Each of the 1,528 pinwheels represents a visit with Cook Children’s Child Advocacy Resource and Evaluation (C.A.R.E) team due to suspected child abuse in 2025. In Prosper, 1,287 pinwheels illustrate the victims of child abuse in Denton County in 2025.

April is National Child Abuse Prevention Month. The pinwheels help draw attention to the issue and remind caregivers, families and parents they are not alone. Each pinwheel isn’t just a case or a number, it represents a child.

“We see kids who are referred to us from other medical providers, law enforcement, or CPS,” explained Erica Bohmer, M.D., a physician with the C.A.R.E. Team. “Anytime there's a concern for any kind of abuse or neglect they are referred to us.”

Dr. Bohmer clarifies that a referral to the C.A.R.E team does not automatically mean abuse is confirmed. In 2024, less than half of the children referred were substantiated.

Protecting the Child, Supporting the Caregiver

The C.A.R.E. Team consists of social workers, nurses, nurse practitioners, doctors and medical assistants who focus not only on the physical well-being of the child but also the family’s holistic care.

“We know that kids are most at risk (for child abuse) when their caregivers are going through really stressful or traumatic times in their own life, and they have a lower threshold of tolerance for being frustrated or they just don't have the right resources,” said Dr. Bohmer. “By providing help to caregivers we can have the biggest impact in preventing child abuse and neglect.”

Dr. Bohmer says abuse is usually identified during physical exams. The C.A.R.E. team most commonly receives outpatient referrals due to sexual abuse and most evaluations from inpatient referrals is due to physical abuse. Across the health care system and nationwide child neglect is often the biggest form of child abuse. The C.A.R.E team also performs neglect evaluations when there are concerns for illicit drug exposure.

A majority of referrals to the C.A.R.E team for suspected child abuse are due maltreatment and concerns for drug exposure.

Child abuse is preventable with the right tools and resources. The C.A.R.E. team understands the stresses of everyday life can take a toll, but it’s important for caregivers to know there is help available.

“We try to help identify resources that we can help families with, whether it's connecting them with food banks or if they need help filling out applications for a WIC or touching base with local, advocacy centers or even clothing, transportation, just anything that we can do to help the families, even down to working with electricity and water companies,” said Carla Davis, RN, nurse manager for the C.A.R.E. team

 In Texas any person who suspects child abuse or neglect must report it to law enforcement or the Texas Department of Family and Protective Services Abuse Hotline. Health care professionals are mandated reporters who must report suspicions of abuse within 24 hours. 

“We care about protecting the children and the entire family,” said Davis, “We want to try to support and help as best we can so that it can be a successful situation where the families can stay together.” 

Related Stories

• Cook Children's Center for Community Health Collaborates with Community Partners to Raise Awareness about Child Abuse Prevention

• Empowering Families through Mental Health Conversations

National Child Abuse Prevention Month brings awareness to recognizing and reporting child abuse. It also recognizes the importance of families and communities working together to strengthen families to prevent child abuse and neglect. Texas consistently has some of the highest child abuse and neglect rates.

Child abuse and neglect include all forms of physical and emotional harm, sexual abuse, neglect, and exploitation that result in actual or potential harm to the child's health, development or dignity. Within this broad definition, five subtypes can be distinguished – physical abuse; sexual abuse; neglect and negligent treatment; emotional abuse; and exploitation.

Each of the 1,675 pinwheels displayed at Cook Children's reflects a child abuse visit. Neglect is the No. 1 type of child maltreatment. One in seven children has experienced child maltreatment in the past year. Texas is the No. 1 state for child abuse fatalities.

Led by a pediatrician who is board certified in child abuse medicine, the Cook Children's CARE Team provides medical and forensic evaluations for victims of physical abuse, neglect and drug exposure, sexual abuse screening examinations and preventative education for victims of child maltreatment.

Resources:

• The Cook Children’s Child Abuse and Neglect Prevention website and a phone number to text for local resources.
• Text ‘FIND’ to 67629 for local resources and support.
• Call 1-800-252-5400 to report abuse. Visit txabuseonline.org to report abuse online.
• Child Abuse and Neglect Prevention (cookchildrens.org)
• Go to saynotoabuse.org for additional prevention and support resources.

Find ways to cope with COVID-19 social distancing guidelines

There are more people staying home and you may have lost your usual activities due to the new restrictions. Social distancing doesn’t mean you’re alone.

