Little Charlotte Friessen, 7 months old, arrived at Cook Children’s only 30 minutes prior and was rushed to the Cardiac Intensive Care Unit. She needed an echocardiogram on her heart so she could get the help she needed. She needed to relax to get the proper readings before treatment could begin. But Charlotte was afraid and unhappy.

The years of training and experience weren’t enough for Tiffany Cox, Jen Jones and Mary Brennan. They needed to find something new to calm Charlotte down to get the ultrasound imaging of her heart.

What to do?

“Charlotte hated the little Doppler on her. The three nurses were doing everything they could to help her,” Anne Friessen, Charlotte’s mom, said. “They were talking to her and nothing worked. Then one of the nurses said, ‘Let’s sing nursery rhymes. The nurses had a blast.’”

The nursery rhymes and lullabies worked to perfection. Charlotte stopped crying. At least until the nurses stopped singing to think of new songs. Each time they stopped, Charlotte began to cry. Soon, everyone hit their stride and even Lane Lanier, M.D., a pediatrician on the Cardiac Specialty Care Unit team, joined in on harmonies.

Cox spent most of her career working with adults in the Intensive Care Unit and Cardiovascular ICU. She says one of the things she loves about Cook Children’s that she couldn’t do in the adult world of nursing “is be silly and play.”

“I have found such a deep joy working with these children and babies. The needs of kids, the things that make them feel better, are usually so simple,” Cox said. “If a little spontaneous singing and making silly faces with my colleagues makes a child in the CVICU smile and feel better, I will do it all day long. I happened to be across the hall that day with my own patient, and heard this poor darling across crying her eyes out during the echo, and I really just wanted to come ‘play’ with my colleagues. They were trying everything to make her feel better.”

But come on - how many nursery rhymes do you know off the top of your head? “We even ‘performed’ a sing-song version of the theme-song rap from The Fresh Prince of Bel Air,” Cox said. The three of us and the patient’s mom are about the same age and grew up watching that show. I mean, who gets to do THAT at work?! I love this place.”

The singing also helped ease Anne’s mind for a little while too. After all, so much had happened in such a short period of time.

“They sang so many nursery rhymes,” Anne said. “I felt like I stepped into an episode of Grey’s Anatomy. They sang for the entire echo. It was really neat.”

A month earlier, Charlotte was taken to see her pediatrician in Andrews, Texas. During her well-child visit, doctors found she had a heart murmur. About three weeks later, a specialist in Lubbock diagnosed Charlotte with a coarctation of the aorta. This means a narrowing of the aorta, requiring the heart to pump harder to allow blood through the narrow part of the aorta.

The family was immediately rushed to Cook Children’s and immediately the care began for Charlotte.

“The nurses met us as soon as we got there,” Anne said. “Everyone was so great. They helped us handle the situation a little more peacefully. Up until then, I had been so wide eyed about everything that happened. We talked to Dr. Lanier and all the nurses, I felt so confident in their work. They were so happy that we chose their hospital. Dr. Lanier thanked us so many times for letting him take care of our daughter. It made me feel good. Even through this horrible situation, it gave me peace.”

The next day, Vincent Tam, M.D., Cook Children's medical director of Cardiothoracic Surgery at Cook Children’s Heart Center, performed the surgery to fix the aorta. Anne said she and her husband, Albert, felt comforted during the surgery. Since the heart murmur was detected, the family's church had been praying for Charlotte and now they were praying for everyone taking care for the little girl.

“So many people, from all over the place, were praying for Charlotte,” Anne said. “But they were not only praying for us, but our doctors and the nurses too. Everything just went so smoothly. We were home in less than a week.”

Other than getting her high blood pressure under control, which was expected after her surgery, Charlotte is back to her normal self. She’s sitting up, playing and holding her own bottle.

And while Charlotte may not remember her time at Cook Children’s, it’s a moment the nurses will never forget.

“It was a special few minutes to be able to serve her and her family in that simple way,” Jones said. “I love that being a nurse sometimes means lots of time management and critical thinking, and sometimes means simply singing nursery rhymes over a scared baby girl.”

Ailments run the gamut from respiratory and fever issues (RSV and influenza) to gastroenteritis with vomiting, diarrhea and severe dehydration. And while there’s not one illness that stands out, one thing is for sure – children in the ED are sicker than they’ve ever been.

