an exam?

D: I can certainly expand on philosophy here, but to remain concise, we typically tell parents: If you feel like you have exhausted all other options, including consultation with lactation consultants, then we promote the procedure. Scientific literature confirming effectiveness and results are scarce. However, we find that about half of our patients report an improvement in nursing.

SLP: If the tongue-tie is impacting the child’s ability to eat or drink – then it is time to consider frenotomy. I look at the overall function of eating or drinking to help determine if the family should talk to their doctor about that procedure. Sometimes, a tongue can look severely tied, but the child still has a great range of motion and no difficulties with eating or drinking. Sometimes a “mild” looking tongue-tie can present with really significant difficulties eating or drinking. You can’t always go by how it looks. For breastfeeding babies, if the mom is experiencing pain with feedings and has tissue damage to her breasts – then I collaborate with physicians about a frenotomy.

LC: I consider clipping tongue ties for babies whose tongues have a "heart shape" when they are extended. If they are unable to lift the tip of the tongue, it is very difficult to breastfeed. If the mom is having a lot of pain with breastfeeding and has lesions/blisters/bruising along the edge of the nipple that is in a "tube of lipstick" distribution this could be due to a tongue-tied baby or if the mom's nipple is shaped like this after every feeding and does not "round out" quickly. I also consider them for breast (or bottle) feeding babies who are taking in a lot of air with feedings, clicking with feeds, or who cannot sustain a latch long enough to transfer milk from the breast. I will also evaluate "posterior" (back of the tongue) or submucosal tongue ties if the baby is not transferring milk well and all of the other factors are accounted for.

ENT: In general, the sooner the better. One of the main goals we have is to help parents who choose to breastfeed to be able to do so- and making sure that we fix a tongue-tie when necessary can be an integral part of this. If there is something that we need to fix, it’s generally best to try to do it as soon as possible so that both the baby and mom can reap the benefits as soon as possible.

Should tongue-tie clipping be done in the newborn period, or do you think there are instances where it should/could be done later in life?

D: I think I answered this in the second question, however, I emphasize limiting any procedure unless necessary.

SLP: Hopefully, if there are concerns noticed with breast or bottle feeding, the procedure is done quickly so that we can support breastfeeding or can help that baby bottle feed. I have seen a few instances where the patient was older, about 12-18 months because the difficulty became more apparent as they were not able to use their tongue appropriately as they began to chew foods.

LC: As a newborn hospitalist, I would clip tongue ties during the newborn period if they were causing very obvious problems or mothers were having significant pain with breastfeeding. Often, I would clip them if the mom was an experienced breastfeeder and had lots of pain or had a previous baby with a tongue-tie that needed to be clipped. Now as an outpatient physician, I will clip tongue ties that have been referred to me by other professionals who have evaluated the mom and baby. These are often done around 1 to 2 months of age. After the parents have exhausted other options.

ENT: It’s easiest if we’re able to do a tongue-tie release procedure before around 3 to 4 months of age because the procedure can be done in the office. When a child gets much older than that, it’s typically recommended to do the procedure in the operating room. Since the research shows that the procedure improves breastfeeding outcomes, it is best performed as soon as possible.

If parents are on the fence about the procedure, who do you think they should reach out to? Do you think they should get advice from more than one profession?

D: I think a team approach is best when diagnosing and treating a tongue-tie. Different specialists’ understanding and communication of specific concerns lead to a well-informed treatment plan. If it is related to nursing, I would follow the advice of a lactation consultant or pediatrician.

SLP: Lactation consultants can help with questions on the latch at the breast. Speech pathology can help with feeding/bottle concerns and speech sound concerns. Dentists and ENTs are also great resources because they can provide insight as well. If you have a concern or are unsure, reach out to qualified health care professionals that are willing to listen to your concerns and that have knowledge on tongue ties – have an open and honest dialogue with them and come prepared with your questions.

LC: If parents are on the fence, I would recommend getting opinions from several trusted physicians. Pediatricians, family doctors, ENT and of course physicians with extra lactation training would be ideal. I would warn families to beware of "professionals" who are pushing the procedure without having done a full evaluation (which includes a feeding assessment).

ENT: I think the child’s pediatrician should always be the first one to evaluate a child and determine if they may benefit from a tongue-tie release. As far as asking other professions what they think/recommend, I would say that it is not uncommon to receive very different advice and recommendations based on who you ask. Each provider likely gives their recommendations based on their own experiences, training and background. ENT physicians also tend to rely heavily on what research papers have shown to help us to determine who will and likely will not benefit from a tongue-tie release.

Some take-home points from me, a pediatrician:

• Tongue-ties are a complex issue that is still being studied, and many factors should be taken into account when trying to figure out whether or not a procedure is needed.
• Not all tissues under the tongue are “tongue ties.” The vast majority of tongue frenula cause absolutely no issues. And many tight tongue ties can stretch out over time.
•  Be careful about what you read on the internet. I can tell you from experience – there is a lot of garbage out there, and I’ve seen many babies fall victim to a painful and unneeded procedure because a parent was so worried about something they read online.
• I’d say that in my personal experience of 12 years as a pediatrician, tongue tie clipping leads to improvement of a feeding or nursing issue maybe 50% of the time. And 50% of the time, it does not help.
• According to our current evidence, tongue ties do not seem to affect speech. Again, this is based on what we know now.
• Some older kids do report having difficulty licking their lips or teeth or licking an ice cream cone. This is one of the rare reasons older kids may need it cut.
• If you’re wondering about getting your baby’s tongue tie cut, consider talking to more than one specialist – the more, the better, especially if you are considering getting a “posterior tie,” or back of the tongue, cut.
• I’d definitely consider getting your baby’s tongue-tie evaluated if he struggles with drawing milk out of the breast or bottle if you are a mother who continues to experience a lot of pain with nursing after more than 2 weeks, and/or if he cannot extend his tongue past his lower teeth or lips (plus struggles with one of the issues above).
• When you read the comments of this post, you’re going to see a lot of “just do it! It helped my baby!”, or “getting the tongue tie cut was the worst decision ever…” – please remember that every child is anatomically and physiologically different, and one person’s experience may not be what you experience.

I hope this post helped give you the slightest bit of clarity on a topic that is not so clear.

For as many tiny studies I found showing that cutting a tongue tie doesn’t help a baby feed, I found an equal number showing that it does in fact help. The truth is, we need more data -- more big studies involving lots of babies -- before our answers will be clearer and more confident when it comes to tongue ties.

The baby in the picture is a sweet patient of mine. He has a normal tongue frenulum that might appear worrisome when you see it, but as a newborn, he was able to transfer milk easily, and he thrived.

Now, for some extra reading!

Ankyloglossia and Lingual Frenotomy: National Trends in Inpatient Diagnosis and Management in the United States, 1997-2012. https://pubmed.ncbi.nlm.nih.gov/28168891/

Breastfeeding: What to do about Ankyloglossia. https://publications.aap.org/aapnews/article-abstract/36/6/11/25079/Breastfeeding-what-to-do-about-ankyloglossia-lip?redirectedFrom=fulltext

A systematic review: The effects of frenotomy on breastfeeding and speech in children with ankyloglossia. https://pubmed.ncbi.nlm.nih.gov/33501864/

Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. https://pubmed.ncbi.nlm.nih.gov/25941303/

Frenotomy for tongue-tie in newborn infants.  https://pubmed.ncbi.nlm.nih.gov/28284020/

Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review. https://pubmed.ncbi.nlm.nih.gov/25941312/

The effect of ankyloglossia and tongue-tie division on speech articulation: A systematic review.  https://pubmed.ncbi.nlm.nih.gov/33964037/

This is an alarming increase compared to January through May 1 in 2021, 2020, 2019, 2018 and 2017, according to Cook Children's data.

This year, 11 drownings have occurred in swimming pools, one occurred in a hot tub, and five drownings were in bathtubs. Children ranged in age from 11 months old to 9 years old.

While most patients survived these incidents, drowning injuries can result in severe effects.

Many of the drownings in 2022 happened during unplanned swim time. This is when parents didn’t expect their child to be in or around the water. 

Parents can put barriers in place to help prevent a child from accessing the water or make it more difficult to access when an adult is not present. Barriers – such as locks, alarms and fencing – can help keep unsupervised young children from getting into swimming pools.

In 2021, more than 60% of drownings treated at Cook Children's were during unplanned swimming time.

Lifeguard Your Child

Cook Children’s initiated a drowning prevention campaign called Lifeguard Your Child in 2015 in response to a high number of drowning injuries treated in the Emergency Department and medical center that year. The Lifeguard Your Child campaign is spread through the Safe Kids North Texas Coalition, which is based in Fort Worth and led by Cook Children’s.

The campaign’s strategies include Cook Children’s Loaner Life Jacket Stations at many lake entry points across the region. Families can go to the stations to find U.S. Coast Guard-approved life jackets in a variety of sizes with easy tips for a proper fit.

Safety tips for home swimming pools: 
• Restrict access by installing door locks high out of children’s reach. Door and window alarms can signal if someone leaves the house. 
• Install four-sided fencing around pools with a self-latching gate that only opens out. The fence should be at least 4 feet (preferably 5 feet) high. 
• Remove all toys and floats from the pool area so children are not tempted to get close to the water. 
• For above-ground pools, make sure the ladder is removed and not accessible when it’s not swimming time. 
• Consider a pool surface alarm to alert if anyone/anything falls into the water. 

Safety tips for the bathtub: 
• An adult must stay at the side of the tub in reach of the child. 
• Pay attention. This is not the time for multitasking. 
• Ignore distractions like the doorbell or phone calls. 
• Drain the tub after each use. 
For more information about drowning prevention, go to www.lifeguardyourchild.org. 

There have been 118 outbreaks reported and more than 22 million birds have been affected since January, according to the CDC.

So what does this all mean for children? Nicholas Rister, M.D., of the Cook Children's Infectious Disease team is here to break down what the bird flu is and share what parents and caregivers need to know.

What is the avian flu and can people be infected by it?

The influenza virus circulates around the world through a variety of human and animal hosts. Generally, the virus tends to stay within the same animal groups (ie, bird/avian flu infects birds and pig/swine flu infects pigs) but since the influenza virus is very good at mutating on a regular basis, it is able to jump from one type of animal to another from time-to-time. 

In particular, bird and pig influenza viruses are known to jump between each other and human hosts. When these jumps happen, the virus is often quite a bit different from the last time human hosts saw it, so our immune system may not be as well prepared (ie, worse infection, easier spread). 

The major four global influenza pandemics in the 20^th century all occurred with an avian influenza jumping back to humans. But that is four pandemics in 100 years, so while we see lots of avian influenza viruses, they don’t all turn into pandemics. We also have flu vaccines made yearly that try to predict which viruses are most likely to emerge and provide so protection ahead of time.

What should parents and caregivers know about the avian flu?

Avian influenza in children presents like many respiratory viruses – fever, cough, congestion, fatigue, rash. In most cases, these symptoms will not become severe enough to require medical attention, but if a parent feels their child is having difficulty breathing or has altered mental status, they should certainly seek medical care. Very similar recommendations to many common illnesses. 

Additionally, the yearly influenza vaccine provides some protection each year against these infections. There are also anti-viral treatments (such as Tamiflu) available for patients that are found to have early infections with influenza to reduce the length of illness although many patients do not get ill enough to present for testing.

Why are zoos removing birds from exhibits?

This is out of an abundance of caution. Coming out of an era of COVID-19 pandemic planning, there is a lot of concern for any potential disease spread. 

The majority of documented cases of avian-swine-human influenza spread occurs at sites with consistent and prolonged interaction with animals. Think pig farms, outdoor butchers/food markers in developing nations, zoo workers. In all likelihood, no one was going to acquire a pandemic bird influenza from visiting a zoo exhibit but adjusting them may alleviate lots of concern with everyone on higher alert for respiratory viruses right now.

Should I be concerned about feeding my child poultry and eggs?

No. The virus spreads through close contact with the animals when they are alive or recently killed. Not from the food you would obtain at the store. However, be sure to cook and prepare all meat/poultry products appropriately since other concerns such as Salmonella always remain.

Should I be concerned about my child interacting with birds, such as feeding the ducks or through bird feeders at home?

Not in particular. While interacting with birds is how humans get avian flu, the conditions for transmission usually require a lot of persistent interaction as mentioned above. Routine interaction with ducks, small birds, outdoor feeders, is very unlikely to contribute much to the spread of avian flu.

As a result, some experts say many children are behind in their social and emotional development. In the first and second grade, kids are struggling with basic skills they’d typically learn in preschool and kindergarten, like taking turns, working in groups, keeping their hands to themselves, sitting quietly for a period of time, standing in line or unpacking their backpack on their own.

“Since the pandemic, I've noticed a lot of regression in kids,” said Amy Arriaga, a pre-K teacher at Fort Worth Independent School District’s Mendoza Elementary. “They have regressed to like they are at 2 or 3 years old and not 4 and 5. I’ve noticed an increase in separation anxiety. Now that we’re starting to go back to normal somewhat and mom and dad say you have to go to school, kids are like, ‘but you’re not going to go with me?’ I’ve also noticed more aggressive behavior and not being able to keep their hands to themselves.”

There’s also been a loss in the mastery of fine motor skills, according to Arriaga. She said most kids used to start pre-K with some basic skills, like how to properly hold a crayon and recognition of some shapes, letters and numbers. That’s not the case this school year.

Teasha-lee Frattarelli, D.O., is a developmental behavioral pediatrician at Cook Children’s Child Study Center. She said what teachers are likely seeing is a lack of typical or normal progression of pre-K students due to fewer opportunities to experience and practice their pre-academic skills, social skills and emotional self-regulation skills with peers and teachers outside of their family.

“I don’t think the children are regressing with their skills,” Dr. Frattarelli said. “It is actually a lack of progression that teachers are reporting which is likely due to the unprecedented experience during the pandemic, particularly when isolated with their family without an opportunity to attend school or daycare in person.”

The early years of education are the ones where kids get hands-on experience with life lessons that shape their social skills. What might look like play and entertainment to the untrained eye, be it in the classroom or on the playground, is actually reinforcing behavioral expectations, healthy relationships and emotional regulation in a way that appeals to kids.

Playing together in centers teaches little ones how to share, work together and relate to each other. A game of Mother May I challenges kids to listen and follow directions. Storytime on the carpet helps busy little ones learn to sit quietly and process what they are hearing.

“Teachers teach those behavioral expectations,” said Kathleen Kyzar, Ph.D., associate professor of early childhood education at Texas Christian University’s College of Education. “What does it look like to stand in line? What does it not look like to stand in line? What does it look like to have to sit in our seat appropriately? What does it not look like? Now we’re going to practice that. We’re going to teach you explicitly what we expect of you when you’re in school.”

