Navigating Cook Children’s Health Care System

Quick Facts:

• A Fully Integrated System: Cook Children’s Health Care System is a comprehensive, not-for-profit pediatric organization encompassing two full service hospitals, physician network, home health care, surgery centers, a health plan, and a dedicated health foundation.
• Cook Children's: Within our network, our two full-service pediatric hospitals are officially named and referred to as Medical Centers (located in Fort Worth and Prosper).
• Urgent Care: For non-emergency medical needs that still require prompt attention, the system also operates seven Urgent Care Centers across the region.

An unexpected visit to the doctor can be stressful, especially when traveling. Cook Children’s Health Care System ensures that families can access health care at any time through its seven Urgent Care Centers (UCCs), or its two 24-hour emergency departments. With help from the Cook Children’s Language Services Department, families can receive care in their native language. 

Know before you go 

Whether visiting the emergency room or urgent care clinic, being prepared will help ensure care is timely and the child is back in action as quickly as possible. 

To be able to treat a child, a parent or legal guardian must be present or provide permission for treatment. If a parent or legal guardian is unavailable, a written letter of permission or immediate phone access to obtain verbal consent from the parent or legal guardian is needed. 

The adult accompanying the child should bring:

• A form of identification.
• Traveler’s insurance information (if available).
• A list of the child's medication. 

When to use the Cook Children’s Emergency Department 

With full-service medical centers in both Fort Worth and Prosper, Cook Children’s provides emergency care for children across North Texas.  

“We are always happy and prepared to help,” said Julio Castillo, M.D., medical director of emergency services at Cook Children’s Medical Center – Prosper.  

Cook Children's cares for more than 300,000 children every year through urgent care and emergency room visits, providing care in more than 200 languages.  

“We have local Spanish translators and multilanguage computerized access,” explained Dr. Castillo. 

Caregivers should take their child to the Emergency Department if their child is unconscious, not responding, a bone is sticking out, or the situation seems critical. For immediate assistance, dial 911. When a condition is sudden, life-threatening, or risks causing permanent harm, transport by ambulance is safest for the child. 

Take the child to the emergency department if your child is experiencing:  

• Severe bleeding that does not stop after 15 minutes of direct pressure
• Severe allergic reactions
• Difficulty breathing
• Bluish tint to the lips
• Coughing up or vomiting blood
• Sudden severe joint pain with swelling
• Insect stings accompanied by breathing difficulties
• Accidental swallowing of medications, chemicals or other substances
• Not being able to move or speak
• Severe or persistent vomiting or diarrhea
• Gaping wound (edges won’t come together)
• Head injury with loss of consciousness, vomiting or causing dizziness/confusion
• Visible broken bones or dislocated joints
• Fever higher than 100.4 F in infants under 8 weeks old
• Diabetes/blood sugar issues 

Urgent Care 

“For simple fever, cough, and congestion, your child can be seen in urgent care or by their pediatrician,” said Taylor Louden, M.D., medical director of emergency services at Cook Children’s Medical Center- Fort Worth. 

When a child needs same-day medical attention for non-life-threatening illnesses or injuries such as X-rays or stitches,a Cook Children's urgent care clinic can provide the necessary care.

“Cook Children’s Urgent Care Centers are available to see patients needing routine or urgent care while visiting our city for the event,” said  Kara Starnes, D.O. medical director of Urgent Care at Cook Children’s. 

Not all urgent care centers are the same. Cook Children’s Urgent Care clinics are not just kid-friendly; they are kid-only. Because childhood injuries and illnesses require specialized pediatric expertise, families must make an appointment prior to ensure a smooth, efficient visit.

When to use Cook Children’s Urgent Care 

• Ear infections/pain
• Strep/sore throats
• Cold symptoms
• Flu
• Mild dehydration
• Respiratory illnesses – including respiratory syncytial virus (RSV), bronchitis, bronchiolitis, pneumonia and asthma without severe breathing difficulty
• Sprains and possibly broken bones
• Minor cuts
• Prolonged vomiting
• Persistent diarrhea
• Infected bug bites
• Foreign body removal (marbles, beans and other interesting things)
• Urinary infection symptoms
• Pinworms, ringworm, rashes and pink eye
• Painful muscle strains
• Head injuries without loss of consciousness or vomiting 

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Iann Ledesma spent nearly half of his first year of life in the Neonatal Intensive Care Unit (NICU) at Cook Children’s Medical Center in Fort Worth. For 193 days, his mother, Giselle, rarely left her son’s side. Having had two previous miscarriages, she relished every moment with her newborn, not knowing if her baby would live to be held again.

“It was challenging since I had previous miscarriages,” Giselle said. “With my first baby, he was a 16-weeker, he just passed in my hands. So it was challenging for me to hold Iann when he was very tiny because he would give me flashbacks.”

Even so, Giselle says holding him was a dream come true.

Iann was born prematurely at just 22 weeks, which is considered the edge of fetal viability. As the only Level IV NICU in Tarrant County, Cook Children’s is equipped with the highest level of neonatal care available. Families with critically ill or premature babies come to Cook Children’s from all over the city, region, state and beyond when their infants need complex care.

However, the unit is bursting at the seams.

