Jakera wasn’t in pain but her mom, Tiffany Ferguson, noticed her little girl had lost range of motion on her right side.

“She couldn’t open her hands, she couldn’t lift her arms. I immediately called her doctor and told her that Jakera couldn’t move anything on right side. She told me it sounded like a stroke and to call 911,” Tiffany said.

An ambulance rushed Jakera to Cook Children’s where she was treated for a stroke and diagnosed with moyamoya, a more serious disorder that developed from her sickle cell disease. Moyamoya can occur when sickled red blood cells cause repeated damage to the blood vessels in the brain. The blood vessels begin to tangle and create a “puff of smoke” appearance on an MRI.

Moyamoya can lead to more stroke activity and typically requires surgical intervention to improve blood flow around damaged blood vessels. Jakera’s medical team decided to intervene before another stroke could occur.

Jakera had revascularization surgery in February 2019, a procedure where surgeons flipped the protective covering on top of the brain (the dura) to encourage the main artery there, the middle meningeal artery, to create new collateral arteries into the brain.

Following the surgery, Jakera now receives blood transfusions every four to six weeks.

Along with interventions such as blood transfusions, sickle cell disease is also managed by medications and potentially a stem cell transplant for long term success against the disease. But finding a donor can be seemingly never ending. Physicians will look to find a match from siblings and family first before trying to find an unrelated donor, according to Cook Children’s physician Clarissa Johnson, M.D. Jakera has not yet had a stem cell transplant, but her family remains hopeful she’ll find her match.

“A stem cell transplant is a cure for sickle cell disease because you’re basically putting new stem cells in the body,” Dr. Johnson said. “Red blood cells are made from stem cells so if you put new stem cells in the body that don’t contain Hemoglobin S, you are creating a situation where you no longer have stem cells that make sickle cells.”

With sickle cell, stroke and moyamoya, Jakera has endured her share of hardships, but it wasn’t until she was diagnosed with Bow hunter’s Syndrome that she was affected by just the turn of the head.

“She started blacking out three to four times a day. It happens [when she turns] like a bow and arrow hunter when they have to turn their head to the side to aim,” Tiffany said. “She was born right handed but when she turns her body to the right, it cuts off the circulation to her brain so she actually switched hand dominance to the left.”

Jakera had a spinal fuse from the back of her neck down to her shoulders to limit the amount she can physically turn. She can no longer turn more than 90 degrees to ensure there is enough blood reaching her brain. While this is not a cure, her physicians believe it will relieve the loss of consciousness.

Jakera is not the only one in her family impacted by sickle cell disease. Her father also faces medical difficulties.

“There were days where I was running from Cook Children’s to Harris and back to Cook Children’s so that I could be with both of them during their crises,” Tiffany said. “Everyone in the family is learning to deal with it because we know it isn’t going to go anywhere right now, but they understand the most important thing is making sure they [Jakera and her father] are OK.”

Four major diagnoses and two surgeries in five years could seem daunting to most, but Jakera has flown through it all with ease, and has even made the local cheerleading squad.

“She’s like a little woman,” Tiffany said. “She takes it and keeps on moving. The stroke limited her a lot but the squad has been so good to her. She always pushes through.”

Dr. Rogers explains that there’s really not a cure for a common cold and then lets them know why she’s not giving the child an antibiotic and why no one else should either.

“I understand this mindset,” Dr. Rogers said. “You come to the doctor and you want to be treated. Parents often want an antibiotic. That’s why they are there to see me. They can’t afford to take time off when their child is running a fever and sick. They think the antibiotic will make the illness go away faster.”

But if the cold is viral, it’s simply going to run its course. The antibiotics will not have any impact on the cold at all. With something like a cold, you just have to wait it out.

The American College of Physicians and the U.S. Centers for Disease Control and Prevention agree with Dr. Rogers. They have issued new guidelines for prescribing antibiotics for acute respiratory tract infections (ARTIs) in adults.