Mastering social and emotional skills is as important to a child’s foundation and future as reading, writing and arithmetic. There is research-based evidence that positive social skills promote positive academic skills, according to Kyzar.

But the pandemic disrupted all of that and now teachers and parents are playing catch up to help kids reach their social and emotional milestones.

“I would say the pandemic has definitely taken people off of their typical developmental trajectory,” said Casey Call, Ph.D., LPC, associate director of professional practice and associate director of education at TCU’s Karyn Purvis Institute of Child Development. “In intervening with children there are two big areas that we focus on. One is building healthy relationships and the other is practicing regulation. The students who haven’t been in a classroom consistently or had any early childhood education have the potential to really get off of their developmental trajectory in these two skills.”

Regulation is the ability of a child to adjust, manage and cope with their environment and situation. As babies, they solely rely on their parents to regulate their environment for them. Eventually, they’re able to point to a blanket if they’re cold and then rely on someone else to give it to them. That’s called co-regulation. In time, they can self-regulate and get up to get the blanket and cover themselves with it.

It’s the co-regulation and self-regulation pieces that some kids are lacking because those are the pieces that require teaching, mentoring and practice. But young children haven’t had consistent opportunities to practice those things outside of their homes and in situations with others where they must manage big emotions and big behaviors. Those immature relationships and regulation skills are evident in many early childhood and elementary classrooms today.

“Early childhood teachers are setting the stage for understanding one’s emotions and being able to regulate behavior,” Dr. Kyzar said. “So engaging in turn-taking so that we understand that it’s my turn now and then it’s going to be my friend’s turn and I need to wait. Those are skills that are setting them up for academic learning later on and being resilient, listening to each other, and learning to problem-solve.”

For kids, consistency is key. It plays a huge role in their feeling of security. Kids who feel safe and secure are less anxious, better able to focus and have more energy to spend on learning. Consistent classroom routines set the stage for learning. Preschool and kindergarten teachers usually spend the first half of the year just going over classroom routines. Once those routines are in place, learning can begin. But with so many stops and starts to the school year, teachers have had to start again, and again, and again in teaching routines and acceptable behavior just to get kids ready to learn.

That’s why it’s so important to reinforce these activities at home. Practicing, modeling and reinforcing social and emotional skills at home — taking turns, keeping emotions in check during conflict, listening well, following instructions, being patient — can help set kids up for success in school and in life.

The good news is that helping kids get back on their developmental track with these skills doesn’t have to be complicated. Kids engage, speak, process and learn through play. Fun is their universal language. When they’re playing and having fun, they’re also practicing important life skills. For example, a game like Simon Says reinforces regulation while players listen, wait and think about their response. And as you play with your child — or cook with them, take a walk with them or participate in any activity they enjoy — you’re modeling what a safe and nurturing relationship looks like.

“I think the stress that parents have been feeling has been really overwhelming,” Dr. Call said. “With everything they have on their to-do lists sometimes parents can spend all of their time on structure, things like setting and enforcing rules, correcting behavior, and making sure school work is complete, while the nurture, or the joy and play, gets pushed down to the bottom of their list. When stress is high, we need to make it a priority to balance nurture and structure.”

Parents, teachers and kids will inevitably play catch up on meeting these social and emotional milestones in the months and years ahead, and time will tell the depth and breadth of developmental and learning loss due to the pandemic. If your child is struggling with social skills and regulating their emotions, set aside a little time for some fun. If you feel they are particularly behind or struggling to cope, talk to their teacher or pediatrician for guidance and help.

Nine of those drownings in the stretch from January through middle March occurred in swimming pools. Three occurred in bathtubs. The children ranged in age from infancy through 9 years. 

Sharon Evans, trauma injury prevention coordinator at Cook Children’s, pointed out that drownings typically peak between Memorial Day and Labor Day but can occur any time of year. 

“If you have water, there's not an off-season,” she said. “A lot of these seem to happen on the weekends when the weather's nice and people go outside working in the yard. The child falls in the pool or somehow gains access.”

Data from Cook Children’s show two or fewer drownings in January-February each year from 2018 to 2021. The trend this year is unusual and concerning to Evans, who urges parents and caretakers to take precautions and stay vigilant to guard against accidental drowning injuries.

Last year, more than 60% of drownings treated at Cook Children’s occurred during unplanned swim time. This is when parents didn’t expect their child to be in or around the water. Parents can put barriers in place to help prevent a child from accessing the water or make it more difficult to access when an adult is not present.

Those barriers – such as locks, alarms and fencing – can help keep unsupervised young children from getting into swimming pools.

“We always talk about those layers of protection. They're not guaranteed to prevent a drowning, but they do slow the child down as far as gaining access,” Evans said. “Toddlers are just curious. They're going to explore and see what they can figure out. As parents, we have to make sure they are safe.”

Sometimes the child who drowns in a backyard pool was playing outdoors with older siblings. Other times, the parent doesn’t realize the child left the house through an unlocked door or doggie door. Ice chests, mop buckets and horse troughs can also present hazards if they hold more than an inch of water, Evans said.

One rule prevails when it comes to bathtubs: Never leave the child alone … not to answer the doorbell, not to pick up the phone, not even for a second.

“I often say with injury prevention across the board, there is no do-over,” Evans said. “Just be alert.”

Cook Children’s initiated a drowning prevention campaign called Lifeguard Your Child in 2015 in response to a high number of drowning injuries treated in the Emergency Department and medical center that year. The Lifeguard Your Child campaign is spread through the Safe Kids North Texas Coalition, which is based in Fort Worth and led by Cook Children’s.

Dana Walraven, manager of community health outreach for the Center for Children’s Health, led by Cook Children’s, said partners across 11 counties share education, access to swim lessons, safety videos, resources and social media with a consistent theme: Lifeguard Your Child.

“Knowing social media messages alone have reached millions, the messages and awareness are making a difference for a safer community,” Walraven said.

The campaign’s strategies include Cook Children’s Loaner Life Jacket Stations at many lake entry points across the region. Families can go to the stations to find U.S. Coast Guard-approved life jackets in a variety of sizes with easy tips for a proper fit.

Safety tips for home swimming pools: 
• Restrict access by installing door locks high out of children’s reach. Door and window alarms can signal if someone leaves the house. 
• Install four-sided fencing around pools with a self-latching gate that only opens out. The fence should be at least 4 feet (preferably 5 feet) high. 
• Remove all toys and floats from the pool area so children are not tempted to get close to the water. 
• For above-ground pools, make sure the ladder is removed and not accessible when it’s not swim time. 
• Consider a pool surface alarm to alert if anyone/anything falls into the water. 

Safety tips for the bathtub: 
• An adult must stay at the side of the tub in reach of the child. 
• Pay attention. This is not the time for multitasking. 
• Ignore distractions like the doorbell or phone calls. 
• Drain the tub after each use. 
For more information about drowning prevention, go to www.lifeguardyourchild.org. 

Flu cases continue to increase at Cook Children's Health Care System. From March 13 to March 19, there were 275 positive cases of influenza A and zero cases of influenza B.

Positive flu cases have steadily increased every week since mid-January.

For the week of March 6 through March 12, lab data showed that there were 242 positive and 511 negative cases of influenza A. There were zero positive cases of influenza B.

By this time of year, typically cases decline.

“But what we have seen over the last week or two is cases are actually on the rise,” said Pediatrician Alice Phillips, M.D. of Cook Children's Pediatrics Cityview.

There has been more activity during the 2021-2022 flu season compared to 2020-2021. Typically, the flu season starts in November and the spike can be in December or January, Dr. Phillips said.

Why is there a current increase in cases? One potential contributing factor comes from people wearing their masks less frequently and returning to pre-pandemic activities. On Feb. 25, the Centers for Disease Control and Prevention issued new masking guidance for areas of low transmission of COVID-19.  These guidelines can be read here.

With students out of school for spring break, it could potentially stop the spike of cases, but pediatricians will have to wait and see the data when kids return to the classroom, Dr. Phillips said.

What are the symptoms? What should I do?

It’s a good idea to get your child tested if you believe they have the flu, Dr. Phillips said. The symptoms are similar to COVID-19 because both have symptoms of fever, cough and a sore throat. Both illnesses could potentially pose a risk to someone who is immunocompromised.

If you have the flu, you should isolate. You can stop isolating once you’re fever-free for 24 hours without fever-reducing medicine.

Common flu symptoms are:

• Fever or feeling feverish/chills
• Cough
• Sore throat
• Muscle or body aches
• Headaches
• Fatigue (tiredness)
• Vomiting and diarrhea are more common in children than adults

When should we go to the doctor?

“I think anytime a parent has a concern about their child, they should call their provider because if you're worried, your instincts as a parent are very strong,” Dr. Phillips said.

She said also it could be good to bring them to the doctor if:

• They’ve had a high fever that you can’t control
• Showing signs of dehydration, such as dry mouth, no tears in their eyes
• If your kid looks sick and you want them checked

Typically, a child can recover at home. You can call and get guidance over the phone if they’re keeping fluids down, and they’re resting and can control the fever.

Remember, it is not too late to get your flu shot. This serves as your best defense against the flu when combined with good handwashing.

Then on Wednesday, a children's hospital and maternity ward in the Ukrainian port city of Mariupol was destroyed in the Russian airstrike and resulted in more than a dozen injuries, according to the New York Times.

Beginning tonight, the blue lights that illuminate Cook Children’s Medical Center at night will shine with accents of gold in support of Ukraine, its children’s hospitals and health care workers.

As the war wages, the health care needs of Ukrainian children will undoubtedly increase, as will the need for additional medical supplies.

At Cook Children’s, we are doing what we can to support efforts to meet those needs. Right now, we are taking our lead from the Children’s Hospital Association (CHA), of which Cook Children’s is a member. Rick W. Merrill, Cook Children’s president and CEO, chaired CHA’s board of trustees in 2018. 

“Knowing that sick and injured children are trapped in the middle of a war zone and supplies will inevitably run low is devastating,” Mr. Merrill said. “Cook Children’s will do whatever it can to support the response efforts of CHA. We are in touch with our colleagues there and will respond if and when a request is made. The ability to coordinate with health care systems all over the country and across the globe to help kids in crisis is the beauty of CHA.”

Children’s Hospital Association is in close contact with its European counterpart—the European Children’s Hospital Association (ECHA). The ECHA comprises hospitals within the European Union and Israel that are closest to the action. Their immediate focus is on critically ill children whose care needs make it very difficult to evacuate them to other hospitals within the region. Most of Ukraine’s pediatric intensive care capabilities reside in the capital city of Kyiv, meaning these hospitals, children and their medical providers are surrounded by heavy fighting.

Children’s Hospital Association and ECHA are working together to coordinate support for these hospitals and their patients, and exploring ways to safely transfer the most critically ill among them to other hospitals within the region and beyond, if need be. The logistics of this are extremely complex.

Children’s Hospital Association is also reaching out to representatives within the federal government to champion the plight of critically ill children in Ukraine and encourage them to keep them top-of-mind as they allocate support for the Ukrainian government.

In the short term, Cook Children’s Command Center is working with the Supply Chain Department to identify supplies that could be sent to ECHA, CHA or other organizations for distribution to hospitals in Ukraine. They’re pulling together things like masks, sanitizing wipes, medical tubing and surgical supplies.

Our hearts are hurting for the people of Ukraine, especially the children. No child should have to suffer the atrocities of war. While our Promise is to care for all children here at home, we stand with our comrades around the globe doing the same within their communities. We will remain aware of their situation and needs, and we will answer the call for help when it comes.

RELATED: How to Talk to Your Children About the Crisis in Ukraine (checkupnewsroom.com)

Fifteen years ago, two young friends made a promise. As 4-year-old Michael Mancuso battled neuroblastoma, a rare type of cancer that occurs in infants and young children, his friend Alexa Sankary supported and encouraged him. Just before he passed away in September 2007, Alexa promised she would help find a cure for other children still suffering from this terrible disease.

Alexa kept her promise by starting The Blast, a walk to find a cure for neuroblastoma. In the 15 years since that promise, The Blast has grown to support children battling all forms of cancer at the Cook Children’s Hematology and Oncology Center.

During the time Michael spent at Cook Children’s, another patient battled neuroblastoma alongside him. Elesha Debenport was diagnosed a month before her third birthday. 

Elesha lost her battle with cancer on June 22, 2007, just three months before her friend Michael passed away. She was 5 years old. When The Blast was held for the first time just a few months later, Elesha's mother, Karen Debenport, and her family were there to help find a cure for other families fighting neuroblastoma. Every year since Karen has been involved in The Blast as a committee member.

“Elesha would have been 20 on Feb. 6, 2022, if she had survived. This memorial of her life, her birthday, has helped me galvanize why I remain involved in The Blast,” Karen said. “I want to be a voice for families affected by childhood cancer. This event uncovers the very obscure lives of children with cancer and their families, and it’s an opportunity to stand with them in their suffering, sorrow, loss and in the overcoming.”

Michael and Elesha met on the hematology and oncology floor, and would often send things back and forth to each other to show love. Karen remembers her daughter as a vibrant little girl who showed love to everyone she met.

“She loved to read, talk and have conversations,” Karen said. “The nurses were in awe of her verbal skills. Elesha was a very sweet child, and she loved her family. She was always thinking about what she could make for her siblings, and what she wanted to share with them.”

Meaghan Granger, M.D., a pediatric hematologist/oncologist, walked in the first year of The Blast, too. Dr. Granger leads the neuroblastoma team at Cook Children’s and personally treated both Michael and Elesha.

“It is a privilege to have known Michael and Elesha and cared for them and their families,” Dr. Granger said. “When they were diagnosed with neuroblastoma, those kids fought extremely hard against a terrible disease. Families with neuroblastoma spend a lot of time at the hospital and get to know other patients. Around the time that Michael and Elesha were in treatment, we had several other neuroblastoma patients who bonded together and formed a small ‘army’ to fight together. They were such an inspiration.”

In the U.S., more children are lost to cancer than any other disease. In fact, about one in 264 children will have cancer before the age of 20.

“When you’re looking from the outside, you think ‘oh, that’s awful,’ and then move on,” Karen said. “On the back of the tribute signs [at The Blast], there are phrases like ‘It could be your child,’ or ‘It could be your friend’s child.’ I hope that The Blast is an opportunity to face the truth that children get cancer.”

When a child is battling cancer, their family suffers as well. Parents often must spend days and weeks away from work and other children as they support their child through inpatient stays. Siblings face long-term emotional struggles as they learn to cope with feelings of loss and loneliness.

“My participation in The Blast announces to these children that they are not alone, and shows their siblings that our community cares about them,” Karen said. “I want them to have a future free from the harming effects of chemotherapy and the emotionally devastating effects of family separation that occur during treatment.”