As recently as September, 102 of Cook Children’s 106 NICU beds were filled—an unprecedented level of demand that shows no signs of easing given Fort Worth’s population boom. Cowtown is now the 12th largest city in the United States, with 59 people moving to the city every day. As Fort Worth’s population grows, so does the demand for pediatric critical care.

Big Growth Fuels Big Plans

Cook Children’s Medical Center has been a fixture in Fort Worth and a trusted leader in pediatric health care for 106 years, consistently rising to meet the needs of the children and families in the communities it serves. To keep pace with current and projected growth in the area, the health system is preparing to meet the moment once again by embarking on a 10-year master plan to expand and enhance its Fort Worth medical center.

“Our place in this world is to be there when kids need us, and to provide that necessary support for that family and that child so that they’re able to have as productive of a life as they possibly can,” said Stan Davis, president of Cook Children’s Medical Center. “So the belief is we do that by having the facilities, having the physicians and caregivers, having the technology, but also having the heart and the commitment of our community and our team to be able to do that when it’s necessary. That’s why we’re here. We stand in the middle of being able to and not being able to provide that necessary critical care.”

The plan includes a new 700,000-square-foot medical tower, known for now as the West Tower, which will add another signature blue peak to Cook Children’s flagship campus and Fort Worth’s skyline. It will be a seamless extension of the existing medical center, connected both above and below ground, and make way for an expansion of the NICU with an additional 37 beds. It also allows for an expansion and redesign of the Pediatric Intensive Care Unit (PICU), and increases capacity for Hematology/Oncology services and research, as well as additional operating rooms and imaging services.

“We have capacity issues in these areas we’re expanding,” Davis said. “We, unfortunately, from time to time have had to divert kids to other places as far away as San Antonio, Oklahoma and Louisiana. We feel like we provide the best care possible for the kids in our community. In order to do that, we need to have the facilities and the accommodations to keep kids here and close to their home.”

Giselle and her husband, Franco, live in Arlington. She says having access to Cook Children’s expert level of care and technology close to home gave them hope for Iann’s future.

“At the beginning, we didn't know what to expect from Cook Children's, to be honest,” Giselle said. “But now I can tell you that if they didn't have a bed for Iann, I would feel hopeless, because I know from my experience that's where miracles happen.”

Connecting the Dots to Peaceful Healing

Much like the NICU, the PICU is experiencing ever-growing patient volumes. During busy sick seasons, it’s not uncommon to see 500 to 600 patients in a single day in the Emergency Department (ED), with many requiring admission to the PICU. Respiratory illness is the top driver of PICU admissions, followed by neurologic injury and disorders of the endocrine system.

“If we don’t have adequate beds in the PICU, kids end up waiting or being held in the ED, which is not the ideal environment for them. They need to be in that critical care environment,” Davis said.

But Cook Children’s isn’t just building to increase bed space. It’s evolving, innovating and advancing to connect the dots between health care delivery and an enhanced patient and family experience.

The medical center’s current 20-year-old ward-style PICU, where nothing more than a curtain separates patient beds, is no longer conducive to the type of experience Cook Children’s believes in giving patients and families. One that balances expert medical care with the creature comforts that support healing of the whole person. 

For example, children in neighboring PICU beds and their families often absorb the sights, sounds and intensity of another child’s situation, especially when there is an emergency. In an already high-stress and emotionally charged environment, this can be a source of increased anxiety and fear for patients and families.

The redesigned PICU will feature 56 private rooms where patients can heal peacefully. Plans call for ample natural light in each room to aid in sleep cycles and support the mental health of patients and their families.

“One thing that always gets asked of me is ‘Are we building for the future?’ Yes, we are,” said Spencer Seals, Cook Children’s vice president of Construction and Real Estate. “While this tower is over 700,000 square-feet, we have about 160,000 square-feet of shell space. What that means is, as we’re going through the programming of everything that has to go in this tower for this campus, we want to make sure that we have the ability to continue to expand services and continue to serve that growing population in Fort Worth.”

Big Steps for Iann and Cook Children’s

Just as Cook Children’s takes a big step forward in its growth, Iann is making significant strides towards his future, too. Now 19 months old, he’s crawling and pulling up to stand. He’ll be walking in no time, his proud mom says.

“It's just been amazing that he's getting things done, but it's on Iann's timing,” Giselle said with a chuckle. “We learned that from the beginning.”

As Iann continues to make progress at his own pace, Cook Children’s is advancing with a similar sense of purpose—one that ensures every child will have access to the care they need when they need it most.

“It’s an ambitious plan, but it’s exactly what we need to support the growing population and demand for services in our area,” said Rick W. Merrill, president and CEO of Cook Children’s Health Care System. “Kids and families rely on us, and have for more than a century, and we want to make sure we’re in a position to continue to be a beacon of hope, where every child receives the care they deserve now and for generations to come.”

About Cook Children's

Cook Children’s is more than a health care system: we strive to be an extension of your family, growing with your child from their first steps to adulthood. By collaborating to deliver on our Promise—to improve the well-being of every child in our care and our communities, we connect the dots for our patients. Between primary and specialty. Between home and medical home. Between short-term care and long-term health.