The two organizations advice to adults is similar to Dr. Rogers’ advice to children: Use antibiotics to treat bacteria that causes the likes of strep throat and food poisoning. For common viruses like the common cold and flu, the recommendation is drink extra water and juice, use a cool mist vaporizer or saline nasal spray to relieve congestion.

“It’s not that I’m against antibiotics, but for the right reasons,” Dr. Rogers said. “Pertussis starts with cold-like symptoms, just kind of a mild cough, and after 2 weeks the cough gets much worse. In those cases, not only the patient, but the entire family, will need antibiotics, but once the patient has been infected, expect him or her to have a prolonged cough.

Other times antibiotics may be necessary with illnesses including:

•  Sinusitis or secondary bacterial infections, related to a cold.
• Certain skin conditions caused by bacterial infections, such as impetigo.
• Strep throat
• A severe ear infection

“I really do try very hard to limit my prescriptions of antibiotics for bacterial infections,” Dr. Rogers said. “If your child has an ear infection and it’s red and bulging, as a parent I would want antibiotics to help ease my child’s suffering.”

However, other caregivers aren’t as careful with their prescriptions, Dr. Rogers warns. She said this can cause the medication to not be effective or even useless when a child actually needs antibiotics. The infectious organisms adapt to the antibiotics, leaving the patient immune to the antibiotic.

Antibiotics have played a vital role in treating patients with infectious disease for 70 years, Dr. Rogers said. When prescribed the right way, antibiotics can prevent illness and even death. But when antibiotics are prescribed carelessly, they lose their effect.

“We frequently see patients who have been prescribed antibiotics at the doc-in-the-box type clinics,” Dr. Rogers said. “It sometimes seems to me that they have a mandate that everyone must walk out with a prescription. They often prescribe an antibiotic, steroid or prescription cough medicine regardless if the patient needs it or not. None of that stuff works for a cold. In fact, studies have been done that say it makes your child worse. The antihistamine thickens the secretion, so you can’t get the yucky stuff out. That’s how you get better, by getting the mucus out and resting. When we’re sick, especially children, we need lots of rest.”

Dr. Rogers’ advice is to see your Cook Children’s pediatrician. Other options include a Cook Children’s Urgent Care Center or Neighborhood Clinic. If a doctor prescribes an antibiotic, she says it’s Ok to ask if it’s the right thing to do. If the doctor says it’s bacterial or to stop an infection, then proceed.

“There’s no magic cure for the common cold,” Dr. Rogers said. “And unfortunately, too many prescriptions of antibiotics are zapping the magic out of what was once a miracle drug."

About the source

Audrey Rogers, M.D., is located at 3200 Riverfront Drive, Ste. 103, Fort Worth, TX 76107. To make an appointment with her or one of her partners, call 817-336-3800. Like her on Facebook.Dr. Rogers received her undergraduate degree from Emory University in Atlanta, Ga., her medical degree at Southwestern Medical School in Dallas, and completed her pediatrics training at Children's Hospital of Oklahoma. Her special interests are behavioral pediatrics and adolescent medicine. She became board certified in 1989.

What will the new year bring?

Will I be able to keep that New Year's resolution?

And where in the world is the flu?

Ok, you may not be asking yourself that last question. Out of sight out of mind right? Well, not at Cook Children's. Our lab specialists have been diligently testing cases each week for influenza. And for the first time in at least 10 years, they haven't identified a single case so far. Since 2005, the closest we've seen to a season hitting this late was back in 2012 when the first positive case popped up on Dec. 26. But here we are, just two days from 2016 and nothing!

Depending on where you look, outlooks on the impending flu season vary. One model, developed by researchers at Los Alamos National Laboratory, shows the flu season will likely peak in February. WebMD is using data from its online Symptom Checker to predict a spike in cases in early January.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s, said the flu is unpredictable and she’s not sure why it’s “late.”

“We don’t know when it will start or peak,” Dr. Whitworth said. “We just generally go into each flu season with a wait and see attitude.”

Dr. Whitworth said how severe the flu season will be depends partly on whether or not the flu shot given is a good match to this year’s strains. Previously, in years when the flu shot strains didn’t match, doctors relied more on treatment with antiviral drugs (prescription medication) that fight against the flu in your body.