Thanks to improved treatments, more children survive pediatric cancer than ever before. Many survivors will, however, face significant health-related issues later in life, caused by side effects of either cancer or, more commonly, the result of its treatment.

“Thanks to Michael and Elesha’s fight and the ongoing support of their families, we have seen miracles happen for those who are being treated today,” Dr. Granger said. “Not all of our patients are cured, and so we continue to fight and pursue new therapies and strategies on how to combat this disease until we see a cure for each and every child.”

The Blast 2022

The 15^th annual The Blast will take place on April 2, 2022 at Panther Island Pavilion in Fort Worth. Every dollar raised will bring more research, clinical trials and treatments closer to home for patients and families at the Cook Children’s Hematology and Oncology Center.

Families and friends of kids like Elesha and Michael walk every year to find a cure. You don’t have to know someone who has been affected by childhood cancer to get involved; The Blast is a way to stand with these families in their grief, and hope for a brighter future. You can support patients through every stage of their journey by signing up to walk, asking for donations and sharing their stories.

“This is our community. These are our children, and we need to provide treatments for them that aren’t as harsh,” Karen said. “The Blast is an opportunity to come together as a community and remember, celebrate and look forward to better, less toxic treatments. It’s an opportunity to hope for better days to come.”

Visit blastwalk.org to sign up for The Blast 2022 today.

Let’s start with a story. 

As I began the introduction of solid foods to my first child, I was by the book! One food at a time. Slow introduction to make sure it was safe.  That kid was pretty picky but as an adult eats just about everything.

Then came my second.  At 7 months, we were out to dinner with family and enjoying some crab dip.  She was begging for it so…. she ate a bunch.  That kid was never picky but as an adult eats just about everything.

Different paths to the same ending

Flash forward to now, as I took on a challenge to dig into baby led weaning (BLW) I learned a lot.  I also learned that we have a ways to go in understanding this subject completely.

The name Baby Led Weaning (BLW) was coined as far back as 2005 by author Gill Rapley who completed some of the early studies on BLW as part of her master’s thesis.

So, what is weaning?  This is best described as the time that infants transition from breast milk or formula to the consumption of solid foods.  Traditionally, this has been recommended to begin at 6 months of age through the gradual introduction of foods via spoon feeding of purees.  As babies mature developmentally, this then transitions to finger foods and use of a spoon and fork.

Baby led weaning (BLW) differs from this classic model because spoon feeding of purees is skipped. Its basic model includes:

• Feeding of complimentary foods begins at age 6 months as infants attain the developmental ability to sit securely in a highchair, SAFETY POINT!
• The baby sits with the family during mealtime.
• An adult is always with the child while eating, SUPER SAFETY POINT
• Food is offered in pieces of shape and size which are developmentally able to be explored by the infant.  At 6 months, this is strips or fingers of foods with transition to bite sized pieces as cutlery is introduced.
• The infant self feeds from day 1.
• It is up to the baby how much and how quickly she eats.

Parents and health care providers seem to agree on the potential but unproven good parts of BLW:

• Self-feeding promotes fine motor skills
• Shared family mealtimes
• Infants develop good recognition and response to hunger and safety cues
• Prevents picky eating (no data to support)

What are the disadvantages of BLW?

It’s messy and time consuming.  When babies are given the freedom to explore food with their hands….man do they explore.  They will squeeze and squish the food with maybe a little bit ending up in their mouth.  More lands on their face, in their hair, in their ears and on the floor.

Time is not a luxury all moms have.  BLW requires giving the infants time for this exploration and when you’re trying to get the crew fed, dressed and out the door, this can be difficult to manage.

The book at first read sounds great.  However, as a pediatrician, I need to dig in on what science we have to support the safety and health benefits to kids.

The more I read and researched, the more I began to see phrases such as:

• Insufficient evidence
• More research is needed  
• Current studies inadequate to support a general recommendation

Even the reference section for the book itself only lists 10 references for the main content of the book and two of those are the author’s own studies.

The greatest concerns from health care providers surrounding BLW include the risk of choking and potential inadequate calorie/energy intake and inadequate nutrients mostly focusing on iron.

Several studies have attempted to dig in on these topics and the results are a mixed bag.

One impressive study, Baby-Led Introduction to Solids (BLISS), did a randomized control study on this topic.  These fancy words mean infants were randomly divided into two groups.  One group received standard well child information on introduction of foods at 6 months while the other had additional education provided for BLW but with something extra.

BLISS provided caretakers with focused advice on minimizing choking! This included both general advice as well as specific foods to avoid such as raw apple slices, grapes, whole nuts, popcorn, and foods such as sausages, which can be sliced into coins. With this education, there was no measurable difference in choking between the two groups.

BLISS also targeted education of the specific types of foods to offer kids for balanced nutrition.

That is a lot of information.  You're probably asking, “Yeah it sounds like a good idea if done safely, but should I do it?”

Here’s what I think.  Most parents I see in my office who try BLW tend to adopt a healthy mix of both old and new - both purees and table food when they are introducing foods to their infant.

Dr. Diane Arnaout at Cook Children's Forest Park seems to see a similar pattern.  She states, “BLW certainly seems to be growing in popularity thanks to social media and the online sharing of experiences. As a pediatrician, I don’t really mind what feeding method parents choose, as long as it seems appropriate to the infant’s developmental abilities. Parents know their baby best - if BLW seems to not be going well, I encourage them to take a few steps back and trial softer, smoother foods. If they try BLW and it just doesn’t fit for their family, no big deal. Purees are totally fine, too. I sometimes tease that this isn’t the difference between Ivy League and community college - all kids will learn to eat eventually.”

These words seem to mirror my story from the beginning.

Different paths to the same ending.

References:

• Rapley, G., Murkett, T. (2008, 2019) Baby-Led Weaning, the Essential Guide. The Experiment, LLC
• Brown, A., Jones, S., Rowan, H. ( April, 2017) Baby-Led Weaning: The Evidence to Date.  Curr Nutr Rep 6:148-156
• Azuria, E. et. Al. ( 2018) Baby-Led Weaning: What a systematic review of the literature adds on. Italian Journal of Pediatrics. 44:48
• D’Andrea, E. et. Al. (2016) Baby-led Weaning: A Preliminary Investigation. Canadian Journal of Dietetic Practice and Research. Vol. 77
• Fangupo, L. Et. Al. (2016) A Baby-led Approach to Eating Solids and Risk of Choking. Pediatrics.

Mixed emotions including frustration, worry and anxiousness (to name a few) fill my being yet again on the eve of the day my kids return back to school. It is no longer a new experience for me or the many other parents who have experienced the same feelings over the last 22 months.

 The significant positivity rate in our community and the marked rapid increase in the pediatric cases and pediatric hospitalizations in the last week and a half (all while kids are out of school) is what causes some of my angst. Unfortunately, now it is not too uncommon to hear situations in which people “did all the right things” but COVID still veered its way in. So while I have been able to shield and protect my own children from being infected during the pandemic so far, I fear that the time will come when the inevitable will happen to my own. What’s different now?

 In the midst of all these emotions, I look for the silver lining in our current situation. My kids are NOW vaccinated! Although we are well aware that even fully vaccinated people are susceptible to infection they are less likely to develop severe disease and the need for hospitalization. So in the midst of the mixed emotions I have come to the point of realization and acceptance that this time around I will not likely be able to shield my own children from becoming infected with the current COVID omicron variant.

 The current significant community positivity rate makes exposure and subsequent infection while attending school more likely in the era of optional masking and confusion regarding isolation/quarantine recommendations. In the midst of an ongoing roller coaster of emotions, I will hold on to what I can control and continue to practice and encourage my own children to practice preventive precautions as best we can, including vaccination (done), hand washing and mask-wearing.

 I make the same recommendations to my own patients and their families including the following disease prevention strategies:

• Eat a balanced diet and exercise regularly
• Get plenty of sleep
• Drink plenty of water
• Do not send sick children to school (regardless of COVID exposures or not). Keeping sick children home is the best way to prevent spread in the school setting. 
• Get yourself/or your child tested if you/they develop any symptoms of COVID-19. Testing and identifying infections and subsequent proper isolation practices will prevent further spread.
• Get vaccinated if you haven't already and get a booster if you or your child are eligible (primary series approved for 5 years old and up, boosters approved from 16 and up and anticipating approval for 12-15 year olds soon).
• Practice good hand hygiene, wear a mask and avoid large crowds.

 Given the ongoing change and updates to guidance regarding isolation/quarantine guidelines for different populations of the community, we know that navigating these situations can become confusing and overwhelming. For questions regarding testing, length of quarantine or isolation, and the COVID-19 vaccine for your child, please ask your pediatrician for guidance.

 Wishing you a Happy and Healthy New Year!

Dr. Soria-Olmos

Get to know Bianka Soria-Olmos, D.O.

Dr. Soria-Olmos is a Cook Children's pediatrician in Haslet. She was born and raised in Fort Worth, Texas, so Cook Children's has always had a special place in her heart. She came to know Cook Children's when she was just a kid herself. She went to the medical center a number of times with her active younger brother, who needed care following several mishaps with broken bones. The visits inspired her to decide, "I want to be a Cook Children’s doctor one day."

In pursuit of her dream, Dr. Soria-Olmos attended Texas Christian University (TCU) for a degree in biology and to fulfill the pre-medical school requirements. After graduating from TCU, she chose to stay local and attended medical school at the University of North Texas Health Science Center/Texas College of Osteopathic Medicine in Fort Worth. She completed part of her pediatric clerkship at Cook Children's, learning about pediatric medicine by attending rounds with pediatric hospitalists. It was then she knew she wanted to be a pediatrician.

She began her career with Cook Children's in 2014 as a pediatric hospitalist caring for sick children admitted to the hospital. Today, she works at Cook Children's primary care office in Haslet. Her special interests include child safety, child development and asthma.

The family of Michael Stuyvesant knows he beat the odds on a hot June day six years ago when he survived being accidentally left in the mini-van parked outside their Garland home.

Michael, 3 years old at the time, experienced brain swelling, seizures and other trauma caused when his body overheated. He was hospitalized for 10 days – three of them in intensive care – and then spent almost a month in a rehabilitation facility. Michael had to relearn skills such as walking, eating and playing.

His father says Michael still deals with short-term memory loss. But the Stuyvesants count themselves lucky that he didn’t die in the accident. On average, 39 children in the United States suffer fatal injuries every year from what’s known as pediatric vehicular heatstroke, a tragic and preventable danger. Four children have died so far in 2021 as of mid-June.

Eric Stuyvesant wishes his vehicle had been equipped with a device to remind him that Michael was asleep in the car seat that day in 2015. Some type of alarm “would have saved a lot of anguish, tears and heartache,” he said.

Legislation introduced last month in the U.S. Congress would require automakers to install technology that detects a backseat occupant, and then alerts the driver. The Hot Cars Act would make the technology a standard safety feature in every new passenger vehicle. The legislation calls for sensors and warning systems in an effort to protect unattended children and pets.

Here’s an example, a rear-seat reminder: If someone opens and closes a car’s back door within 10 minutes of starting the ignition, an alert will activate later whenever the vehicle shuts off. The alert chimes and a message on the instrument panel tell the driver to check for backseat riders. Supporters of the Hot Cars Act draw comparisons to other technology mandated over the years for auto safety, such as seatbelt reminders and levers for emergency release in trunks.

Chad Hamner, M.D., pediatric surgeon and trauma medical director at Cook Children’s, believes in the potential benefit of such devices whenever parents and caregivers unintentionally leave their little passengers behind.

 “It’s not a sign that you’re an unintelligent person or forgetful. It just happens,” Dr. Hamner said. “We get in a routine or we’re thinking about other things. It’s natural human behavior.”

When it comes to excessive heat, infants and young children are particularly at risk. Their bodies heat up five times faster than an adult in the same environment as a result of a larger surface area relative to body mass for heat exchange with their surroundings. Infants are at exceptional risk as they also have an immature temperature regulatory system.

What happens during heatstroke? Dr. Hamner said profuse sweating leads to loss of water and electrolytes, which can rapidly produce dehydration. A severely dehydrated child can’t maintain adequate blood pressure to support the delivery of oxygen and nutrients to their vital organs. According to Dr. Hamner, eventually heat stroke results in cardiovascular collapse and damage to muscles, the kidneys, the intestines and the brain. In the emergency department, the staff works fast to bring down the body temperature and replace lost fluids and lost electrolytes.

 Symptoms of hyperthermia include rapid pulse, shallow breathing, flushed skin, high fever, vomiting, dizziness, confusion and loss of consciousness. Organs start shutting down when the body core temperature reaches 104 degrees, said Sharon Evans, trauma injury prevention coordinator at Cook Children’s.

“Usually by the time the child is found (in a hot car), they‘re dead. They rarely even make it to the hospital,” she said.

Texas leads the nation in the most fatalities, with 132 since 1998, including five last year. Evans said public awareness campaigns in the state have made a difference. But she also favors the implementation of more technology, such as devices that detect motion or breathing in the back seat. She supports the Hot Cars Act.

Experts want caregivers and bystanders to know: 

1. Never leave a child unattended in a vehicle, not even for a second, even with the windows cracked and the air conditioning on.
2. Create a habit of checking the back and front seats before you walk away from the vehicle.
3. As a reminder, place something essential -- your purse, briefcase, shoe or other personal items -- next to the child during the drive.
4. Teach your children that a vehicle is not a play area. Keep the doors locked, even if the car is in the garage. Keep the keys out of reach.
5. If you see a child alone in a car, try to get him out. Call 911.

State law in Texas gives liability protection to anyone who forcibly enters a locked vehicle (by breaking a window, for instance) to reach a vulnerable person inside who faces imminent harm. State law also protects the confidentiality of anyone who calls to report suspected child abuse or neglect.

Statistics kept by the advocacy groups KidsandCars.org show July as the deadliest month for pediatric heatstroke. Even in milder weather, the temperatures inside a vehicle can quickly climb to a hazardous level. Studies found that in just 10 minutes a car’s internal temperature rises 19 degrees. To put it another way … 80 degrees outside, but a sweltering 99 degrees for anyone inside the vehicle.

KidsandCars.org keeps track of pediatric vehicular heatstroke in three main categories: A caregiver forgets the child (55% of cases), the child gets into the car on his or her own (26%), and someone leaves the child in the car deliberately (14%). A common thread in many instances is a deviation in the family’s routine on the day of the accident.

That’s what happened to the Stuyvesants on June 10, 2015. Eric Stuyvesant normally dropped off Michael at daycare and then drove his wife Michelle to work. But this particular day, to get Michelle to work earlier, he drove her to the office first with the intention of stopping off at daycare on the way back. But the phone rang, autopilot kicked in, and he forgot about Michael.