Based in Fort Worth, Texas, we’re 10,000+ dedicated team members strong, passionately caring for over 2 million patient encounters each year. Our integrated, not-for-profit organization spans two medical centers (including our state-of-the-art location in Prosper), two surgery centers, a physician network, home health services and a health plan. It also includes Child Study Center at Cook Children's, Cook Children's Health Services Inc., and Cook Children's Health Foundation. In 2024, Forbes named Cook Children’s the top health care employer in the U.S., and third on the list of ‘America’s Best Large Employers.’

And our impact extends beyond the borders of Texas. We proudly treat children from virtually every state in the nation and 32 countries. By seeing the world through the eyes of children and their families from all backgrounds, we’re able to shape health care suited to them: connected by kindness, imagination and respect—with an extra dose of magical wonder.

Discover more at cookchildrens.org.

Read more about the conference on the Congenital Hyperinsulinism International website.

They shared how Cook Children’s is currently being impacted by a surge in COVID-19 cases and hospitalizations.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases, Corwin Warmink, M.D., medical director of Emergency Services, Kara Starnes, D.O., medical director of Urgent Care Services, and Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Pediatrics Haslet have all worked tirelessly to ensure our patients and families are receiving the best care throughout the pandemic.

During the news conference, the experts addressed what they are seeing in our urgent care locations, emergency department, and Cook Children’s system as a whole.

“We need compassion from the community and this is an illness affecting our children,” Dr. Starnes said. “We are hitting crisis mode and we can’t do it without your help.”

Cook Children's Urgent Care facilities are being stretched thin. Over the weekend, Cook Children’s was forced to close its Hurst location due to a lack of staff members and high demand for services.

"This is the first time we’ve had to take such measures. We closed in an effort to consolidate staff and safely take care of our patients,” Dr. Starnes explained.

On Monday, the six remaining urgent care locations saw 1,400 children. This is twice the number of patients the urgent care centers typically see.

Dr. Starnes stressed that if you believe your child has been exposed to COVID-19, it is best to find a local testing site in the community or use an at-home testing kit. You can find a list of local COVID-19 testing locations here. 

Cook Children’s Emergency Department (ED) is experiencing patient volumes not seen since the H1N1 pandemic in 2009. On Monday, the ED saw 601 patients with patients arriving every 2.5 minutes.

“We are breaking records we don’t like to break,” Dr. Warmink said. “I have been at Cook Children’s for 18 years and this is the worst it’s ever been.”

We encourage all families to come to the emergency room for emergencies but ask that they do not come for a simple COVID-19 test. This pulls resources away from critically ill and injured patients and takes up already limited bed space. Along with COVID-19, we are still seeing RSV cases but thankfully, they appear to be on a downswing.

“The adults in the room need to step up and do the right thing,” Dr. Warmink said. “If you send your kid to school without a mask, it’s not if they are going to get sick, it’s when.”

Dr. Warmink advises all parents, “Ask yourself if this can wait” before bringing their child into the emergency department.

Most children have mild illness with COVID-19, but that is not the case for everyone. Throughout the course of the pandemic, Cook Children's has hospitalized 1,129 children with COVID-19, with 241 of those admitted to the Intensive Care Unit (ICU). Throughout the pandemic, seven children with COVID-19 have died. Two died this past week. They were a 4 year old and a 15 year old. 

"We are seeing more severe illness than we have seen at any point during the pandemic. The January surge was nothing compared to what we’re seeing now,” Dr. Whitworth said.

As a result, on Monday, Cook Children’s opened up a third COVID-19 unit for the first time since the start of the pandemic. This unit has nine beds – and within the first 24 hours of being open, was completely full.

With Labor Day weekend ahead of us, Dr. Whitworth encourages everyone to be safe, mask up, and socially distance, as we cannot handle another influx at this time.

“Every child that has the virus inside of them has the potential to spread it to someone else, and they don’t mean to,” Dr. Whitworth said. “Much of what we are seeing is 100% preventable, children have to wear a mask.”

Cook Children's also set a record for COVID-19 hospitalizations on Wednesday with 35 patients. This is the highest number of COVID-19 patients hospitalized at the medical center at any point in the pandemic. The COVID-19 ICU was also filled. 

What can the community do to help?

All four experts we heard from on Wednesday have a few simple pleas:

1. Get vaccinated and get your child vaccinated as soon as possible.
2. Please have your children wear a mask to school.
3. Wash your hands frequently.
4. Re-think gatherings – if you gather, wear masks, stay socially distant and gather outdoors if possible.

Across the board, Cook Children's is seeing record numbers of families each day who are wanting rapid COVID-19 tests for their children.

"We understand this is a scary time, but want to remind families not to panic if your child was exposed to COVID-19," Dr. Starnes said. "We understand schools have requirements, but we need you to understand we do not want you to panic or rush in to be seen immediately after an exposure. Rushing to our urgent care locations puts a strain on our resources.”

The best thing you can do if your child was exposed is find a local testing-only site in the community or use an at an at-home testing kit.

Cough, fever, runny nose, sore throat, body aches, headache, vomiting and diarrhea are all common symptoms of COVID.

For children over the age of 3 months, these symptoms can typically be managed at home with symptomatic care. Medications such as acetaminophen or ibuprofen can help with fever and pain. You should encourage your child to drink plenty of fluids and it is ok if they do not have much of an appetite.