• Stay in regular contact with family, friends and neighbors by phone, social media or other technology! Even a few minutes of conversation a day is important.
• Take part in healthy activities that relieve stress. Take walks, go outside, read or tell stories. Find ways to cultivate joy and connection.

Reduce the pressures of parenting

You may feel like you have a lot more on your to-do list, especially with kids at home.

• Feel good about what is going well and celebrate the small things! Pat yourself on the back for a decent meal, a funny joke or just quiet moments.
• Build a new routine at home. Remember to include breaks for everyone to take care of themselves with downtime, playtime and exercise.
• Speak up when you need help and offer support when you can.

Reach out for help

Sometimes the pressure can be too much. Reaching out for help is important for you and your family. The following are 24-hour free help lines for different needs.

• For confidential support when you need help with the stresses of parenting, call Child Help:
  • Call or text 1-800-4-A-Child (1-800-422-4453) or live chat at childhelp.org
• For help with teen specific concerns:
  • Call Texas Youth Helpline: 800-989-6884 or text 512-872-5777
• For help with parenting tips, local resources and to learn about family fun:
  • www.helpandhope.org
• For mental health support and crisis care, call iCARE:
  • Call or text iCARE at 817-335-3022
• For access to services through a social service hotline:
  • Dial 2-1-1 or 877-541-7905 or go to 211texas.org

For all other questions/updates on COVID-19, visit cdc.gov.

If you suspect a child is being abused or neglected, please contact the Texas Department of Family and Protective Services (TDFPS) toll free at 1-800-252-5400, 24 hours a day, 7 days a week. You may also file a report using the secure TDFPS website. Reports made through this website take up to 24 hours to process. The Texas Abuse Hotline is 1-800-252-5400.

For more resources:

• The Center for Prevention of Child Abuse and Neglect
• About The Center for Prevention of Child Abuse and Neglect
• Early Detection of Child Abuse and Neglect Training
• Predicting Child Abuse and Neglect
• childhelp.org
• Childhelp National Child Abuse Hotline

About The Center for Prevention of Child Abuse and Neglect

The Center for Prevention of Child Abuse and Neglect is focused on innovative ways to address this important concern in our community.

Through the 2007 Community-wide Children's Health Assessment & Planning Survey, child abuse/maltreatment was identified as one of the top seven health issues affecting the children of North Texas.

Child abuse and neglect includes the issue of child abuse but is also a more all-encompassing term that describes a wide range of behaviors and related risk factors that are unacceptable and must be addressed. These include:

• Sexual abuse
• Physical abuse
• Psychological abuse
• Neglect
• Neglectful supervision
• Medical neglect
• Threat of gang violence
• Bullying
• Cyber bullying
• Related trauma
• Trafficking

Learn more about our program here. 

Jamye Coffman, M.D., medical director of the Child Advocacy Resource and Evaluation (CARE) Team at Cook Children’s, says if we don’t talk about the issue, change won’t ever occur.

“Children are dependent on adults so it’s up to us to make sure they are protected and taken care of, regardless if they are our children or not,” Dr. Coffman said.

Today, we discussed abuse and neglect with Dr. Coffman to learn more about the types of abuse our children face and what we can do about it.

What are the types of services the CARE team provides?

The CARE team is made up of board-certified pediatricians and advanced practice nurses trained in the treatment of child abuse. Our team is involved in providing assessments, education and medical evaluations of the child.

What are the different types of abuse seen at Cook Children’s?

I think when people hear  the word "abuse" they think of sexual or physical abuse. But we also see kids for neglect.

Would you mind explaining neglect a little more to us?

The most common form of child maltreatment is neglect. We see different types of neglect, which is defined as a failure to provide adequate food, clothing and shelter. Children who are neglected are often underweight and/or unkempt. They may beg for food or eat out of a trashcan at school, or they may be dirty, have dirty clothes and have a bad odor. For infants, underweight or malnourished, unbathed and dirty or severe diaper rash can all be signs of neglect.

What is the impact that neglect can have on a child?

Neglect, especially in children under the age of 3, can cause the same long-term chronic health problems as being physically or sexually abused.