“I drove down to my regular exit, drove home, finished my phone call, went in the house and cooked my breakfast,” Stuyvesant said. “About 45 minutes later I remembered we hadn’t been to the babysitter.” He found his son “barely hanging on.”

He rushed Michael into a cold shower, gave him mouth-to-mouth resuscitation and put an ice pack on his carotid artery while waiting on paramedics to arrive. At the hospital, doctors put the boy into a coma to reduce swelling in his brain. Recovery wasn’t easy.

Stuyvesant and others emphasize that heatstroke accidents can happen to anyone. Because of what his family went through, Stuyvesant now makes the case for all new cars to come equipped with the features that the Hot Cars Act endorses.

“If we have technology in our vehicles that remind us that our cell phone is plugged in, our headlights are on, our turn signal has been blinking for awhile, we ought to have technology that remind us we forgot where we are and we need to turn around and go to the babysitter.”

She gives tips to parents about the importance of checking the volume of their child’s headphones and earbuds. The question for the column: My child wears headphones for school and on long car rides. Can this hurt their hearing? The answer, yes.

We live in a world where children love to watch movies or play games on their electronic devices, but Vaughan warns that prolonged headphone use can be risky.

“What is ‘too loud’ can vary based on a child’s ear size, type of headphones, and length of listening time,” Vaughan said.

With children having control of how loud or soft the volume is in their ear, she says listening at too high a volume can cause permanent hearing damage.

Vaughan explains if you can hear what your child is listening to, the volume is too loud and urges parents to use headphones with volume limits.

In the column, she also teaches parents that headphones are always a better route to go than earbuds, and often the volume has to be louder in earbuds to compensate for the way they fit in a child’s ear.

Lastly, she gives guidance that best practice may be for your child to go without headphones, but to also remember that external speakers can also be a hazard if your child is too close or the volume is too loud.

Now that that’s out of the way.

They’re painful, not fun to look at and just all around annoying, for everyone, but especially for teenagers.

Which is why it’s important that parents and teens know what they are and what treatment options are available.

What are fever blisters?

Fever blisters are ulcers of the lips, usually at the border of where the lips meet normal skin. Other types of ulcers can be confused with fever blisters but these usually occur inside the mouth or on the tongue.

They are caused by a recurrence of a viral infection known as herpes simplex virus (HSV). Many families are not aware of their children’s first HSV infection because it may be mild or have no symptoms. They are contagious, so it’s not uncommon for multiple family members to struggle with fever blisters.

The sores can come and go, especially during times of stress, illness, sunlight or fever. Most commonly they’ll appear around prom or other times when pictures are super important (acne has a similar skill). Before the sores erupt, some people will feel itching or pain in the area, but not always.

How can we treat fever blisters?

There are two main considerations for treatment of fever blisters:

1. Who needs treatment
2. What strategy of treatment are we going to use

Treatment is unnecessary for most teens with fever blisters. If the pain isn’t severe and their outbreaks are small and short, it’s perfectly fine to keep an eye on them and treat pain with topical therapy or ibuprofen.

In children with more severe but infrequent issues, treatment with an anti-viral medication can be started when they first begin to feel the signs of an oncoming fever blister. This treatment has been shown to decrease the severity and length of the outbreaks.

This pediatrician has watched your mental battles from the sidelines this year, Mama.

2020 was not an easy year to be a mom.

Personally, I can tell you it kind of sucked, right? Just a little. The pandemic brought about so many hard choices that NO mother should ever have to make. My brain’s stream-of-consciousness ran a little something like this:

“Should I let my kids play with other kids? Will they get sick if they do? Will not interacting with others harm them more than catching COVID will? Should we start in-person school? Will masking all day be hard for them? Is virtual school a better option for us? Will looking at a screen all day hurt my kid’s eyes? Will lack of interaction with peers lead to social regressions? Are my kids eating and snacking too much? Do I need to choose between my kids seeing their friends, and my kids seeing their grandparents? Is my child in his room too much? Is he exercising enough? Is he sad too often? Is social media going to influence his behavior? Is it normal for sleep to be this much of a struggle – for both me and my kid? Am I telling my kids to wash their hands too much? Will this give them a germ complex? What do I tell my kids when they see those protests on the street? What do I tell them when they see the news on TV? What do I say when they hear people angry and shouting at each other?”…and so on and so forth…over and over…and for me, usually happening at 3 a.m.

So now that you know that I worried about a lot of the same things you did, let’s talk.

This Mother’s Day I’d like to tell you about what I’ve seen and heard in the privacy of my exam rooms.

More anxiety than I’ve ever seen in my career. In both parents and kids.

More depression in children and teens.

More mental crises.

More weight gain.

More screen addiction.

More sleep problems.

More suicidal thoughts.

Momming has never been more difficult. Not only have we been burdened by our own mental struggles, but we’re trying to cope with our kids’ mental strain now more than ever.

Some advice:

1. “Put on your own oxygen mask first – and then help your children with theirs”. Take care of yourself so that you can then throw that energy into your child and his/her struggles.
2. Look for help – Cook Children’s pediatricians, psychologists, and psychiatrists and hospital staff are here for you. We know kids - especially the mental health of kids. Check out the new Cook Children’s JOY Campaign for TONS of resources.
3. Please, ask questions. If your kid is struggling, ask your pediatrician – will some socializing be okay? Should my kiddo return to school/ go to camp? Is it safe? What are the pros/cons? What is the risk by doing this activity or that one? How much screentime is healthy for my kid? Is this behavior normal, or is my teenager showing signs of a problem? What are some resources so I can learn more?
4. Look into counseling. At my office EVERY DAY I tell parents: every single human on the planet goes through a time in their life where they’d benefit from therapy. Do it. Don’t feel weird about it. Just go talk to someone – and take your kid to talk to someone. Psychologists are trained to help you through this.

From one mom to another: we are not meant, as humans, to deal with as much stress as we have in the past year and come out unscathed.

There’s a reason you keep hearing the word “unprecedented” when it comes to 2020 and 2021. The pandemic, the politics, the civil unrest - this was a year that no one anticipated, and no one was prepared for. Know that you’re not alone in what you or your child may be dealing with.

So put down your armor, you warriors. And reach out your arms and accept some help! And give yourself a little grace.

This year was a scary and painful mess. And this Mother’s Day, no matter how much you yelled at your kids, no matter how much you felt you didn’t have the answers, and no matter how much you questioned your decisions, I want you to pat yourselves on the back. Because just surviving has been the victory here. And you’re doing the best you can.

As COVID-19 continues to inundate our society, there arises the question of when to start the countdown clock of quarantine. Let’s say mom gets sick with COVID-19 and stays at home as she is supposed to. Centers for Disease Control and Prevention (CDC) guidelines state children should avoid physical contact with the sick parent.

For children staying in the home of a sick parent, the CDC recommends:

• Both parent and child (over age 2) should wear a mask while in the same room

• Wash your hands frequently for at least 20 seconds

• Try to stay six feet apart, if safe to do so

• Increase ventilation by opening a window

• Disinfect high touch surfaces (phones, remote controls, counters, table tops, doorknobs, bathroom fixtures, toilets, tablets, bedside tables, light switches) often

• Avoid sharing personal household items (dishes, cups, eating utensils, bedding, towels)

• Watch closely for any symptoms of COVID-19

Now let’s say dad has COVID-19, and his symptoms started seven days after mom became sick. What do you do about children returning to day care or school?

The CDC states anyone who has had close contact with someone with COVID-19 should stay home for 14 days after their last exposure to that person. What is not exactly specified is what to do if the COVID-19 positive parent and asymptomatic children are in constant contact in their own home. I recommend a safe watch and wait approach, practicing the above recommendations and if the child is still asymptomatic at the completion of 14 days after the parent’s 10 day isolation ended (which is a total of 24 days after the parent became ill or had a positive test), then they can resume day care and school attendance. The 14-day countdown would begin at the end of the most recent family member’s 10 day isolation period (in our scenario that would be dad’s). And as COVID-19 can slowly trickle through the household, this can be a month-long lockdown.

With any sick symptoms in your child following an exposure of COVID-19, they should see his or her pediatrician and get tested. If your child does test positive for COVID-19, they can be around others 10 days after symptoms first appeared, as long as their COVID-19 symptoms are improving and they have not had fever in 24 hours without the use of fever-reducing medications.

What is mRNA, and how does it differ from other vaccines we are familiar with?

Messenger RNA is a new type of vaccine technology. It has been studied for a couple of decades and has been researched for things like cancer vaccines. Messenger RNA is a molecule that we all make billions of copies of in our bodies every day.

The way this vaccine works is that messenger RNA is in the syringe and is injected into your arm. That messenger RNA is taken up by muscle cells and other white blood cells in the area. The messenger RNA tells your body to make the spike protein from the virus. When your body makes the spike protein, that's recognized as foreign, it doesn't belong there. Your immune system learns what the spike protein from coronavirus is, makes a response and develops antibodies, while other parts of your immune system learn about the spike protein. The coronavirus has the spike protein, and if you're exposed to it later, your body says, “Oh, this is that spike protein, I know what to do about this,” and binds it and prevents infection.

How was the COVID-19 vaccine made so quickly and how does that timeline compare to the development of other vaccines? 

The speed of this vaccine is one of the real miracles of modern science. The difference between this vaccine’s development and other vaccines like Prevnar, Menactra or the hepatitis A vaccine is that the steps for those were done one at a time over about six years. For the COVID-19 vaccine, all the steps were all done simultaneously.

If you're developing a Prevnar or a hepatitis B vaccine, you:

• Figure out what kind of vaccine you want to make, a live virus vaccine or a bacterial protein.
• Develop the vaccine.
• Conduct a Phase I trial to look at the dose.
• Conduct a Phase II trial where you look at about 500 or a thousand people, and you give them the vaccine to see if it's safe. 
• Conduct a Phase III trial of 10,000 or 20,000 people to see if it works.
• Get FDA approval.
• Make the vaccine. That may take a year.
• Distribute the vaccine. That may take another six to 12 months.

For Operation Warp Speed, a couple of things worked in our favor. Messenger RNA technology was available and the machines and scientists were already in the labs. Normally, a Phase II trial would take a year or two to get a hundred or more volunteers to enroll. It could take three years to get another 10,000 or 15,000 volunteers. With there being an active pandemic going on, there were more than 30,000 volunteers overnight.

To see if the vaccine works, there has to be enough disease in the community to cause enough infection to see if the vaccine is better than the placebo, or if they're equal. Normally, that may take a couple of years. In this case, the pandemic was so bad that we could see right away that placebo recipients had a lot of COVID-19 and the vaccine recipients didn't. That endpoint was reached quickly and very safely.

Also through Operation Warp Speed, the vaccine was being tested at the same time it was being manufactured and while plans were being made for distribution. Operation Warp Speed also paid for vaccines to be developed by companies, even if they were determined to be ineffective or didn't work. You'd never get a vaccine company to make a hundred million doses of a vaccine and take that financial risk, but Operation Warp Speed paid for that. The fact that there was plenty of disease and that everything was done at the same time allowed for very safe development of the vaccine in about 10 months. I've gotten both of my doses now. I think it's a very safe vaccine.

Is it normal for a vaccine to be released while still in a clinical trial?

I'm not sure that a vaccine has ever been released for EUA (Emergency Use Authorization) before. The reason that is done is that when there's been a pandemic declared, the FDA is allowed to use a vaccine or monoclonal antibodies or an antiviral medication if it's believed that the benefit outweighs the risk and it's deemed to be safe from everything that's known about it. The Phase III trials are still ongoing, which means that for the 40,000 people in the trial for Pfizer that were vaccinated, they are still being watched and are still collecting data.

Would we know by this stage in the trial, if there were major side effects with the COVID-19 vaccine?

You cannot be 100% sure. They watched about 20,000 people who got the vaccine for two full months and looked at every adverse event that happened to those people. When you look at the side effects of all kinds of vaccines throughout history, all of the serious side effects happen within about six to eight weeks. It's very rare to have a side effect from a vaccine after that time if it happens at all. We know that influenza vaccine can cause Guillain-Barre syndrome, which is a temporary paralysis requiring hospitalization. It’s a terrible side effect that happens in about one out of a million doses of influenza vaccine. That happens within six weeks. We know that with the measles, mumps, rubella (MMR) vaccine, you can get low platelets that happens at about three weeks. We know that with any vaccine or medicine, you can have anaphylaxis, which is a severe life-threatening allergic reaction that happens within two hours. For the vaccines that are known throughout history, there's no significant major side effect that's long-term. The only one I can think of is measles vaccine. There can be chronic measles infection that can lead to problems even a decade later, but that's a live virus vaccine. The COVID-19 vaccine has no virus in the vaccine, that would not even be a consideration for this. 

Have there been studies specifically on the safety of the COVID-19 vaccine in children?

There have been some children, 12 years of age and older, in the vaccine trials, but it's not enough that it has been licensed for children yet. There are some trials currently enrolling pediatric patients with Pfizer and Moderna.

Do you know when the COVID-19 studies regarding children will be complete? 

I don't know for sure. I think everyone is hopeful that we'll have some results by the spring, in the next three or four months.

When will the COVID-19 vaccine be available for children? 

There will have to be trials that document safety in children, and document that it works. Then it will go through the FDA, just like it went through for the adult COVID-19 dosing in December 2020. Then the FDA will give a ‘yes’ or ‘no.’ The Advisory Committee for Immunization Practices (ACIP) will then give a recommendation for a time frame and which children should receive the vaccine. I hope it will be here before the summer, but I don't know.

What benefit is there in vaccinating a healthy child if the statistics show that 99% of children recover from COVID-19?

You could say that for chicken pox, and for a lot of things that kids get vaccinated for. I think when you look at a pandemic, and you look at the transmission of the virus, you have to stop transmission of the virus. Even though children are not great transmitters, they still do spread the virus. You would want to add them in safely if the vaccine is safe for children. You would want to immunize children to remove another place for the virus to land. You want as much of your population as possible to be immune to the virus, to slow down community numbers, and stop the pandemic spread. 

What should parents who have children with underlying health conditions know about the COVID-19 vaccine?

Parents should talk to their child’s pediatrician. They need to see if the underlying condition puts the child at increased risk for problems with the COVID-19 disease and make that decision with their doctors. There is not a tremendous amount of data in immunocompromised hosts or other conditions, but there's some data and they'll need to talk to their doctors about their child's specific situation. Keeping in mind that if their child catches COVID-19, that may be riskier than the vaccine, there's always a choice. If you decide that you don't want to get the vaccine, you are saying ‘yes’ to the ongoing risk of infection. Depending on your child’s condition, that may be a reasonable choice.