Parents should seek care for their child over 3 months of age if they have had 5 days or more of fever, difficulty breathing, inability to keep fluids down or stay hydrated (no tears or no urination for 8 hours or longer) or if their child is having pain or fever that is not helped by an appropriate dose of fever reducer/pain reliever.

Patients under 3 months of age who are sick should be seen in person and evaluated.

Also, if there is at least one known positive case at home and others are sick, it can be assumed that all have COVID and everyone needs to isolate at home for 10 days from the start of symptoms.

“We cannot magically create hospital beds at the drop of a hat,” Dr. Whitworth said. “Wear a mask no matter if you’re vaccinated or not, wearing a mask is not an option.”

Throughout the COVID-19 health crisis, Cook Children’s has made every effort to keep patients and families safe while following the latest guidelines provided by the Centers for Disease Control and Prevention (CDC). Since Nov. 16, only one caregiver has been allowed at Cook Children’s Medical Center per patient. Beginning at 5 a.m. on Monday, March 8, the visitation policy will change, allowing two primary caregivers inside the medical center per admitted patient.

The new visitation policy affects families with a child admitted to Cook Children’s Medical Center. Two primary caregivers will be able to accompany the patient in the hospital and stay with them in their room while they are an inpatient. Siblings and other visitors will not be allowed.

For primary care appointments and other outpatient visits (such as urgent care, specialty care, neighborhood clinics and surgery centers), any two people from the child’s household are permitted attend to appointments or visits. For example: mom and sister; dad and daughter; mom and grandmother.

For emergency room visits, special exceptions will be made for families who have other children with them when they arrive. Special considerations are also made for situations involving end-of-life and other times when an additional visitor may be necessary.

Cook Children’s will still require masks to be worn by employees and anyone over the age of 2 entering Cook Children’s locations. This includes patients, caregivers and those who have been fully vaccinated. In addition, all visitors will be screened for the virus via temperature and symptom checks.

Arlene marked 47 years of service in January, and at 63, she says it wasn’t until a week later she realized another anniversary had come and gone. During her time at Cook Children’s, she has seen eight presidents in the White House and the cell phone evolve in every stage. Arlene’s longevity mirrors the story of growth and change that Cook Children’s Medical Center has embodied for more than 100 years.

The Early Years

A Fort Worth native, Arlene was only allowed to go to school with Black students until her junior year when she learned that she would be leaving IM Terrell High School for Southwest High School. For the first time in her life, she would be going to a school with white students, and she recalled the experience as ‘new’ and ‘scary.’ Arlene was bussed to Southwest High School from the south side of Fort Worth and to her surprise, she didn’t encounter very many issues. One thing she remembers is the mascot of Southwest High School being the Rebels. During her first pep rally, she says all of the Black students walked out because of the offensive mascot. Decades later, Arlene is happy the mascot has changed.

Her new school also brought new opportunities, including her first job at just 16 years old. Through her health occupation class, she was hired at Cook Children’s as a nurse’s aide in 1974.

“I assisted the nurses. I took the temperatures, emptied and filled water pitchers, and helped where they needed me,” Arlene recalled. She did that every evening until she graduated high school.

After graduation, Arlene became a ward clerk, now known as a unit secretary. She recalls being one of very few minorities working in the hospital and remembers other Black employees on the maintenance staff and working in the dietary department. Arlene recognizes she was hired during a time when segregation was still being battled in many places. But that was not her experience at Cook Children’s. She says she was welcomed with open arms and never had any issues due to the color of her skin.

What stands out most to Arlene is how close-knit the staff at Cook Children’s became during her early years when the hospital was located on Lancaster Avenue. She said the “meet-up spot” was in the kitchen and doctors and nurses were really good friends. Arlene reminisces on how things were different at the old hospital.

“We pretty much wrote everything by hand, and we had to physically get up and change the channel on the TV,” Arlene said. “Now, we just put the information in a computer, and it does the work for you and a simple remote click will change the channel.”

The Shift: Growth and Change

When the current medical center was built in 1989, Arlene says it was an experience she will never forget.

“The move was fun and exciting, but it was also scary. We went from a building where you knew everybody you worked with, to a building where every time you looked up you saw a different face you didn’t know,” Arlene said.

Arlene continued to work as a unit secretary when the new medical center was built. She worked in that capacity for five years before moving to Infectious Diseases where she was quickly promoted to office manager. Arlene’s position was soon phased out, and she decided to take a well-needed vacation. Before long, she received a phone call asking if she planned to come back, and letting her know there was a position waiting for her in patient registration. Arlene continues to serve in this same department today.

During her service at Cook Children’s, Arlene has seen many changes in the world and at work. One area she says has been monumental is seeing minority employees come through the doors in different capacities.

“It has been great. There are more minority physicians and employees and that’s not something you think we would be doing. It makes me proud when I see them and their titles,” Arlene said. “For example, Ms. Wini, her position brings out a sense of pride in me, because she looks like me. If she can do that, a lot of other girls can do it too,” Arlene explains.

Arlene is referring to Winifred ‘Wini’ King, senior vice president and chief of communications, diversity, equity, and inclusion at Cook Children’s. She says she was proud when Wini was promoted and the diversity, equity, and inclusion department was formed in 2020. She believes it is important to have representation and it is something that’s needed everywhere. Arlene describes having representation at the medical center to the recent presidential election. Not only has she seen a Black woman work her way through the ranks at her job, she says seeing Kamala Harris become the first woman U.S. vice president gives her something to smile about as well.