Primarily for younger children, babies, we see a lot of failure to thrive cases. Usually, these are kids under 2 or 3 years of age, who can’t get food for themselves. It may be because the parents are impaired with substances and are not paying attention to the needs of a child most of us take for granted like feeding the child or changing his or her diapers.

When the child gets older, we see school-aged kids who appear to be malnourished. The only meals they are getting are at school and they get breakfast and lunch. But during the weekends or summer when school is out, these kids are looking in the trash outside for food.

Another form of neglect is parents simply not watching their kids. That’s where we see bathtub drownings or a child left alone in a car.

Sometimes it’s about knowledge and awareness. It doesn’t always mean a criminal act. Sometimes the parents need to be educated and learn they can’t leave their child alone in the tub or in a car for even a short period of time.

What can the public watch for when it comes to child abuse and neglect?

For neglect, people should watch for a child who is extremely underweight or malnourished. They may beg for food or always have dirty clothes or a bad odor.

Any bruise on an infant is concerning because they are not mobile enough to bruise themselves, so if a bruise occurs it’s more than likely that someone else had to have had a part in it. Any unexplained injury of a young child. Infants under 6 months of age should not have bruises.

For older children, the concerning bruises are ear bruises, bruises on the padded parts of the body or the cheeks, and anything from the hips to the shoulders, on any side of the body (excluding the hip bone). If the child has bruises on the bony prominences such as forearms, shins, elbows, knees, forehead, nose or chin, those could all come from normal play that the child engages in and are not as concerning.

Other things to be looking for are pattern bruises anywhere on the body, which means anything that looks like an object such as a belt, switch or spoon. Similar to this are burns. If there is an emersion type burn on a child as if they had put a whole body part into hot water, that is also concerning. This is different from an accidental burn. Those types of burns, such as pulling a pot of hot water off the stove, would have a splash pattern from all the places the water went, whereas an emersion burn has a distinct pattern that usually looks like a glove or sock pattern. This means that their body was placed into hot water and was forced to stay there long enough for severe burns to form.

Sexual abuse can be difficult to detect because it doesn’t have many specific symptoms or behaviors. Some physical signs of sexual abuse, however, could include trauma or damage to the genital or anal areas, sexually transmitted diseases, or pregnancy.

Children may act out with sexual or inappropriate behavior that is beyond their expected developmental knowledge. This may indicate the child has witnessed or experienced the sexual behavior.

If someone does suspect a child is abused or neglected, how should they go about reporting the situation?

You should call the Texas Department of Family and Protective Services at 1-800-252-5400. If the child is in immediate danger, call 911.

I know it’s difficult to be involved. But these children are at increased risk of long-term poor health and early death. It’s our moral responsibility to act now and put our children first and get involved.

It’s also important to do what you can before things escalate. We have to watch out for one another. If you know someone, whether it’s a family member or close friend, offer to be a resource for them.

Step in and offer to babysit if you see a parent is struggling.

That doesn’t mean you don’t call if you see abuse though.

We all have to work together to do better and care enough to work together to improve the future of our children.

On Wednesday, Oct. 17, experts from Cook Children’s gathered at the Regional Child Health Summit to look at 2018 data and trends from more than 8,000 parents who participated in a survey. People from Tarrant, Denton, Parker, Johnson, Hood and Wise Counties participated in the latest Community-wide Children’s Health & Assessment Planning Survey (CCHAPS).

The purpose of the summit was to look at key children’s health priorities in the region and discuss potential area for community action to improve children’s health with the experts in the room.

During the course of the day, several important topics were discussed. Here are some of the highlights.

1. Play time with other children

• 82 percent of the children in our region play with other children every other day or every day, but there is a decrease in daily play from 2015 (from 71 percent to 63 percent.

2. School safety

• 92 percent across the region report children are safe at school. This is lower than the national rate (98%) and the state rate (97%).

3. Children and health care.

• Children in our region are more likely to have a primary physician than children statewide or nationally – even our homeless children. Between 85 – 98 percent of children in this region have a primary care doctor; compared to 65 percent statewide and 73 percent nationwide.
• 10 percent of children in our region, were without health care at some time in the last 12 months. That’s lower that the state average (15%), but slightly higher than nationwide (8%)

4. School Days Missed

• Children in our region are more likely to miss school than the state and national rates reflect and they are more likely to miss more days annually than statewide and national rates reflect.
• 65 percent of our children miss between 1 and 6 days of school per year due to illness or health problems.