Are there any medical conditions that would prevent a child from getting the COVID-19 vaccine?

You don’t want to get the vaccine if you are allergic to the vaccine components. There's not a known, proven medical condition where the diagnosis would prevent getting the vaccine. You don't want to get the vaccine if you've had anaphylaxis to the ingredients in the vaccine. If you've had anaphylaxis to the first dose of the vaccine, you wouldn't get the second one. 

Do we know what ingredients in the COVID-19 vaccine causes allergic reactions?

It is thought that part of the allergic reaction may be the polyethylene glycol or the PEG that's in the vaccine. Some individuals are allergic to polysorbates, and that can cross-react with polyethylene glycol. People that are allergic to either of those two compounds would be a contraindication for them to get the vaccine.

It's a very small vaccine. It contains the messenger RNA and a fatty or a lipid capsule around that little piece of RNA. There is a list of what's in that capsule on the Pfizer, CDC and FDA websites. There are no adjuvants nor preservatives in the COVID-19 vaccines that are currently available.

One of the complications of COVID-19 in children is MIS-C. What is MIS-C? 

MIS-C stands for multisystem inflammatory syndrome due to COVID-19 disease. If you catch the SARS-CoV-2 virus, you can get an asymptomatic infection or a symptomatic infection with a cough, fever, and shortness of breath. There are some children who, about the third or fourth week after they start their infection, will develop an inflammatory syndrome. The first part of their initial infection may not have any symptoms at all, and they can still get this inflammatory syndrome. Children with MIS-C have high fevers and appear very ill. They have very abnormal blood values for inflammation, and they have evidence that multiple organ systems are involved. They may have inflammation of the heart, which we can pick up with lab tests. They may have inflammation of the kidneys or the liver. They often will have a rash on their skin, pink eye and/or red swollen lips. When these children are admitted to the hospital, they frequently require intensive care before they get better. 

How should MIS-C be considered when weighing the risk and benefit of the COVID-19 vaccine in children? 

MIS-C is a high morbidity rate, meaning children are terribly ill, often in the intensive care unit (ICU), and occasionally on life support. You don't want your child to get MIS-C, it's serious. For reasons that are not clear to me, the mortality rate is very, very low, which we're grateful for. There aren't very many diseases like that. These children are ill, and the huge majority of them live through that, but not always unscathed. Some will have ongoing damage to the coronary arteries or the heart. When the data comes out about children, the hope is that it will show that those who are vaccinated are not only are protected from COVID-19, but protected from getting MIS-C. That data should be forthcoming. 

What are the side effects and adverse reactions of the COVID-19 vaccine?

There are a group of side effects that are part of the reactogenicity or part of your system saying, “Hey, I need to do something with this new spike protein floating around my body.” These side effects occur within the first 48 to 72 hours after the vaccine and are typically headache, muscle aches, fever, chills, joint pains, and sometimes redness and swelling where they get their vaccine. This occurs in about 20% or 30% of people after the first dose, and it might even be 40% of the people after the second dose.

The other side effects from the vaccine include anaphylaxis where you have a life-threatening allergic reaction within two hours of the vaccine dose, and it often happens within 15 to 30 minutes. You're more at risk for that if you've had anaphylaxis to something else in the past. It's thought that anaphylaxis happens in about one out of 90,000 doses of the vaccine. I have read and have not seen any deaths from that. Everyone has recovered and gone home from the hospital, and they can't get their second dose. That's probably the most serious side effect. Then there are some things that we're not sure about whether or not they're from the vaccine.

If you watch 20,000 people for two months, you can expect some of them will have a heart attack. Some of them will have a stroke. Some of them will be killed in a car wreck. All of those things happen. When you watch a large group of people for two months, it's not always easy to tell if the vaccine triggered the problem that happens. We know that in the Pfizer trial, there were four cases of Bell's palsy, which is paralysis of one side of the face that almost always completely resolves, but not every time. There were no cases of Bell's palsy out of 17,000 people that got the placebo. But four cases out of 17,000 is not above the baseline rate that you'd expect. Nobody knows what to make out of that information. There were about 12 cases of appendicitis after the vaccine and eight cases after the placebo, a tiny difference, but not different than the background rate. There are some side effects that you'll read about that are hard to determine if they're related to the virus, but for sure the anaphylaxis is in some cases. For sure, the reactogenicity side effects can be seen from the vaccine. 

If a child has a history of allergic reactions, should they avoid the COVID-19 vaccine? 

If they have an allergic reaction to something not related to the vaccine, a food allergy, a penicillin allergy, a bee sting allergy, they can still get the vaccine once it's approved for children, but their 15 minute observation period will be 30 minutes instead. Any child who’s had an anaphylaxis type of reaction to anything, needs to talk to their doctor first before they sign up for the vaccine and go over that with them.

What research is going on to track long-term side effects of the COVID-19 vaccine? 

For the people that are in the Phase III trials, it's my understanding that those companies will follow those recipients for two years, and they've already been following them for six or seven months. One of the things that you have to keep in mind about long-term follow-up for these vaccines is that in the current pandemic, you can't justify waiting another year to release these vaccines. With 3,000 or 4,000 deaths a day in the country, it only makes sense for something that's been proven to be safe to be released because the benefit of the vaccine at this point outweighs the risk of getting COVID-19. 

Does the COVID-19 vaccine change your DNA?

No. The vaccine injects messenger RNA into your muscle cell, or your white blood cells nearby. It never enters the nucleus where the DNA is. It doesn't integrate itself into your DNA. The messenger RNA particle is very fragile and it's not even around for very long, it disintegrates and goes away very quickly. This is why the vaccine has to have a deep freeze, and if you thaw it out for too long, it doesn't work. If you open the freezer for too long, and it gets at the wrong temperature for too long, it's inactive. It's a pretty fragile particle, and there's no evidence that it integrates into your DNA. 

Does the COVID-19 vaccine cause infertility? 

No. There were pregnancies during the vaccine trials, and there's no reason to think that it would cause infertility. If you think about it, if you make antibodies to the spike protein from the vaccine, that's exactly what you're going to do if you catch the COVID-19 infection. Either way, you get antibodies to the spike protein. If the COVID-19 infection doesn't make you sterile, the vaccine wouldn't either. 

Is the COVID-19 vaccine safe for pregnant women? 

I recommend that pregnant women speak with their physicians and make their own decision about the vaccine. If pregnant women want the vaccine, they can get it. The American College of Obstetricians and Gynecologists has said there's not any reason not to vaccinate pregnant women. What is recommended is that pregnant women talk to their physicians and make their own decision. Pregnant women have to keep in mind that if they catch COVID-19 during the pregnancy, they fare worse than if they're not pregnant.

Are there any other common myths about the COVID-19 vaccine?

There's no government implanted chip. I've heard the rumor that you get implanted with a chip when you get vaccinated and that the government is going to track you. All I can say is if you have a smartphone, there's probably already someone tracking you.

“We usually see a cluster of patients from crashes in the three to four days before and after Christmas,” said Sharon Evans, trauma injury prevention coordinator at Cook Children’s. “People are stressed, and it’s the height of travel season. We don’t know what it will be like this year due to the pandemic, but we know this time of year is especially dangerous.”

Since 2015, an average of 12 car wreck victims were admitted to Cook Children’s between the dates of Dec. 20-30. Out of those, three were typically not restrained with a seat belt or car seat.

“If a child is properly restrained in a car seat, we may see some cuts and bruises, but they usually ok,” said Evans. “The ones who are much more seriously injured tend to be children in seat belts who are too small and should be using a booster seat.”

In Texas, children are required to remain in a car seat until they are 4 feet 9 inches tall or 8 years old. Experts like Evans say that is the bare minimum, and it’s more important to pay attention to a child’s size than their age since seat belts are made for adults and don’t fit small bodies properly.

“When children are using a seatbelt prematurely, the belt doesn’t fit across the center of their shoulders like it should and kids will tend to put it behind their back or under their arm,” she explained. “Now, their entire upper body is unrestrained. In a crash, this means the child folds over the seatbelt.”

She says these children can suffer cervical spine injuries, as well as serious internal injuries to the spleen, liver and intestines. This is why it’s so important for children to remain in a car seat or booster seat until they fit into a seat belt. Also, any child under 13 years old should ride in the backseat.

“There are no do-overs,” said Evans. “A lot of times we see families who say their child was really tired or fussy and didn’t want to get into the car seat or they wanted to lay down. We understand how that can happen, but families need to know that kind of normal decision can affect your life forever.”

Most Dangerous State

A recent report released by Go Insurance’s partner nonprofit, Go Safe Labs, shows Texas is the least safe state in the country for children in vehicles. Between 2015-2018, Go Safe Labs found that 1,172 children were injured or killed in traffic accidents in the state, with 55% in rural areas and 45% in urban areas.

Further data from the Texas Department of Transportation shows it’s been more than 20 years since the state has seen a day without a death on its roads. November 7, 2000, marked the last time that happened. Since then, more than 70,000 people have lost their lives on Texas roads, with an average of 10 people dying every day.

“You hear about wrecks every time you turn on the news and I think we’ve almost become desensitized to them,” said Evans. “You have to remember, it could be you and it could be serious.”

Due to the COVID-19 pandemic, this holiday season could see more deaths than usual.

According to a study by the Center for Transportation Safety (CTS) at the Texas A&M Transportation Institute (TTI), the number of Texas traffic crashes in April dropped by nearly 50% compared to 2017-2019 averages. While there were fewer crashes, researchers say there was a 50% increase in traffic fatalities. They believe the data is evidence that the risk of death and injury is greater when roads are more clear, likely because people tend to drive faster with fewer cars on the road.

“There’s no way to predict what will happen this holiday season, if there will be more people on the road or less,” said Evans. “But one thing I know for sure is accidents don’t take a day off.”

What Can Parents Do?

If you are traveling with children, make sure they are restrained properly. According to Safe Kids North Texas, four out of five car seats are installed incorrectly. For this reason, they offer free car seat checks to ensure your child’s safety. Due to the COVID-19 pandemic, car seat checks are being offered virtually only at this time. You can easily sign up for a check online by clicking here.

But, at what cost?

Physicians, psychologists and child development experts have warned of the dangers of too much screen time for years as studies show that it can negatively impact everything from a child’s eyesight, to weight, to sleep and to mental and behavioral health.

“The reality is kids are spending way too much time on screens,” said Lisa Elliott, PhD, licensed psychologist and manager of Cook Children’s Denton Behavioral Health Clinic. “There are a lot of studies now that show that too much internet gaming and too much social media causes structural and functional changes in the brain. But there’s also a chemical response, too, just like an addictive reaction to a drug.”

In 2015, the National Institutes of Health launched a multi-year research project called the Adolescent Brain Cognitive Development (ABCD) study to examine the impact of a number of childhood experiences—screen time included—on the social, emotional, mental, behavioral and academic health of youth. The study partners with leading adolescent development and neuroscience researchers all over the country as they follow 10,000 children from pre-adolescence into adulthood. It’s the largest long-term study of brain development and child health in the United States, according to the study’s website.

Early data from ABCD research released in 2018 demonstrates a correlation between screen time and premature thinning of the cerebral cortex, or the outermost layer of the brain that processes information from the five senses. While maturation of the cortex is normal with age, research indicates it’s happening faster in kids glued to screens versus those who are not, although more investigation is needed to determine why and to understand what it means for the cognitive health of children, according to articles linked on abcd.org.

So what is a parent to do, especially in 2020 when online learning became every kid’s virtual reality and exponentially increased their exposure to screens?

“We have got to control our kids’ time in front of screens as much as possible and take part in activities that promote deep, close family interaction,” Dr. Elliott said. “I am a huge believer in family dinners and making them fun. One idea is to appoint a family king or queen of dinner each night and that person gets to pick the meal idea and help prepare it.”

Dr. Elliott also believes in sparking communication with your kids by sharing the highs and lows of the day.

“This helps kids open up and talk about their daily experiences, challenges and feelings and how to work through them,” she said.

The upcoming holiday break gives kids the perfect opportunity to walk away from their screens as both online and in-person learning come to a halt for a few weeks. We asked Lauren Lasrich, a Cook Children’s child life specialist, to help generate ideas for parents on how to set the stage for a screen-free winter break.

“As child life specialists, we use play for kids to express their emotions and feel a sense of control over their environment,” Lasrich said. “In uncertain times like now, it’s important to help kids express their emotions through creativity and connection with others. These ideas not only help kids feel in control, but also helps them express their feelings about their experience and understanding about what’s going on in the world.”

Screen Free Family Time

• Set aside time on a beautiful day to take a walk, have a picnic, ride bikes or play an outdoor game together.
• Make a gratitude list together with your child to generate discussion on life’s blessings, big and small. Hang the list somewhere each family member can see as a daily reminder for thankfulness.
• Kids love board games. Pull out your family’s favorite for a weekly game night.
• Let each person in the family choose a recipe and help cook/bake it together each evening.
• Make slime or kinetic sand together.
• Create a family kindness jar that includes ideas for acts of kindness. Every day or week, have each family member draw an act of kindness from the jar and complete the act for a parent, sibling or friend.
• Go camping in your backyard.
• Have a scavenger hunt. This can be done indoors or outdoors. It can be as easy as hunting for certain household or outdoor items in a particular color, or writing your own unique clues. Have each child write one clue of their own to stoke their creativity.
• Decorate the house as a family for the holidays or bake and decorate Christmas cookies together.
• Have a holiday music family sing along.
• Read a story as a family every night.
• Create and bury a time capsule. This year has been full of history-making circumstances. Have each child write a letter about the year and its impact on them as individuals or as a family and what they hope for the future.
• Throw on your favorite festive jammies and drive thru neighborhoods to look at holiday lights. Don’t forget to take along a cup of hot cocoa!

Need a few quiet, kid-free minutes to yourself? Here are some screen-free activities kids can do on their own.

• If you’re doing any online holiday shopping you probably have an abundance of empty cardboard boxes. Give them to your child to make it into something creative. A cardboard gingerbread house? A train? A car? Give them some supplies and let them loose with their imagination.
• Draw pictures or write letters to someone special. Think about who might be alone for the holidays, or who could use some cheering up. Not only does this occupy your child, but allows them to brighten the day of someone else through their creativity and thoughtfulness.
• Write in a journal. If your child isn’t sure how to begin, give them a writing prompt. One idea is to write out their goals for 2021 and their plans for how they can be accomplished. This will help keep their writing skills sharp while on break, too.
• Create an “okay to get messy” area where your child can play freely with the slime you made together.
• Encourage reading by having them build a reading den or fort where they can cuddle up with a good book.
• Make a homemade board game. Another use for those empty cardboard boxes!
• Listen to music and dance. This keeps them occupied and gets them moving.
• Play hide and seek. It’s an oldie but goodie!
• Make up a story and share it with someone special. Put together props and costumes and act it out for the family.
• Create a comic strip.