An Encounter with the CEO

Arlene’s favorite memory is sitting under the leadership of former Cook Children’s CEO, Russell Tolman. Mr.Tolman was the CEO of Cook Children’s Health Care System for 25 years before retiring in 2007. Arlene says she owes her tenure at the medical center to Mr. Tolman, and will always remember how hard he fought for her.

“When my position in Infectious Diseases ended and I took that vacation, it was a day or so after that time period that I would have lost my tenure and he fought for me not to lose my tenure,” Arlene recalled. “That will always be one of my best memories because I knew I didn’t want to start over somewhere else,” She said.

Another memory that serves Arlene well is the life-long friendships she developed at an early age.

“When I was working at the original hospital, I worked with the first pediatric surgeons in Fort Worth, Dr. Dick Ellis, and Dr. Charles Mann. Until Dr. Ellis passed in April of 2020, we had always been very good friends,” Arlene shared.

Cook Children’s met a need in the community by bringing on top pediatric surgeons, and they were able to help children from all walks of life, which in return enriched Arlene’s life. Arlene says it has been a blessing to see children who weren’t supposed to make it past 10 years old, grow up and defeat the odds.

The Future & the Next Generation

You may be wondering what drives someone to stay at one place for nearly 50 years. Arlene says she comes to work every day to see smiles on patients' faces. She adds that she looks forward to Christmas every year for that exact reason—seeing children smile because of the Christmas magic.

Arlene makes it clear to everyone who asks, that she has no plans for retirement.

“When God tells me it's time, I'm going to listen. Right now, there’s nothing that I want to do that I'm not doing. I can travel and still do things that I want to do,” Arlene explains. “I'm just not the type that can sit at home. I tell everyone, one morning, God may wake me up and say, ’this is the day, give them that resignation,’ I'll come in and I will give two weeks’ notice. I'm leaving it up to God to help me make that decision.”

As for advice for the younger generation starting at Cook Children’s, Arlene wants new employees to look forward to the next 100 years.

“First, remember #WeAreCookChildrens means love. Love for one another, love for our community and our patients,” she explains. “Have patience and don’t always expect everything to be perfect. Be willing to listen and learn, regardless of your position, and always remember to be willing to accept change.”

Dr. Keator, who is a pediatric neurologist and epileptologist at Cook Children’s, began volunteering at Cook Children's at the age of 14 as a title holder with the Miss Texas Organization. Along with many of the other titleholders, she would perform her talent for patients in the atrium. Back then she performed ventriloquist routines.

“My fondest memory is being in the Atrium performing and you look up and see all the children and their parents looking down and watching you,” she said. “It was so daunting then and now I walk past it all the time.”

Then in 1998, through a senior internship program during her senior year at Trinity Valley School, she spent her spring semester with Hematology and Oncology at Cook Children’s.  

The department held a special place in her heart because her cousin battled cancer there. That stint with the doctors made such an impact on her that after completing her internship, she continued to volunteer at the medical center.

When asked if she always wanted to be a doctor, Dr. Keator said, “I always knew I wanted to do something in the medical field. We all have that childhood dream of what we want to be when we grow up, and even then I always wanted to help people, especially children.”

As a volunteer, she tried to ask good questions and absorb as much knowledge as possible to prepare her for medical school. She learned the importance of listening to the patients and their families. She also saw science come to life. It wasn’t just about studying words in a book; it was seeing how medicine and medical care actually worked.

“Volunteering here I also realized how little I knew!” Dr. Keator said. “Just regular biology or chemistry class in high school is nothing compared to what people do in real life. It was a process, where I learned that being a doctor was about more than just being smart, it really takes a lot of compassion and motivation. I was able to see the interaction of the doctors and nurses with the patients. I realized I had so much more to learn than what was just in a textbook. ”

It was through her volunteering at Cook Children’s that she developed her interest in working with children, especially those needing chronic or long-term care. “I learned my true passion of wanting to help others was the relationships you develop with your patients and their families,” says Dr. Keator. “In neurology, we care for many children with neurological conditions that require close follow up and care, as many of our patients are cared for from birth through adulthood. Of course, I enjoy the pathophysiology of neurological conditions, especially epilepsy, but, what I also love about my field is that you become part of the team and you truly get to know the family.”

Now at Cook Children’s, Dr. Keator sees new people learning those same life lessons. “I see volunteers today at Cook Children’s and they are all age groups who choose to spend time with our patients. I’m so thankful so many people want to come here and volunteer and help with the children. It’s pretty incredible. “Everyone should volunteer. It’s good for the soul.”

Dr. Keator said that working at Cook Children’s is “totally surreal” because it was everything she aspired to do as a child. “It’s really cool to look back and say, ‘Wow, I did it.’”

Count your many blessings. See what God has done!"

- Johnson Oatman Jr.

I grew up knowing every word to the song, “Count Your Many Blessings,” but never truly appreciated the powerful message until this past summer.

Our daughter, Eliza, got sick June 19, 2015. It seemed like a typical stomach bug. But by the next day, we knew something was wrong. She was hospitalized at Lakeside Covenant in Lubbock, Texas a couple days later.