“For now, we don’t know how serious the flu will be, but for now getting a flu vaccine is still the best way to prevent what can be a potentially serious disease,” Dr. Whitworth said. “By immunizing every year, that’s how we, as a society, build up a community that protect themselves for new strains.”

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

According to the study, approximately 15 percent of 2-year-olds consume as much as 4 ounces of coffee daily. It’s a practice, health experts say, that comes with a dangerous dose of health risks.

The study followed 315 pairs of mothers and infants who were participating in an analysis of weight change during a child’s first week and its impact on body mass index at age 2. While examining diets, researchers found that 48 of the participating mothers were feeding their 2-year-olds coffee as part of their daily fluid intake.

Infants and toddlers of Hispanic mothers were more likely to drink coffee than those of non-Hispanic mothers, according to the study, but researchers did not examine further to determine why. Female infants were also found to be more likely to drink coffee than male infants.

Cultural practice may be one of the reasons some children drink coffee at younger ages, according to the study. In some countries, including Cambodia, Australia, and Ethiopia, children under 5 are given coffee.

“I think too much caffeine in childhood is a bad thing and worse in the case of a younger child,” said Joel Steelman, M.D., endocrinologist at Cook Children’s. “Coffee consumption by younger children is a big deal. I wouldn’t recommend parents start this practice. There are much healthier options. Caffeine could interfere with sleep – naps and bedtime. Overconsumption of caffeinated drinks could lead to symptoms of dizziness, headaches, mood changes and seizures.”

The U.S. Federal Drug Administration (FDA) has not provided guidelines on coffee consumption for children, but previous studies suggest there are potential negative health impacts, including Type 2 diabetes, depression, obesity and sleep disturbances. The American Academy of Pediatrics (AAP) recommends against the inclusion of caffeine in a growing child's diet.

Deborah Schutte, M.D., cardiologist and medical director of Cardiology at Cook Children’s, said her chief concern regarding toddler coffee consumption is the cardiovascular effect, particularly increased heart rate and high blood pressure.

“It boggles my mind why any parent would give a toddler caffeine. Toddlers are wired enough, why would anyone want to add to that?” Schutte asked. “My concern with caffeine and toddlers is more about tachycardia and arrhythmias. Caffeine can cause the heart to pump at an unnatural pace, resulting in palpitations.”

Schutte also points out that giving toddlers coffee could lead to dehydration, particularly since caffeine is a diuretic.

A 2013 study found that 2-year-olds who drank coffee or tea between meals or before bedtime were three times more likely to be obese in kindergarten.

“Just because there are no guidelines, doesn’t make it OK,” Schutte added. “What people don’t consider is that there is caffeine in drinks and food that we don’t always realize, such as chocolate and coffee- flavored ice cream, so caffeine levels can sneak up on you.”

According to the FDA, the average American adult consumes approximately 300 mg of caffeine each day - the equivalent to between two and four cups of coffee.

Canadian guidelines recommend no more than 45 mg of caffeine for children ages 4-6. This is equivalent to one 16 ounce can of soda.

If parents are already giving their toddler coffee, it’s possible to wean their child off the caffeinated beverage, Steelman said. He recommends parents talk to their pediatrician about a weaning off caffeine schedule.

•  Two kinds of fever reducers are approved for children — Acetaminophen and Ibuprofen. Aspirin SHOULD NOT be given to children as it can cause a serious illness called Reye syndrome.Ibuprofen can be used AFTER 6 months of age.KNOW THE PROPER DOSE.In Pediatrics these medications are based on your child’s weight. If you are not sure of the dose ask us or the pharmacist.MEASURE ACCURATELYUse only the dosing device that comes with your medication

  DO NOT GIVE ANOTHER DOSE TOO SOONRead the label on your medication to make sure you know how often to give it. Make sure all adults in the household know when a medicine is given so we don’t accidentally re-dose.

  It’s a good idea to keep a log and write down the medicine and when you gave it. This way Mommy doesn’t accidentally give a dose when Daddy just did. We see this over sight all the time so be aware.