Most of all, enjoy the holidays and time connecting as a family. Be together away from the screens and take a moment to decompress from the stress of this year.

Medical Director of Infectious Diseases, Suzanne Whitworth, M.D., hosted a Q&A with reporters today about this latest update.  

What’s the capacity like at your hospital?

We have devoted 10 beds to COVID-19-infected intensive care patients. So those 10 beds are available. We have two or three of them occupied right now. I believe the most we've had occupied in the ICU with COVID-19 at one time is five. We have plenty of room to expand and we are okay. The volume of children in the hospital with COVID-19 is much less than the volume of adults. We are almost at capacity for our floor COVID-19 unit. We have 20 beds there and 17 patients in those beds, but we are already looking at which other unit we can add so that we should have plenty of room for our patients. We're not worried about running out of beds.

Just hearing the amount of children that are in the hospital is gut-wrenching enough, but I'm wondering what those children are like right now. What are their symptoms? How are they feeling?

I think our children are like most of the children hospitalized nationally. We have some children in the hospital who are not very ill. They need oxygen for a day or two, and then they go home and they're fine. We have some children who are really more ill with COVID-19 pneumonia. Those children we've been treating with remdesivir, and dexamethazone, we have some that wind up in the ICU with COVID-19 infection. We have some children who have the multi-system inflammatory syndrome, that MIS-C that you've read about. We've reported about 21 to 24 of those to the health department so far since the beginning of the pandemic. And I believe we have a couple of those kids in the hospital currently, too. Some of those children are even sicker and require ventilation in the ICU also. So it's really a full spectrum.

Did you expect this exponential growth in cases and is this something you’re anticipating going forward?

We have been very hopeful that this would not happen like all the rest of the world, but it has. And we do think that the number of children that will require hospitalization over the next few weeks or months will very likely go up. We think this will increase.

Are you planning on adding additional beds?

I think we will have to change a little bit of what we're doing. I am not fearful that we will not have enough beds, period. I think we will have plenty of beds in the hospital, but we want to maintain areas that are devoted completely to COVID-19. We have one area completely devoted to COVID-19 on the floor and one in the ICU. We're probably going to need to add another floor unit to take care of COVID-19 patients over the next few days or the next week. So we look at which units we can do that with based on air flow and staffing and those kinds of issues.

What are your feelings moving forward into the holiday as we're dealing with this and what are your fears?

It's hard for me to imagine a way that this is going to get better before January or February at the earliest. My fear is that at this moment, we have so much more community disease. When people gather at Thanksgiving and Christmas, I'm worried that our more vulnerable populations will get sick. Right now, the people that are ramping up the numbers of COVID-19 infections are younger, and many of those do not require hospitalization. So at the moment, our hospitals are getting full, especially the adult facilities. I'm worried about those adult facilities and their capacity, but we're okay in pediatrics.

The problem I see could get worse if over Thanksgiving, there are family gatherings where elderly people become exposed and more of those require hospitalization. My fear about the holidays is that we will increase disease and then increase hospitalization at a time when many of the adult facilities are already maxed out. My sincere hope is that there will be minimal family gatherings and minimal disease transmission over the holidays. We haven't had holidays during a pandemic, so we really don't know how it's going to go. But I'm hopeful that everyone will continue to do their social distancing and masking and staying six feet apart and hand-washing and all of those kinds of things that we've been talking about since the beginning, so that things won't get worse during the holidays.

A lot of parents are wondering if children are getting infected at school or if they're actually getting infected at extra-curricular activities. What are your thoughts?

The numbers of kids that are believed to have gotten infected at school really has not been bad. We had been concerned about how kids in schools would do. I know there have been outbreaks with football and volleyball and some other team sports. And I think the classroom has gone probably better than what we expected. The problem that you run into is that kids are together all day at school, wearing a mask, six-feet apart and often behind Plexiglas shields. And after that, the parents feel like it's normal to say, they're at school together all day anyway, let's have the birthday party. What they don't realize is the birthday party is unmasked because people are eating, several parents show up at birthday parties who would not normally be in the same space, and I worry that it is more, the extracurricular events than it is actually in the classroom.

I think a lot of people were under the impression that kids don't get COVID-19. Not true?

We are living proof that that is not the case. We know that we're really lucky that children do not get as sick in high volumes as adults do. But certainly kids get sick and certainly kids get intensive care unit sick with this disease. Absolutely they can. We are very fortunate we have not had any deaths here. It is my understanding that there have been a couple of deaths in the Texas Panhandle. Certainly there are isolated cases with pediatric deaths in the country.

Biggest takeaway that you would hope people would take from hearing these statistics today that you guys have the most patients at one time?

Overall, things are worse. And when you look at the population of America, we have so many people that remain at risk. It isn't just the elderly. It's thought that 150 million American citizens have a pre-existing condition that puts them at risk for severe COVID-19 disease. That's almost half of our population. So even though it's the holidays and even though we're tired of staying home and wearing masks every time we leave the house, we just can't stop it. You just have to keep wearing your mask because you never know if you're carrying this virus asymptomatically, you could be putting other people at risk. When you're out in public, begin to think about standing six feet away from whoever you're talking to. Many people already have, but make it your habit to stay feet away from other people, and wear your mask. I think we just have to be more aggressive and do that more thoughtfully and not stop over the next few months.

Have you seen children without underlying conditions become hospitalized with COVID-19?

Yes, we have seen perfectly healthy children come into the hospital who have COVID-19, who wind up on a ventilator and life support. That does happen. It's not a high number, but you can't say that children are not at risk. That has happened here and it does happen.

The past nine months have been marked by upheaval, uncertainty, isolation and change with the youngest among us feeling the weight of it all, and doctors at Cook Children’s Medical Center are sounding the alarm.

“I’ve been employed as a psychologist at Cook Children’s going on 26 plus years and never in my time have I seen such an intense number of patients with severe anxiety and depression,” said Lisa Elliott, PhD, manager of the behavioral health clinic at Cook Children’s. “It’s not uncommon for us to have high acuity patients periodically, but that’s become the norm for weeks and weeks where 70 to 80 percent of our total number of visits for anxiety and depression are severe.”

Dr. Elliott attributes the uptick, in large part, to fallout from COVID-19. 

A June 2020 survey of parents published in the medical journal “Pediatrics” revealed that, since the start of the pandemic, more than 1 in 4 parents reported a decline in their own mental health, and 1 in 7 reported worsening behavioral health in their children. Both a decline in parental mental health and child behavioral health were reported by 1 in 10 families, according to the study “Well-being of Parents and Children During the COVID-19 Pandemic: A National Survey.”

Cook Children’s mental health experts say screen time, social media, academic performance pressures and lack of sleep all stress a child’s mental and behavioral health. All of those stressors have been exacerbated this year by pandemic-induced factors such as school closings, virtual learning, social distancing and isolation, according to Kathleen Powderly, M.D., a pediatrician on the medical staff at Cook Children’s. If ignored, these pressures can be a breeding ground for anxiety and depression.

And mental health experts are bracing for what is yet to come during the holidays as it’s not uncommon to see an uptick in depression and anxiety in children this time of year, particularly when there has been a significant family change, like in the case of divorce or loss of a loved one, according to Dr. Elliott.

So what is a parent to do? How do we help our children process these pressures to protect their mental and emotional well-being?

“We have to instill hope and stay calm and reasonable about it and, at the same time, not show fear.” Dr. Elliott said. “This is critical because we are going to set the tempo for our children. We will be what they follow. So it’s critical that we are calm and follow the safety guidelines, but tell our children this is not the way it’s going to be forever.”

And what better time than the holidays to model, teach and inspire hope?

Generosity Breeds Health and Hope

As stressful as the holiday season in tandem with a pandemic can be, it also presents a unique opportunity to teach children a concept that studies show actually improves mental health. It’s long been known that generosity and giving incite the same increase in one’s happy hormones as exercising. Giving makes you feel good—emotionally and mentally.

“Research shows that in addition to eating healthy and getting quality sleep, there are three things we can do to help keep depression at bay,” Dr. Elliott said. “One of them is exercising and another is socializing because they both increase endorphins. But the one that has the most long-lasting impact is philanthropy work. Doing things for others.”

A 2018 study published in the journal “Psychosomatic Medicine: Journal of Biobehavioral Medicine” showed a correlation between giving and increased activity in parts of the brain associated with altruism, reward and parental care and behavior. It further demonstrated that acts of generosity toward a targeted, or known, individual in need resulted in reduced activity in the amygdala—a positive given the amygdala is an emotion processing brain structure that signals the fight-or-flight mode when under stress. Increased activity in the amygdala is often seen in individuals with anxiety.

In addition to the chemical reactions philanthropy produces in the brain, doing good for others can help reframe one’s focus. Seeing the pain, suffering and circumstances of others gives perspective on one’s own struggles.

“Volunteer work helps create compassion because it draws concern away from ourselves,” Dr. Elliott said. “That’s why doing for others is so valuable for children. It teaches them compassion and optimism, and helps them develop gratitude.”

It also promotes the concepts of empathy and resilience, which are important building blocks for emotional and mental strength and valuable coping skills that help children deal with other challenges that come their way, according to Dr. Elliott.

This year, the need for generosity and service to others is especially great, given the economic impact of the pandemic. COVID-19 safety guidelines may require outside-of-the-box thinking to safely, yet personally, meet a need, but don’t let that stop you. It’s a great opportunity to get creative with your child.

With the help of Cook Children’s certified child life specialist Lauren Lasrich, MS, CCLS, we’ve compiled a list of ideas to help you and your family get started.

• Pack a grocery bag full of items and ingredients needed for Thanksgiving dinner for a neighbor in need. Let your child help create the menu and shop for the items together, either online or in the store. Deliver the groceries to their doorstep with a homemade card created by your family/child.
• Gather the family to rake leaves and clean up the lawn of an elderly or disabled individual. You’ll help a friend and get some sunshine and exercise for yourself and your family at the same time. Sunshine and physical activity are mood boosters!
• Adopt a family in need for the holidays. Check with your child’s school to see if they collect Christmas gifts for students in need and offer to purchase something on the student’s/family’s wish list. Get your child involved in the shopping process, be it online or in store.
• Together with your child, research a local organization or charity that promotes a cause you connect with and find out how you can help them meet the needs of those they serve. Create a family donation jar and save change to donate to the charity.
• Organize a neighborhood food drive and collect non-perishable food items from your neighborhood to donate to a local food pantry. Let your child decorate a donation box and put it on your porch so that your neighbors can safely deliver their donations.
• The end of the year is a great time to reduce and reuse! Go through your house and collect gently used household and clothing items you no longer need/use to donate to a local charity.
• Write letters/draw pictures to deployed military members or health care workers. For information on how to do this, or other ideas for supporting our troops, check out How Can I Support the Troops? 5 Ways You Can Help Deployed Soldiers at uso.org.
• Do a drive-thru Christmas caroling tour in your neighborhood. Let your neighbors know ahead of time when you plan to be out caroling so they can step outside and enjoy the show. Decorate your car ahead of time as a festive and fun family activity.
• Make toiletry kits and donate them to a local homeless shelter.

Not only will these activities help others, but they’ll give your child a project to look forward to.

“I tell people, especially during the pandemic, you have to have one thing to look forward to,” Dr. Powderly said. “It may not be the same thing that you enjoy previously, but you have to have something to look forward to because it gives you hope, and that’s what we all kind of need a little bit more of right now is hope.”

What to Watch For

Knowing the signs and symptoms of anxiety and depression can help you help your child before things get severe. For children, look for three or more of these symptoms, according to Dr. Elliott:

• Excessive worry for more time than typical. The difference between normal worry and anxiety disorder is the severity.
• Difficulty controlling worry.
• Easily fatigued.
• Restlessness and difficulty concentrating.
• Irritability.
• Muscle tension.
• Sleep disturbances.
• Sudden change in grades and school performance.
• Disinterest in a previously loved activity.

If your child is experiencing any of these symptoms and you are concerned about their mental or behavioral health, Cook Children’s is here to help. To access any of the hospital’s behavioral health services, call 682-885-3917. For emergencies, call 911.

Now that schools have opened, who needs COVID-19 testing?

Rapid testing for COVID-19 can be helpful to promote isolation for positive cases, and to prevent prolonged unnecessary isolation for those children exposed to COVID-19 or with questionable symptoms. The symptoms that most likely warrant testing are combinations of the following: fever and headache, vomiting, diarrhea, congestion, loss of taste or smell, cough, muscle soreness, extreme fatigue and shortness of breath. Children with diabetes may see unexplained difficulties with sugar control. Any combination of these symptoms should be taken more seriously if there has been a known contact with a COVID-19 case.

Does a child who has had COVID-19 need a negative test to return to school?

While we have seen some schools and athletic programs requiring a negative test in order to return, this is based on outdated guidance. Testing may remain positive for weeks after symptoms have passed but does not mean that the child remains contagious. The current guidance is that students may return when their symptoms have resolved for 24 hours AND they are 10 days since the start of symptoms. In practicalities, most of these students will be waiting until the 10 days pass. If a child was hospitalized, it is recommend that they wait 20 days from the start of symptoms.

If a child is exposed to COVID-19, can we end their quarantine early with a negative test?

Testing is reasonable if symptoms develop to make a diagnosis, but quarantine should continue for 14 days from the end of the last contact. A negative test should not provide false reassurance as symptoms could continue to develop throughout the 14 day period despite a negative test.

Many parents are concerned about whether their child is at more risk for COVID-19. Which patients are at risk for more severe disease?

Risk factors for severe disease at any age include: cancer; COPD; immunosuppressed state due to organ transplant; obesity (BMI >30); serious heart disease such as heart failure, coronary artery disease, and cardiomyopathies; sickle cell disease; and type II diabetes.

Individuals with the following conditions MAY be at increased risk for severe diseases: asthma; stroke; cystic fibrosis; hypertension; immunocompromised state due blood or bone marrow transplant, steroids, or immunosuppressing medications; neurologic conditions; HIV; liver disease; pregnancy; pulmonary fibrosis; smoking; thalassemia; and type I diabetes.

Children who are medically complex, who have serious genetic, neurologic, metabolic disorders, or congenital heart disease might be at increased risk for severe illness from COVID-19, as well as children with obesity, diabetes, asthma and chronic lung disease, or immunosuppression.

What do you do when a child has a family member who is at risk for severe disease? Does the child’s age matter?

In this situation, distance learning might remain the best option for this family. Because the disease can be contracted at any age, this should not factor into the decision. While child to adult spread may not happen as easily as adult to child, there are studies that show it does occur.