It was there that we received her diagnosis, Hemolytic Uremic Syndrome, or HUS, caused by E coli. They arranged for us to be immediately flown to Cook Children’s Medical Center in Fort Worth.

Three letters: H.U.S – that would change our lives forever.

Eliza’s kidneys began shutting down; she was exhibiting signs of neurological disturbances as well. We couldn’t believe our healthy child was going downhill so quickly. She was transferred to the PICU (Pediatric Intensive Care Unit), where we would spend the next 26 days.

The staff in the PICU started Eliza on dialysis right away. As a mother, it was my worst nightmare, to see my child unresponsive, lying on a bed with multiple machines keeping her alive.

Eliza wasn’t following the normal progression of HUS. She began having seizures, her kidneys still refused to work, she continued to have gastrointestinal bleeding, and was showing signs of extreme pain.

By this point, she had gone through several blood transfusions, plasma exchanges, dialysis around the clock, numerous MRIs, CAT scans, EEGs, and EKGs. She had a whole team of doctors and they were all stumped. We were constantly told that she wasn’t their typical HUS patient.

Thankfully, Eliza’s nephrologist, Dr. Jennifer Willis, kept researching and questioning Eliza’s unusual symptoms. This would eventually save Eliza’s life. She suspected Eliza not only had HUS, caused by E coli, but also atypical HUS, a genetic disease.

She approached my husband and I about running a genetic test on Eliza to confirm the atypical HUS diagnosis, but the results would take up to 8 weeks. In the meantime, she wanted to try a medication called Soliris. She warned us that it was very expensive and she was not sure if insurance would cover it.

We continued to pray, we asked for prayers, and decided it was worth the risk. We just wanted our Eliza back! This was the first moment I truly realized we might lose our precious baby. We had been so hopeful and optimistic the entire time, but my hope was gone. I pleaded with God to be with Eliza and her medical team and save her life.

He answered my prayers and the prayers of many who were praying all over the world for her. Dr. Willis was right, after two doses of the medication, we began to see dramatic improvement. Eliza woke up, began talking, and progressed more and more every day.

Fifty days after exhibiting her initial symptoms, we were released from Cook Children’s. During Eliza’s summer at Cook Children’s we became friends with all the employees. We knew the PICU nurses, the receptionists and Eliza’s specialists.

Cook Children’s became our home. Eliza now looks, sounds, moves, and plays like a normal 2 year old. The syndrome, atypical HUS, has long-term side effects on some of her organs.

Currently, Eliza’s kidneys function at 60 percent. She is on multiple medications for both seizures and high blood pressure. The atypical HUS diagnosis was correct, as genetic tests eventually confirmed. Eliza receives a Soliris infusion every other week. Our sweet girl is a model patient. She jumps on the scale, stands to get measured, picks an arm for the blood pressure cuff, and watches while her port is accessed.

We owe so much to all the wonderful doctors, nurses and staff at Cook Children’s, as well as family, community, and the countless people praying for Eliza.

Is it a normal life? No, but it is her life and we thank God every day.

“Count your blessings, name them one by one. Count your many blessings, see what God has done.”

My wife nudges me. It’s 2 a.m.

“Hey babe, did you hear that? Who is coughing? Can you go check on them? Take your stethoscope.”

That’s what an Emergency Room visit looks like in our house in the middle of the night. This time of year, many of you might wish you were married to a pediatrician … but, alas, Mrs. Doc Smitty is one of the few with that privilege.

We at Cook Children’s, and hospitals around the nation, have seen a significant rise in the use of our Emergency Departments and Urgent Care Centers over the past few weeks. Not only are we seeing more kids, many of those kids are more complex and more sick than we have seen in previous years. We are seeing RSV, flu, vomiting/diarrhea and just about every other pediatric illness you can imagine. It’s all going around.

Not only do we find ourselves servicing our local area, we are accepting transfers from most of North Texas in an effort to provide service to very ill patients who need the level of care that Cook Children’s can provide. This responsibility is based on Cook Children’s promise that every child’s life is sacred.

But that important commitment to helping so many children means helping a lot of kids. Here’s what we know that means to you.

We know that wait times are longer than usual right now.

We follow the trends in wait time closely – both at our medical center and in our region. All across Dallas-Fort Worth, hospitals are experiencing this surge in visits and we are hearing about increased wait times at emergency rooms throughout the area.

We are working to address this issue. We are increasing the number of providers ready to work in the ED. These are not our regular ED physicians but physicians who will be available to help out with patient surges after their “day jobs.” We are working to educate our families about other locations where they can receive care. Unfortunately, once a patient is checked in at the ED, we cannot ask that they leave to receive care elsewhere. Asking them to leave would be a violation of a law known as EMTALA.

Another issue we are facing is limited space. Hospital beds are filled with sick children that are not ready for discharge. This requires that children who need admission remain in our ED as they wait for a room in the hospital.

Space in the ED is already limited based on the fact that it was built to accommodate 45,000 visits per year but is currently seeing more than 120,000. Much of this problem will be addressed when our new Emergency Department opens, but, for now, we have to work to maximize the use of the space that we have.

Therefore, increasing providers will not cut your wait time down to zero but we will do our best to shorten it as much as possible.