• If your child is under 2 months and has temp more than 100.4 F rectally, they need to be seen either in our office or the emergency department.
• If your child is under 24 months and has a fever more than 102 F for over 24 hours, they need to be seen in the office.
• If your  child is older than 24 months and has fever present for over 72 hours you should be seen by your pediatrician
• If your child’s temperature IS NOT responding to fever reducers let your pediatrician know. They may need to be seen.WE DO NOT RECOMMEND ALTERNATING ACETAMINOPHEN AND IBUPROFEN. This practice has NEVER been recommended by the American Academy of Pediatrics and may result in confusion and dosing errors.You can also try lukewarm baths, but do not use cold baths or alcohol baths as this may make your child shiver which will raise their temperature.

  If your child is vomiting and can’t keep Tylenol down you can try Feverall (acetaminophen) suppositories.

Sandra Peak, M.D., joined Cook Childrens Physician Network in Lewisville in 2004. Dr. Peak enjoys gardening, yoga, and boating and in her spare time can be found at the lake with her husband Jay, stepson Sage and the world’s most amazing Lab, Sugar Mae.

1. What do you need to know as a parent?

The flu may start like the common cold with symptoms of cough, congestion and runny nose, but may also be associated with prolonged fever, muscle and body aches and fatigue. It is spread from person to person when an infected person, coughs, sneezes or talks and droplets are released into the air. It can also be spread less often from touching surfaces where drops are present. The flu virus is contagious from up to 1 day beforethe person presents with symptoms and up to 5-7 days after the symptoms resolve.

2. How can you protect yourself?

The best way to protect yourself is by getting the flu vaccine as soon as it becomes available. Other means to protect yourself are effective hand washing and wiping down surfaces with anti-bacterial/viral cleansers.

There are multiple flu vaccines available but the two common types are the inactivated virus which comes in the injectable from and the live virus which is the nasal form. The determination of which vaccine is right for you will be made by your healthcare professional.  Most important to remember, you CANNOT get the flu from either vaccine. Minor side effects may include congestion and runny nose for 2-3 days.

3. Why get the flu vaccine?

Even healthy persons who have never had the flu in the past can get the flu and experience serious complications. Older people, young children, pregnant women and people with medical conditions like asthma, diabetes, heart disease, or kidney disease are at especially high risk from the flu, but kids, teens and adults who are active and healthy also can get the flu and become very ill from it. In the United States each year, more than 200,000 people are hospitalized from seasonal flu-related complications. Last year from September 30 to February 9th, 64 children died from flu-related complications.

4. Who should get the flu vaccine?

Everyone over the age of 6 months.

Higher risk populations include those between the ages of 6 months to 5 years, children with asthma or other chronic disease,  pregnant women, people with immune problems, and adults  more than 65 years old.

Children under the age of 8 MAY require 2 doses of the vaccine 4 weeks apart from each other depending on their previous immunization status.

5. How is this year’s flu vaccine different than last year’s?

Last year, the flu vaccine contained two common Type A strains called H1N1 and H3N2, and one strain of Type B. This year, a new quadrivalent form of the vaccine is available which includes the two Type A strains and 2 Type B strains.

Manufacturers anticipate producing between 135 million and 139 million doses of flu vaccine this year, but only about 30 million doses will offer the four-strain protection. All of the nasal live virus formulations will be the quadrivalent and a portion of the injectable form will be quadrivalent. The CDC and the AAP does not recommend one over the other, as long as you get vaccinated.

6. What happens if you get the flu?

See your health care professional as soon as possible because if it is treated with anti-viral medications in the first 48 hours, the duration as well as the severity of the illness can be decreased. The CDC does not recommend treatment of healthy individuals with anti-viral drugs, but certain high risk populations will benefit from treatment.

Lizy Varughese, M.D., joined Cook Childrens Physician Network in Lewisville in 2013. She is married to Dr. Shane Varughese and has two children, Noah and Sarah. Dr. Varughese enjoys photography, cooking, and church activities. Her passion in life is taking care of children and educating families on preventative care and battling childhood obesity.