Do children who are planning to do virtual learning need to have their vaccines updated?

According to the Texas Department of State Health Services (TDSHS), vaccine rules are still in effect regardless of whether a student is participating in on-campus or virtual learning.

Read more about Cook Children's recommendations for safely returning to school on our website.

*This post includes information provided by Marc Mazade, M.D., medical director of Infection Control and Prevention at Cook Children’s and Justin Smith, M.D., pediatrician at Cook Children’s Pediatric Trophy Club.

This is sound advice that everyone should follow but with so many kids home, Cook Children’s has begun to see rising numbers in outdoor- and home-related injuries.

During the past month, Cook Children’s Trauma team numbers show five children were treated for non-fatal drownings and two children were treated for non-fatal gun-shot wounds.

“Parents are multi-tasking even more today. Even though they may be working from home, they are balancing watching the kids, doing school work and trying to do their full-time job. Everyone is stressed about finances and what the future holds as well,” said Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s. “All these factors create the perfect storm for injuries. With all of the COVID-19 stress, the last thing a parent or maybe even a grandparent needs is for a child to be injured or killed because they weren’t watching their children. There are no ‘do-overs.’”

Many families have turned to walks, bike riding and other physical activities outdoors, which have led to increased injuries from not using helmets, protective gear and other safety guidelines. Head and arm injuries are common problems associated with outdoor riding and other activities.

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

In order to prevent head injuries, Dr. Starnes recommends proper supervision and use of helmets and other protect equipment. Arm injuries can be prevent by using protective equipment and teaching your children to fall on their forearms rather than on the outstretched hand-one of the most common types of fractures.

“As a pediatrician, it is hard for me to fathom for my patients no parks or interaction with other children, but we are living through a difficult time with COVID-19. Some ideas to keep your children healthy and active while maintaining safe distancing from others include a multitude of online activity classes online geared towards children such as dance lessons, yoga, or exercises geared towards certain sports,” Dr. Starnes said. “Other ideas include creating a contest between your children to see who can dribble a basketball the longest with the winner getting to skip their least desired chore for the day.”

There is no instruction manual for parenting in a pandemic, but following safety precautions can drastically improve some of the stress from having the kids outside all day.

Here are some particular precautions you should consider in regards to keeping your child safe during this time:

Water and Pool Safety in the time of COVID-19

One of the great things about being stuck at home is the opportunity to start some of your summer activities early.

Grills are firing up. Kites are flying. Pools are starting to be used.

But all the early summer play and exploration is not without risks.

Over the past few weeks in the start of the COVID-19 orders to stay at home, Cook Children’s has seen five non-fatal drownings in both parent’s and grandparent’s pools.

It’s important to keep in mind this risk as parents are distracted at home more than ever by their own fears and work responsibilities. Alcohol use has also increased which can lead to distracted parenting. Even during the best of times, drowning is the leading cause of accidental death for children ages 1-4 and the second leading cause of death for kids 1-14 in Texas.

Here are some general and COVID-specific tips to help protect your child:

• While swimming in your pool, remember to practice social distancing in the water, just like you do on land.
• Install four sided fences with self-latching gates around pools. Walk around existing fences and gates and check for proper functioning.
• Have your family safe swim talk today. Especially enforce no swimming alone as bored children tend to explore.
• Remind your kids that the water might be cooler than they expect. Surprise cold water can lead to panic and increased risk.
• Use pool door/child alarms and check their functioning.
• When able, take CPR and swim lessons. If your child can’t swim, you must be within arm’s reach AT ALL TIMES.
• Have a non-distracted adult watching the water at all times. Designate who that person is and rotate frequently.

For more information on how to implement this advice, please visit Cook Children’s Water Safety website.

Gun safety during Stay at Home

Well, parents, welcome to helping to teach your kid whether you wanted to or not.

But, while we might not be able to help all our kids with “The New Math,” there is one particular topic that you should definitely cover with your children during these times as it could save their life: gun safety.

Gun awareness and gun safety are a passion for Daniel Guzman, M.D., the medical direct of the Aim for Safety program at Cook Children’s, which promotes fire arm safety. Dr. Guzman has the following advice:

Safe Play

If your child sees a gun, teach them to:

• Stop
• Don't touch
• Run away
• Tell a grownup

Safe Storage

• Store firearms unloaded in locked locations, out of reach of children.
• Use trigger locks and gun boxes.
• Secure ammunition separately.
• Hide gun safe and trigger lock keys.
• Keep unlocked guns in your possession.
• Make sure all guns are equipped with effective, child-resistant gun locks.
• If a visitor has a gun in a backpack, briefcase, handbag, or unlocked car, provide them with a locked place to keep it when your home.

Safe Children

• Ask the parents of your child’s friends if they have guns in their homes and how they are stored.
• If you are asked about your guns, don’t be offended.

Another way to easily remember and share with family and friends is what Dr. Guzman coined the "3T's of firearm safety and children.

Talk – to your family, friends, and neighbors about the importance of firearm safety to keep our children safe

Teach – your children how to respond if they encounter an unsecured firearm

Take – personal responsibility to store your firearms appropriately to keep ALL our children safe

Other safety concerns include:

• Chemical exposure - Extra cleaning supplies around the house are important to keep our families safe but ensuring safe and secure storage is important, particularly with younger children in the house. Click to learn more way to protect your child.

• Head injuries and falls - Allow kids to get outside and relaxed rules inside can be helpful to pass the time but ensure that children are properly supervise and using protective equipment correctly. Find out more safety tips here.

• Vehicular hyperthermia - Change in routine is one of the biggest risk factors for a child being left in a car. Build in safeguards to ensure that you remember that you have a child with you anytime you are in the car. Also, always remember to keep your doors locked in the driveway to prevent child access. Learn more here.

• Parental frustration and child abuse - The stresses of COVID-19 are heavy on both children and parents. The anxiety and isolation can lead to frustration which can lead to abuse. Ensure that you are finding time to take care of yourselves and reach out for help if necessary. Read our article we wrote on this topic.

Helpful Safety Information:

• Aim For Safety/Gun Safety Program
• Bicyle Safety
• Child Abuse and Neglect Prevention
• Drowning Prevention
• Medication Safety, Storage and Disposal
• Poison Prevention
• TV and Furniture Tip-Over Information
• Vehicle/Car Safety
• Frequently Asked Questions About Hyperthermia

The licensed psychologists at Cook Children's have seen this issue throughout their careers. It’s a symptom of a feeding disorder she describes as “pocketing.”

Alaina Everitt. a licensed psychologist, said the issue of pocketing usually begins when children are young. The children may experience something painful, such as reflux or a sore in their mouth, and they find it difficult to eat.

The children then may begin a process of holding, spitting out or refusing food altogether.

Children who pocket food should be checked out by an occupational and speech therapist, even if they have had no other type of therapies or been diagnosed with any medical conditions, according to Everitt. She said those specialists can make sure there are no other problems, such as difficulty moving food around in their mouth with their tongue or if the tongue is weak. These children can usually be cured with basic therapy exercises to overcome these obstacles.

If it’s a sensory issue, more extensive therapy may be needed. Children with sensory difficulties, autistic children for instance, may need a lot of food for them to even feel it in their mouth.

“These kids will over stuff and pile food in their mouth and get the ‘chipmunk cheeks,’” Everitt said. “These children tend to like crunchy or spicy foods because they may have trouble tasting or feeling other foods because of sensory issues.”

Lots of toddlers will hold their food and that tends to be developmentally appropriate. If a child gets closer to age 5 then parents may have cause for concern.

As children get older, they become more skilled at pocketing food. The kids may keep their food in their cheeks until they discard it or the parents can’t get their children to swallow.

“It becomes a meal-time battle,” Everitt said.

Cook Children’s helps parents with a team approach to treating children with a feeding disorder. A pediatrician would help guide the child’s care. A dietitian may help the child find foods they can swallow. Speech and occupational therapists lead the actual therapy portion to teach swallowing and resolve sensory issues. Everitt comes in to help with any emotional or behavioral issues, such as anxiety or parent-child power struggles.

“Therapists have little tricks they teach parents; how to do the right type of massage or how to get in their child’s mouth with a vibrating tool as it helps them from a sensory perspective,” Everitt said. “These things can help children swallow easier. You also have to make sure they don’t have a swallowing problem at this phase and the speech therapist will help with that. If the kid has choked before or has trouble swallowing, why would they try to swallow? Even when that issue gets treated the kids are still scared and that’s when they come to me.”

Hot weather and summer vacation means Texas kids are headed to the water. Sadly, it also means more opportunity for tragedy.

Summer has barely begun and Cook Children's has already seen 24 children at the medical center this year for drowning, with 15 occurring at a swimming pool.

Dana Walraven, community health outreach manager for Cook Children’s, stresses adults supervision of children at all times. She calls the parents who are in charge of lifeguarding the kids a Water Watcher.

So what does it mean to be a “Water Watcher?”

An adult is within arms-reach, no distractions, while children are in and around all water. After 15 minutes, another responsible adult takes over. This allows everyone to enjoy the party while ensuring the kids are being properly watched. It is especially helpful at parties or around the pool or lake. 

Water Watcher tags are available to any person or group who will use them or would like to distribute them. To receive a Water Watcher Tag, email safe.kids@cookchildrens.org. 

Leslie Zvitt works at Cook Children’s as the Senior Epic Business Intelligence Developer and is the mother of two children, ages 12 and 8 years old.

Zvitt makes sure a Water Watcher is on hand for all of her pool parties and makes sure adults are supervising the pool with undistracted attention.

"Our kids love to invite friends over for swim parties, and often times it’s a relief to us, as parents, for the kids to occupy themselves with their friends, while the adults visit and have grown-up discussions," Zvitt said. "However, we still have a very real responsibility to keep them safe from harm; after all, a pool is no substitute for a babysitter. Since I found out about Water Watchers, I’ve been applying some simple guidelines for our pool parties that are really easy to follow, and make all of us safer as a result."

Every Valentine’s Day, KidsHealth asks kids questions about love. The more than 4,300 participants of the survey said they feel uncomfortable when:

• Getting a phone call, email or note from someone who likes you.
• Admitting that you like someone and finding out he or she only likes you as a friend.
• Getting turned down after asking someone to dance.
• Talking on the phone to someone you like and having your mom pick up the phone.
• Hearing false rumors that you like someone or when people talk about how you like a certain person.

About 80 percent of the kids say they had a crush one someone. Some were more prone to keep things quiet, with 40 percent saying they like to keep their feelings to themselves. And when the other 60 percent decided to share their feelings with others, they admitted it could lead to problems.

"I was so embarrassed that I hid in the washroom for most of the day!" one girl said after finding out a boy had started rumors that they were an item.

Kids who participated in the survey offer the following tips to avoid embarrassment:

• Try not to make fun of others or spread rumors about who likes whom. (It's tough to avoid, but remember how it feels when it happens to you.)
• If someone says they like you, but you don't like them, try to tell them in a kind way.
• If you like someone, consider that person's feelings. It's great if the person likes you back. But if your attention makes the person feel uncomfortable or angry, try to back off.
• Talk to a parent or a trusted adult if you need help or advice.

That embarrassment and the crushes that go along with them are all perfectly normal and part of growing up.

“I certainly think elementary age kids can ‘like’ others and have what they think is a crush,” said Joy Crabtree, Psy.D., a licensed psychologist for Southlake Urgent Care and Pediatric Specialties and Hurst Urgent Care Psychology Clinics. “and by middle school feel the pressure of ‘going out,’ etc. but by high school it’s full on and everything turns into a big deal.”

For moms and dads, you can expect more drama as your kids get older. But you knew that already. After all, you were a kid too.

“I think at every age it’s important to stress balance and moderation in relationships and friendships,” Crabtree said. “But for Valentine’s Day at younger ages, stress to your kids it’s more about showing love for your family and appreciation for your friends."

More on This Topic:

• Read more about the survey here.
• Teens Talk Love
• Your Thoughts on Falling In Love
• Love and Romance
• Sexual Attraction and Orientation

You’re holding your child’s hand on your way to the first day of school. The squeeze on your hand is tighter than usual. Then suddenly your little one sees a friend, smiles, releases your grip and you watch them run to school together without a care in the world.

Everything is great.

But then you notice a tear in your eye. Suddenly, you realize your child isn’t the one nervous about going back to school. It’s you.

The back-to-school transition can be stressful for many parents, and the reasons are valid.

For example, knowing that your child struggles with change can increase your own feelings of tension.

You may worry that your child will struggle to fit in with peers and make friends.

Maybe your child had a bad experience at day care or a previous school year, leaving you both with lingering anxiety.

Some parents are concerned that schoolwork or a tight schedule may be too difficult for their child or that a teacher will not understand their child's unique needs. 

Maybe, you’ve waited until the last minute and just aren’t ready. The need to buy new clothes and school supplies may cause concerns about finances, and a steady stream of demands on your time can leave you feeling pressured and stressed.

Plus, there’s just the feeling that your young child is growing up too darn fast.

If you are stressed about your child's return to school, you may wonder if you should share your concerns. Sam McCage, clinic manager of Behavioral Health Services in Fort Worth and a licensed psychologist,  says that could be a mistake. Your child looks to you for signs that school is fun, exciting and safe and not something to fear, so it's important to discuss school in an upbeat and encouraging way.

"Recognize that children will sense your anxiety and their own will increase if you express your anxiety too much," McCage said. "If they ask about your concerns, tell them that you are excited for them and confident they will do well."

McCage reminds parents that "it's normal to feel anxiety about your child going back to school, but he says there are strategies to help you effectively manage your stress.

Here's how you can calm your concerns and enjoy this annual adventure with your child.:

• Visit the school and connect with your child's teacher and other school staff.
• Make arrangements for car pools, play dates and after-school care well in advance.
• Be patient and give the teachers time to develop a relationship with your child.
• Make sure you have realistic expectations about how your child should perform in school and extracurricular activities.
• Talk with other parents about how they handle their anxiety.
• Use humor to diffuse the stress.
• Schedule fun family activities with your children.

For starters:

1. No, it's not that cattle disease with a similar name. Heehee. 
2. Yes, it's super contagious. 
3. Nope - no reason to freak out. We see it all the time. You probably had it when you were a kid.
4. Go get some popsicles. I'm gonna prescribe them.

Hand Foot and Mouth Disease (HFM from here on out) is caused by a virus. What does that mean? Come on - I know you're sick of hearing me say it - that means no antibiotics needed! Woo hoo! This is a virus which your strong kiddo can clear on his own!

Most of the time this happens in kids under 5. They catch it from day care or school classmates. Usually they catch it by getting oral secretions or fecal secretions in their mouth or airway from a buddy. I'll let your imagination run wild on the methods kids go through to experience this fun transfer of germs. It's really contagious.