You can help by utilizing our various other ways to care for your child’s medical issues addressed. Do not hear this as a lecture to not go to the ER; that is not the point of this post. We are working hard to provide other means that might help you by addressing the problem more quickly. Consider calling your Cook Children’s pediatrician. Even if they are not open, you can get advice from our outstanding pediatric nurses who can take your phone calls overnight. If your issue requires a visit but the ER seems like too much, check out one of the four Cook Children’s Urgent Care Centers throughout the Fort Worth area.

We know that waiting is terrible.

Doctors are some of the most impatient people I know. I don’t like to wait for anything. I get antsy and frustrated and become very difficult to deal with. If the radiology report or the lab result takes longer than expected, our anxiety level goes up. When we know our patients are suffering and we need those results to relieve suffering, we become even more frustrated. We hope you don’t sense our frustrations as frustrations with you. We just hate to see kids sick and to see more of them sick than usual makes us all sad.

You can hear the frustration in this brief interview with Corwin Wormink, M.D., Cook Children's Assistant Medical Director of Emergency Services.

We are working to address this issue. We are working to speed up all the processes associated with caring for your children so that our providers can be as efficient as possible. We are working to support providers (doctors, nurses and all other staff) so that they can be energized (physically and emotionally) to continue to provide excellent care for your child.

We know that waiting with a sick child is even worse.

We hate it that you are waiting hours to be seen in our ER. When our providers walk into the room and see that you’ve been waiting, our heart hurts about the time you’ve spent sitting in an uncomfortable chair trying to corral your sick child (often with their siblings). We know that you are worried about your child because he or she is sick. You’ve been scared to go to the bathroom, afraid you might miss your name being called out and that you are hungry and tired.

We are working to address this issue. We are looking to staff volunteers in the waiting rooms to help you get to where you need to be, to provide distractions for your children and to do anything they can to help you while you wait. We also are looking to increase our use of text and other notifications to update you on the status of your wait times, need for vital sign checks and other issues. Even when you are waiting, unable to be seen by a doctor, our triage nurses are checking and re-checking your child’s vital signs to make sure that your child’s medical condition is not changing, requiring them to be moved up in line to be seen sooner.

Your child is important to us.

Despite the fact that the numbers of children in the ED are high, we want to continue to provide the best care for your child. No matter how long your wait, we want you to feel like your concerns and questions have been addressed and that you have received the personal care your child deserves. If at any point, you do not feel like you have received that level of care, feel free to reach out to us at 682-885-6698.

You may not have a pediatrician lying next to you in bed for a quick ER check in the middle of the night but we do want you to know that we are here for your child in many other ways. Start by picking up the phone and calling your pediatrician or nurse triage line. If you decide your child needs to be seen, think about trying one of our Urgent Care Centers or in an emergency, our Emergency Department.

Our providers in each area are ready to provide the best care for your child.

Previous articles, related to this topic:

• Sicker kids means longer wait time in ED
• 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

Turner syndrome is a common genetic condition occuring in 1 in every 2,500 girls born. It is caused by missing all or a portion of one of the X chromosomes. The condition varies in severity but has physical and psycho-educational impacts.

Care of the girls with Turner syndrome is an integral part of the practice of the pediatric endocrine group at Cook Children’s. The majority of girls affected will have short stature and early failure of the ovaries. Growth hormone treatment is prescribed and monitored by pediatric endocrinologists to treat short stature. The task of monitoring puberty and timing of estrogen replacement is equally important to insure overall health.

As I said, new insights were gained by me at this meeting. I have cared for girls with Turner syndrome from infancy to adolescence. The concept of transition medicine is a growing, important areas in the lives of both of pediatric physicians and the children treated by us with chronic medical conditions. The medical treatments offered currently, have led to vastly improved life quality and long life expectancy.

A new challenge has emerged for physicians, families and emerging adults with a chronic condition – how to live life with the unique challenges of their particular diagnosis. Learning from experiences in education, employment and health shared by young adult women with Turner syndrome during Q&A in my talk was very enlightning.

I was very pleased to spend some tiem at this year’s meeting and learn more about the society. The Turner Syndrome Society, like many other organizations devoted to support and advocacy for a specific condition, provides a forum for families and women with Turner syndrome throughout the stages of life. The education and social support provided by this organization at the national meetings is admirable, and the atmosphere of learning can only benefit girls and women with Turner syndrome in the future.

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., 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 the Physician Perspective page on the Cook Children’s Web site.

Occasionally, I’ve been lucky to know someone personally whose life has benefitted from such progress which was the case this past month. Multiple news outlets reported dramatic results of a new therapy for infantile hypophosphatasia. Hypophosphatasia is an extremely rare genetic condition affecting less than 20,000 people in the U.S. The condition is due to defective action on a vital bone enzyme known as alkaline phosphatase which is necessary in the formation of bone. There is a spectrum of severity tied to how active the enzyme is. Those with some to modest enzyme activity have symptoms appearing in childhood or adulthood, including weakness in bones that causes them to break more easily and premature loss of teeth.

Babies with the severe infantile form of hypophosphatasia progressively weaken as bones dissolve away. Movement and eventually the vital function of breathing become progressively more difficult. Toll of the disease is terrible with half of babies with infantile hypophosphatasia dying of respiratory failure in the first year of life. Progressively fewer live to see subsequent birthdays.