5. Mental Health Disorders

• The most common mental health disorder among children in the area is sleep problems, followed by self-esteem, overeating or undereating, traumatic events, wetting the bed and negative or obsessive thoughts.

6. Bullying

• The number of children in our region bullied or teased at school decreased in 2018 from 17percent to 13 percent. Still the number of kids impacted is large with an estimated 93,655 children.

7. Abuse and Neglect

• Except for Denton, the rate all of the CCHAPS region counties is higher than the statewide rate for all three years. The Denton County rate of confirmed child abuse and neglect victims is half of the statewide rate (4.3 percent vs. 8.5). The Hood County rate is more than two and a half times the statewide rate (23.2 vs. 8.5) [Source: Texas Department of Family and Protective Services Data Book. (2016).]

To learn more about the CCHAPS survey and findings, click here.

Obesity? That's one.

Car accidents? That's a big risk too.

But would you guess the number one issue is asthma?

In Tarrant County, 19.5 percent of children suffer from asthma, according to data gathered in a survey sent to parents by The Center for Children's Health led by Cook Children's. The Community-wide Children's Health Assessment and Planning Survey (CCHAPS) was completed by more than 8,600 parents in Tarrant, Denton, Hood, Wise, Parker and Johnson counties.

"We questioned parents on everything from how often their child is buckled in properly to how many grocery stores in their neighborhood sell fresh fruits and vegetables," said Larry Tubb, senior vice president of the Center for Children’s Health. "The information we are gathering is extremely valuable when it comes to measuring the overall health of children in our region."

Overwhelmingly, parents in Tarrant County (and all of the surveyed counties) reported their children are dealing with asthma. In fact, children in this area ages 6-9 are three times more likely to have asthma than children living in other parts of Texas. While we don't know why the numbers are so high, we do know people with asthma have varying triggers, and what affects one person will not necessarily affect another. Those triggers include, but are not limited to, cigarette smoke, indoor and outdoor mold, pet dander, air pollution, dust mites, cockroaches, pollen, smoke and strong odors.

The second biggest health issue on parents minds is obesity, with 17.8 percent reporting concerns about their child's weight, activity level and access to healthy foods.

Accidental injuries rings in third. In Tarrant County, 11.9 percent of parents reported their children had been injured and required medical care. Those injuries range from car and ATV-related incidents to drowning, bicycle falls and crashes.

The fourth issue on the list is a lack of dental care for children. Parents reported 9.7 percent of children either didn't see a dentist regularly, didn't brush their teeth enough or some even reported their child didn't have their own toothbrush.

Finally, mental illness is the fifth biggest issue concerning parents in Tarrant County. Behavioral and emotional development is on the minds of 8.5 percent of respondents. Many reported their children have suffered sleep problems, self-esteem issues or have tried to harm themselves.

The survey used to gather this data is part of a Cook Children's initiative to improve the health and well-being of every child in our six-county region by 2020. This initiative launched in 2009 with the very first survey of its kind sent to parents. Since then, the surveys have been sent out every three years.

"The information provided by parents in our community is available on-line and being used by a host of organizations, including Cook Children’s, to build programs and services. There isn’t one perfect answer, but, together we are making solid progress in improving the health of the children in our community by putting the child and family at the center of our planning," said Tubb.

About The Center for Children's Health

The Center for Children's Health, led by Cook Children's, is home to the Community-wide Children's Health Assessment & Planning Survey (CCHAPS), Community Health Outreach and Community Health Research. The center's goal is to create aligned collaborations that will allow us to make our North Texas region one of the healthiest places to raise a child.

The school nurse has long offered an escape from the classroom… and as many Band-Aids as a kid could need. But the responsibilities of a school nurse stretch far beyond their tiny office walls. They are the keepers of care for hundreds, if not thousands, of students. Their duties range from administering CPR to managing insulin pumps and blood sugar levels. In between all of that, there is another heavy responsibility they are tasked with: recognizing and reporting suspected abuse and neglect.

“We want our nurses to have the updated knowledge, skills and resources they need to keep our kids safe and to do their job effectively,” said Cindy Parsons, Director of Health Services at Keller ISD. “The school nurse has an important role in education about child abuse. Teachers and other school staff members may not be as familiar with subtle signs of neglect, and the school nurse is often the person who helps to educate them.”