People with HFM are most contagious during the first week of their illness. However, they may be contagious for weeks after symptoms go away. Some people, especially adults, may not develop any symptoms, but they can still spread the viruses to others.

This is a common SUMMER virus! But can happen any time of year.

Soon after catching it (like 3-5 days), kids start with a fever and a new rash. The fever is usually low (under 101) but can be high at times. Sometimes they have a runny nose, or other cold symptoms.

The rash is unique. They're red spots with/without thick bubbles of fluid.

Usually, they're on or in the mouth, and on the palms of the hands and soles of the feet. Hence the name. However, I joke with parents that it should be called "Hand-Foot-Mouth-Butt-Arms-Legs" because you can see the spots in other places, too.

HFM is commonly mistaken for other things. Often, parents worry about chicken pox. Remember - chicken pox is itchy and tender. HFM is not. People also mistake these for bug bites - again, not itchy like bug bites are.

The mouth sores hurt. They're typically the main complication I see with HFM - they hurt so much kids don't want to eat or drink. The eating I don't mind -but it's important that they drink. Load up on popsicles. All my "sugar rules" go out the door when a kiddo has HFM. Sometimes if it's really bad we will prescribe a mouthwash for pain.

Something else you should know - more than one strain of virus causes this bad boy. So kids can get it more than once. And if an older child/adult catches it? It can be more troublesome/painful than in a younger person.

It'll go away on its own. This can typically take 7-10 days. The fevers usually last just a couple of those days. Kids typically are just fine. It's actually adults that can experience the worst of it!

Hope this helps!

Hugs,

Dr. Diane

It is likely the only thing that will be on my TV for the entire 16 days!

Even though we don’t get a lot of snow and cold weather here in Fort Worth, many kids in Texas are able to partake in winter sports. Sometimes this is at a local indoor skating rink, and sometimes we travel to the ski slopes. However, the wintery fun can bring injuries along with it. In fact, research shows that 3.8 million people in the U.S. experienced an injury while participating in a winter sport in 2013. The most common injuries include concussions, ACL tears, ankle and wrist sprains, strains, shoulder and elbow dislocations and broken bones.

There are several things that you can do to prevent winter sports injuries, should the Winter Olympics leave your child feeling inspired. Here are some tips:

Use the proper equipment:

• Wear a helmet! Look for a helmet with a hard outer shell, a shock absorbing layer, and fits appropriately without impacting your vision.
• Inspect your skis or snowboard. Make sure that the edges have been properly sharpened and there is an appropriate wax on the underside.
• Make sure you have well fitted ski or snowboard boots. They should be snug. If you aren’t sure, be sure to ask a pro at the rental shop or ski store.
• Get fitted for the proper ice skates if you are playing hockey or going ice skating.
• Don’t forget about other safety gear such as goggles and pads!

Dress for the weather:

• Choose base layers, such as long sleeve shirts and long underwear, that are loose fitting, breathable, and made of synthetic material. This will allow them to wick sweat away from your skin, helping you to stay warm and dry.
• Long wool socks are the best for skiing and snowboarding, but don’t double up your socks. This actually makes the socks rub together and tends to give you uncomfortable blisters on your feet.
• Don’t forget your sunscreen! You can get a sunburn even on the slopes.

Warm up your body:

• It’s cold outside! Get moving before you skate or ski!
• Get your heart rate up by doing jumping jacks or jogging in place.
• Stretch your arms and legs by doing arm circles, upper body twists, squats, and lunges.
• Start with several slow laps around the skating rink or an easier ski slope to get your legs under you before you get going.

Learn from a pro:

• Take a lesson, or several, from a qualified instructor. They can teach you the rules of the rink or slopes, as well as how to fall correctly.
• Be sure to learn the basics. It is important that you can skate safely before you can play hockey. You also have to know how to safely turn and get on and off a chair lift before you can head up the hill on your skis or snowboard.

Know your limits:

• If you are cold or exhausted, take a break! Let your body rest and then get back to the fun.
• Remember that you don’t have to follow the crowd. If everyone else is hitting a double black diamond, you can always take a hot cocoa break if you don’t feel up to it!

So let the Winter Olympics inspire you to have some fun this year, but stay safe while you are out there!

About the author

Jacky Arrow, PT, DPT, SCS, is a physical therapist for the SPORTS program at Cook Children's. The Cook Children's Sports Performance Orthopedic Rehab Team Specialists (SPORTS) program offers care to children and adolescents with orthopedic or sports-related injuries. If your child gets injured and needs medical care, it's very important to choose a program that has experience working with the growing dynamics of your child's body to prevent further injury. Click here to learn more about the program or call 866-205-7270 to make an appointment.

We mustache you a question.

Do you think developing your child's sense of humor is important?

It is. Lettuce explain.

We've all been told laughter is the best medicine, but have we really considered the social, emotional and health benefits of humor?

Children with good sense of humor have been shown to be happier, more flexible and more liked by their peers. 

They also tend to have a more positive frame of mind, higher self esteem and the ability to handle difficult or stressful situations well.

"It is never too early to start developing a sense of humor," said Christina York, Ph.D., a psychologist at Cook Children's. "All children will face very challenging circumstances, and humor may help them work through those sometimes-trying times of childhood."

Health benefits

Not only does laughter provide social and emotional benefits for your child, but a good sense of humor provides health benefits, including:

• Better pain management and toleration
• Improved digestion
• Increased illness resistance and immune function
• Less depression
• Lower blood pressure and heart rates
• Lower stress levels

Guide their humor

As a child explores new and funny things, always teach him or her what type of humor is acceptable for certain situations. If a joke is inappropriate, gently correct the child and provide alternate jokes or stories to tell instead.

Put a smile on our face by sharing funny stories about your children.

Extremes in height- short stature or tall stature - further call attention to a person’s uniqueness and may represent challenges for some in everyday life. The judgment of what is normal height can be distorted in a variety of ways including media images, peer groups, and family/cultural backgrounds.

Being short seems to be negatively viewed in the range of height difference. Men and boys, in particular, seem more impacted by short stature with research reports from several decades ago reporting negative psychological and social effects in males with short stature. And while, more recent research calls into question whether or not there is a negative impact, it’s still difficult for many to forget old impressions and stereotypes.

Short stature referrals are one of the main types of referrals seen by most pediatric endocrinologists. While the medical evaluation of short stature is a fairly straightforward process (at least for a pediatric endocrinologist), navigating the family and emotional dynamics can sometimes be tricky. I think offering education to child and family about normal expectations is an essential part early in the first referral visit.

The first and perhaps most important part in short stature evaluation is understanding that a child’s growth and height are strongly connected to genetics of his or her family. In other words, short children typically have short parents.

It is also important before moving further for a reminder of average height for women and men in the U.S.

Average women’s height is 5’4”

Average man’s height is 5’10”

A handy formula used to help estimate a child’s genetic height target (the range of their adult height) is as follows:

Let’s look at two examples to illustrate,

Short Parent Family: Mom 5’0” Dad 5’7”

Height range for son: Middle of target: 5’6”Range: 5’2’ to 5’10”

Height range for daughter: Middle of target: 5’1”

Range: 4’9” to 5’5”

Tall Parent Family: Mom 5’6” Dad 6’1”

Height range for son: Middle of target: 6’0”Range: 5’8” to 6’4”

Height range for daughter: Middle of target: 5’7”

Range: 5’3” to 5’11”

The formula gives a target estimated height with a range of 4 inches above or below the target that will cover almost all children. Still, it’s a wide range when you consider the difference between being a 5’3” woman compared to a 5’11” woman.Knowing a child’s genetic height target range is important in determining the location on the growth chart like the one shown below where most of a child’s growth points should be located.

A child growing below their expected height range needs a closer check. A child progressively falling lower on the growth chart likely needs an in-depth investigation to determine if a problem exists.

Causes of short stature in children are numerous, ranging from normal variations in growth to serious underlying health problems. My first priority when a child is referred to me is to further investigate short stature is answering the following question:

Is the child's short stature OK or not OK?

What I mean by OK is that there is no apparent underlying negative reason for a child’s short stature. There are really only two reasons that fall in the OK category.

• Familial (genetic) short stature
• Constitutional delay of growth

Children with constitutional delay of growth will start off slower in growth compared to other children. They will fall to the lower part of the growth chart in early life which can concern parents and pediatricians. A child with constitutional delay grows at a slower, but normal pace during childhood and early adolescent years and gets the growth spurt of puberty later than average. These “late-blooming children with constitutional delay will eventually reach a height within their family height range.

Answering that initial question of OK or NOT OK can sometimes be difficult. Return visits to monitor growth are almost always a necessity to reassure that “growth and health are OK.”

Key steps in the process of monitoring a child’s growth include a medical history and an examination. The first two steps help me and other pediatric endocrinologists decide both if further special testing is necessary and what kinds of special tests may be needed. Different kinds of special testing include

• Bloodwork
• Radiology tests such as a bone age X-ray or MRI scan of the brain
• Growth hormone stimulation testing

The bone age X-ray is an important tool used by me in the early stage of short stature evaluation. The test looks at the appearance of growth plates in the hand. The growth plates start out in early life with lots of room to grow. The size of growth plates becomes progressively smaller as a child ages. By the time an average child reaches the end of puberty…...

• Girl around age 14 years
• Boy around age 16 years

…….the growth plates are nearly closed, and there will be very little increase in height.

A bone age is a very useful tool in helping me figure out quickly my level of concern and the types of testing which might be done in a child’s investigation.

For instance, look at the two bone age images of a boy’s hand below. The white arrow shows a growth plate located on tip of the finger. A 10-year old boy's hand is on the left and a 15-year-old boy's hand is on the right:

10-year-old boy's hand:  15-year-old boy's hand:

Get to know Joel Steelman, M.D.

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

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

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

But are they ready for the hottest part of the year?

Locally, the National Weather Service has issued a heat advisory that remains in effect until 8 p.m. Saturday. Daily temperatures will range between 94 to 102 degrees, with a heat index between 105 to 109 degrees.

So while you don't want your children to waste their summer vacation away playing video games inside, warm summer temperatures can lead to more than just a sunburn. Being outdoors in the heat for too long can pose a heat-safety risk.

Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children's, says eight kids have been treated in the ED this summer with a chief complain of heat related illness.

"As the outside temperature rises, your family's risk of heat stroke rises right along with it," Dr. Warmink said. "On 100-degree days, it's best to stay inside when it gets that hot. If temperatures exceed 90 degrees, stay in the shade and keep an extra eye on the kids."

Children today are spending increasing amounts of time in air conditioned environments, lured indoors by the constant upkeep of social media accounts and online gaming. One study of nearly 9,000 U.S. children, ages 3 to 5 years old, found that only half were taken outside by their parents on a daily basis to walk or play.

"The more you're out in the heat, the more your body gets used to it, or 'acclimatizes,'" Dr. Warmink said. "Children who are always inside are more prone to heat exhaustion and heatstroke than those who are frequently outdoors and active."

Play it cool

But don't mistake what Dr. Warmink is saying. Too much time out in the heat can cause heat-related illnessess such as heat exhaustion and heatstroke.

Lack of acclimatization has led to an uptick in heat illness among children in recent years, according to Dr. Warmink. Most incidents occur during the first two weeks of school athletics training when kids begin cross country, football, cheerleading or band practice.

"More is being demanded of young athletes during the late summer months," Dr. Warmink said. "Kids who spend all summer indoors and then go out for training in August are setting themselves up for heat illness."

Staying safe

Symptoms of heat exhaustion include flu-like symptoms such as paleness, sweating, nausea and vomiting. Signs of heatstroke include hot, red and dry skin, as well as confusion, vomiting, rapid heart rate, decreased sweating, shortness of breath, decreased urination, increased body temperature (104 to 106 degress Farenheight), or convulsions.

MedStar reminds us that heatstroke and heat exhaustion are common this time of year, but they can be easily prevented:

• Hydrate: Drink plenty of water during the day, especially if you are engaged in any strenuous activity. Sports drinks are a good choice if you're exercising or working in hot conditions, but water is a good way to hydrate as well.
• Ventilate: Stay in a place where there is plenty of air circulating to keep your body cool. If you are indoors and don't have access to air conditioning, open windows and use a fan.
• Cover Up: Wear light-colored and loose-fitting clothing to avoid absorbing the sun's light and trapping heat. Wear a hat to shield yourself from the sun, but once you feel yourself getting warm, remove any items covering your head which can trap heat close to your body.
• Limit Activity: Heatstroke can occur in less than an hour when you are participating in strenuous activity during a hot day. If you feel yourself getting hot or light-headed, stop your activity and rest in a cool place out of the sun. Be sure to drink water or a sports drink before, during, and after any strenuous activity.
• Check on Loved One’s: MedStar reminds families to make sure that your child's grandparents are OK. The elderly are especially vulnerable to heat related emergencies. Many elderly residents are not aware of how hot it may get in their residence. Call on older friends and family members regularly to assure they are doing OK.

About the source

Corwin Warmink, M.D., is the medical director of Emergency Services at Cook Children's. Cook Children's Emergency services are available 24 hours a day, seven days a week. Cook Children's Emergency Department (ED) treats more than 105,000 patients every year. Our ED is the only EMS-designated pediatric trauma center in Tarrant County. 

Dr. McGehee, seen here with his daughter Brigid, became a stepfather of two younger girls 15 years ago, after his own four children were nearly grown and out of the house. He feels like the commitment he keeps to his wife, Pam, is what makes him a better father of a strong family.

“I know, to some, it sounds like it defies common sense to say put the children second,” Dr. McGehee said. “But, I think you have to have a strong marriage and a strong bond between the husband and wife. From there, everything grows from the love in that relationship. If the marriage is solid, the kids will benefit.”

That strong relationship between spouses will also be needed, Dr. McGehee said, with the extra challenges that come from being a stepparent.

Children of divorce often have emotional issues, sometimes of abandonment and sometimes of anger against the new father. Dr. McGehee said the parents need to have a unified front in dealing with their kids.

“You have to eventually find that place where you trust the stepparent and their objectivity,” Dr. McGehee said. “The stepparent can look at things with fresh eyes and without some of the emotional entanglement that may be there with the biological parent and the children. Hopefully, the biological parent will find that objectivity helpful.”

And then there’s one more relationship that Dr. McGehee feels stepdad has to at least attempt to make – with the biological dad.

“We have something in common – the relationship with the kids,” Dr. McGehee said. “I would hope that we are both trying to love and nurture the child. You have to try to get along with each other, eventually you will have things like graduation and weddings to attend together. You may not ever be friends, but you should at least be colleagues in raising a child. All the parents involved should have the same goals for the child – making them a happy, healthy and successful person.”