“Our ED is running beyond full capacity and has been since December. But in the last few weeks we’re seeing a larger number of very ill children than even during flu season.” said Corwin Warmink, M.D., assistant medical director of the Emergency Department at Cook Children’s. “The sicker the child, the longer it takes to diagnose, treat and properly care for them.”

In December, 20 to 30 kids were admitted for treatment per day from the Emergency Department, but by February, those numbers jumped to about 40 to 50 children a day.

The Emergency Department is averaging nearly 400 patients per day, and during its busiest times a patient will check in every two minutes.

Overall, children appear to be sicker this year. Compared to this time last year, Cook Children’s has seen a 60 percent increase in the percentage of children who need critical care.

As the number of patients admitted and treated in the ED increases, so does the time physicians spend with each child, which contributes to the much longer waiting times.

Depending on the severity of the illness or injury, it could take 4 to 6 hours to care for a child. But it’s not just one physician treating that child. Nurses and health care providers may be brought in too.

“Many of the children we see are dealing with very serious emergencies and they receive immediate care,” Dr. Warmink said. “We use all necessary resources and manpower to care for those children. Unfortunately, that means longer wait times for the families in the waiting room.

“Families could spend anywhere from 5-10 hours or longer in our waiting room, depending on the day they visit. We are actively bringing in extra doctors, nurses and support staff to try and improve these times.”

Dr. Warmink advises parents that Sundays and Mondays are the busiest days of the week in the ED. Evenings after 5 p.m. seem to be popular too.

Families with sick kids who aren’t experiencing emergencies do have other options. The first line of defense is your child’s pediatrician. Making an appointment with a child’s doctor may help avoid a long wait at the ED. Cook Children’s also has several Urgent Care Clinics for non-emergent needs.

Previous articles on this topic:

• More flu, longer waits in the ED
• Emergency? 6 signs from an ER doc
• Cook Children's to build new South Tower on main campus
• Is it RSV?
• 8 flu myths I wish would go away

Donald Murphey, M.D., medical director of Infectious Disease at Cook Children’s, worries over the fact that diseases like measles and pertussis are once again in the news.

“It’s alarming to see the rise in these diseases that were so common prior to the advent of effective vaccines, but largely disappeared with immunization,” Dr. Murphey said. “It’s frustrating too because we have safe vaccines that prevent these diseases. The solution is for kids, teens, and adults to get immunized.”

Measles is a highly, dangerous, but preventable disease with vaccinations.

The CDC report says that many of the cases are from people who visited other countries. Of the 129 cases reported by the CDC, 34 were “importations” from other countries. The Philippines has seen 20,000 confirmed or suspected cases of measles cases from Jan. 1 to Feb. 28 and 69 confirmed deaths.

But why is this happening? “The increase in importations from this outbreak and subsequent transmission in certain settings in the United States highlights the importance of ensuring age-appropriate vaccination for persons traveling to areas where measles is endemic and maintaining high vaccination coverage at the national and local level,” The CDC report states.

Parents can make an important step in preventing their children from catching measles through the use of two doses of the MMR vaccine.

“We thought we were on our way to eradicating these diseases,” Dr. Murphey said. “Our goal was that these diseases would be completely controlled by the year 2015. But misinformation and fear about immunization has prevented that from happening. It’s a very sad situation because children suffer, but it can be much worse if segments of the population refuse to receive their vaccines.

Measles is particularly contagious. Transmission is by coughing, sneezing or simply being next to someone laughing. It’s that easy.

Dr. Murphey said what’s particularly frustrating is that these diseases can be contained and even eliminated if we do our part. MMR vaccination remains the most effective way to prevent outbreaks. In children, the first MMR vaccine dose is usually administered at 12-15 months and the second at 4-6 years.  However, the MMR vaccine is recommended for children as young as 6 months old when they are traveling abroad. Children under 12 months of age and traveling internationally should receive 2 doses of MMR, separated by at least 28 days

All college students, international travelers, and health care personnel should receive two doses of MMR vaccine, unless they have other evidence of measles immunity.

“I can’t stress enough if you are traveling abroad, the importance of making sure you are updated on your immunization,” Dr. Murphey said. “This holds true for pregnant women, infants, kids, teens and adults. We all have to do our part and have our shots updated to keep each other healthy.”