The news stories reported specifically about one patient, Janelly Martinez. Janelly’s parents watched helplessly as their daughter followed the typical grim course of infantile hypophosphatasia, requiring escalating levels of medical care to survive. For a time, I shared in the family’s struggles as a member of the endocrine team at Vanderbilt University that diagnosed and cared for Janelly.

Janelly’s parents faced the prospect that she would not survive the scarce few months until her third birthday. Her parents needed a medical miracle. For Janelly and her family, the miracle came. A new experimental therapy with the drug Asfotase alfa, a synthetic form of alkaline phosphatase became available in 2008. The results were dramatic for Janelly and other babies receiving the drug. New bone began to grow. Treatment results were dramatic, appearing within six month. Some older toddlers were able to stand for the first time.

I am deeply touched by the new life Janelly has received from this treatment. From struggling to breathe with mechanical assistance to now bearing some weight, Janelly has made remarkable progress. The prospects for an average childhood for Janelly even with treatment remain unknown. She is nearing 7 years old but remains the size of a toddler. Her contribution and her family’s contribution to medical discovery will endure.

It doesn’t matter how many years I’ve been in medicine, I continue to be impressed with advancements in modern medicine. I’m amazed at the science of it all and so thankful that it can helps special little children like Janelly.

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., 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 the Physician Perspective page on the Cook Children’s Web site.

Did you know the beginning of April marked national public health week? Probably not. The observance which began officially in 1995 doesn’t garner much in the way of public attention. Still, it serves to highlight public health achievements as well as talk about ongoing public health issues.

Many of the numerous accomplishments of public health are now considered basic services not recognized for the benefit they have given us all in health improvement. The newborn screening program was one of the accomplishments highlighted this year. This program has in particular greatly impacted my specialty of pediatric endocrinology, and I think it is important to acknowledge its important place in public health history.

Every year, newborn screening efforts test nearly every baby born in the U.S. for serious health conditions. Early detection of these conditions allows prompt medical treatment and potentially prevents disability, suffering, and death. In particular, testing the 4 million infants born every year for congenital hypothyroidism costs $5 per newborn and is estimated to prevent 160 cases of intellectual disability associated with untreated hypothyroidism.

I’ve written in the past about congenital hypothyroidism. The condition refers to a specific type of hypothyroidism diagnosed in newborn babies. This serious condition occurs in roughly 1 in every 4,000 newborns and can have devastating effects if not detected and promptly treated. Eighteenth century medical literature described the mental retardation and physical effects of untreated congenital hypothyroidism, cretinism. But only in the last 30 years have doctors been able to detect these issues prior to birth, allowing for parents to be prepared and physicians and family members to lay out a plan for the child’s future.

The Texas state newborn screening for congenital hypothyroidism has been active since 1980. It is estimated that 120-150 newborns in Texas with hypothyroidism are identified annually by screening. The program is a cornerstone in Texas public health and continues to grow. Today, the program tests newborns for 30 life-threatening issues including sickle cell disease and cystic fibrosis. Congenital adrenal hyperplasia screening represents another important life-threatening condition with pediatric endocrine ties that are screened by the state.

There are many other accomplishments in public health largely unrecognized by us. Thankfully, the U.S Centers for Disease Control & Prevention has compiled a list of the 10 great public health achievements in the 20th century.

Many other Cook Children’s specialties besides endocrinology rely on newborn screening to identify at risk babies early. Many of the conditions tested by newborn screening are rare metabolic conditions. The metabolic genetics program offers evaluation and treatment of these inherited metabolic conditions to help families understand and cope with their child’s diagnosis. A visit to that program can help with a more accurate diagnosis and appropriate treatment, while also helping families determine the best short- and long-term care.

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., 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 the Physician Perspective page on the Cook Children’s Web site.

I was immediatley interested when I chanced on a recent radio interview with the author, Michael Moss, who has written a new book about the inner workings of the processed food industry. The book deals specifically with the reasons that these companies use three key additives – salt, sugar and fat – in the processed food they create and market.

The term processed foods sounds somewhat sinister, but some of the ways that food is processed such as pasteurization or freezing are quite beneficial to people for both health reasons and convenience. The primary goal in most processing of foods is creation of a food product that is near ready to eat and is stable on the shelf or in our homes for a long period of time. This particular goal and the goal of making tasty processed foods according to Mr. Moss is where the problem begins.

In the book, Moss interviews food scientists in many of the large processed food companies. These scientists are tasked with making tasty food products that apeal to a large group of people. Moss describes the use of the three key additives to mask odd or bitter flavors that develop during manufacturing and to hook consumers on taste.

Moss argues that company pressures to create new appealing snacks, grow market share and improve profitability often result in unhealthy foods that contribute to the U.S. and global obesity epidemic.

The interview concluded with the debate about what steps can be taken to reduce these activities and make healthier foods. The debate no doubt will continue between different philosophies of strict government regulation and independence of consumer choice.

I’ve downloaded the eBook and look forward to learning more and examining different viewpoints. In the meantime, my family and I will continue to see fresh ingredients and discover new recipes.

More information is available if you are interested with links to the NPR interview and the book.