We’ve all bought the desired backpack or lunch box, purchased the needed clothes and shoes, and reviewed class schedules and lists with a fine-toothed comb. As parents and caregivers, so much detail and organization goes into getting things ready for going back to school. 

Every one of my girls has a different priority - how many classes do they have with a friend, if they made it into the class they hoped for, if they got the teacher they wanted, and do they get to do the activity this year that they really want to do. 

All of our priorities collide and we forget the most important priority is who we are in the midst of all of these things. As we prepare our kids for returning to school, it can be easy to get caught up in the supplies, schedules and activities. However, preparing our kids for the character traits they will need throughout the year and their lives is also important. 

If I focus on just the year in front of me, I can get a little overwhelmed with the extras and forget that my kids’ integrity matters most. Their character, in terms of their kindness, gratitude, honesty, and making good choices, will carry them further than any other detail of the year.

Kindness

Kindness is not the easiest way all the time. It takes work and fortitude. Choosing kindness is intentional and as an adult, I need reminders and help to choose kindness when others are not. 

Our kids need even more help with this. They need ideas and help processing exactly what kindness looks like when they really don’t feel kind toward someone. 

Sharing with someone who never shares, helping the person that doesn’t help you, responding softly when others use their words to hurt – all of these things and more are hard but effective in the long game of life. 

This is not something that comes naturally. It is important to remind our kids that we don’t know everyone’s story or even all of their story.

We want to be people and raise people that leave a positive mark on others’ lives. So, while we aren’t wanting to kill anyone with kindness, we can be certain that kindness will overshadow meanness every time. 

Gratitude 

I have said, “Name 10 things you are thankful for!” about a million times in my parenting journey. The minute their world is falling apart and nothing is going their way, I am giving them a speech about everything that is good. 

I found years ago, though, that having my kids list the things that they are grateful for made a bigger difference than my lecture. 

Just like kindness, gratitude is also not always easy. Some days I can barely come up with three things for my list when the reality is that I truly have a thousand things a day to be grateful for. Again, our kids need help.  It has been researched and studied for decades, but what we know is true is that gratitude changes our perspective and ultimately the atmosphere around us. 

You put a bunch of ungrateful kids in a classroom together and you have a classroom full of complainers that cannot be happy. You add one grateful kid into the mix and they can change the group. Help your kiddos be the grateful kids. 

One way I often see parents help their kids practice this is through highs and lows at the end of the day or as one of my friends calls it “roses and thorns.” Have your kids name their top three good things and the top three hard things of each day. 

I also recommend having your kids say three things (or 10) they are grateful for on the way to school before the day starts. This helps set the tone for the day.

Honesty 

Honesty can come with some weight. If you don’t choose the honest way, then your words become meaningless to those around you. To be a person of your word comes with consequences, but it also builds you into a trustworthy person.

I find that honesty can be difficult for kids because they are more fearful of the consequences of their honesty than they are of lying.

This is often because they can’t see how lies pile up and that they will have to lie to keep their first lie intact. It’s our job as parents to help them make the hard choice to tell the truth even if there is a short-term consequence. 

Years ago, one of my precious daughters drew on her teacher’s couch and then lied about it saying she didn’t do it. While she wasn’t the only one, she was one of the artists. She had to write a note apologizing for not telling the truth, look her teacher in the eyes and tell her she lied and then I joined her for a lunch hour to try all the options for cleaning ballpoint pen off of a faux leather white couch. She still remembers this! 

Good choices 

As my kids head out of the car every day, I say, “Be kind. Make good choices.” I was reading another mom’s encouragement the other day: “You (and everyone you know) are just one decision from falling off a cliff.” It is the truth. One bad choice can change the course of a whole day, week, month, year or even someone’s life. 

My husband always says that he wants our kids to know how to think. Being able to stop and think through your next move and decision is incredibly important. This is also something all of our kids need help with. 

As parents and caregivers, we want to provide a safe space to think through decisions. We want our kids to learn how to stop and think before impulsively moving into a choice. 

If we can remind them and help them to be mindful, we can help them establish their moral compass that will last them a lifetime. Good choices account for yourself, for others, and for the future. 

As you blaze into this next school year, try to remember that your kids character matters the most in the long game. It doesn’t mean that we don’t focus on the schedules, activities and supplies, but we prioritize their character and the attention it needs and deserves. Also, don’t forget, we are all in this together! 

Enrolling a child in day care might raise a few concerns or unknowns about the steps the facilities take to protect the kids they serve from illness and injury.

It’s important for parents to know that the Texas Health and Human Services Commission (HHSC) sets rules that state-licensed day care operators, including in-home day cares, must follow. Those rules aim to minimize the risks for infants, toddlers and older children while playing, eating and sleeping at day care. The goal is to make the settings as sanitary and hazard-free as possible.

Across the state, there are about 8,300 licensed child care centers and in-home day cares with a combined capacity for more than 997,000 children. Sharon Evans, trauma injury prevention coordinator at Cook Children’s, advises parents to make sure the facility they choose is licensed and subject to the regulations.

“Day care regulations are in place to keep your child as safe as possible. However, Cook Children’s still sees broken bones and head injuries from day cares due to kids playing,” Evans said.  

The HHSC requirements are published in Minimum Standards for Child-Care Centers, which was revised in March 2023. You’ll find specifics on many topics – from food allergies and first aid to fever and fire drills – in the updated manual. Sections cover illness protocol, required immunizations, playground equipment and much more in 294 pages.

Here’s a shorter and simplified look at a few key requirements.

Parents will need to provide:

Medical information at admission: Name, address and phone number of the child’s physician; authorization for emergency medical care; an emergency plan for any severe allergic reactions; a statement of any special care needs.   

Health statement: Signed by a health care professional who has examined the child in the past year. It says the child can participate in the day care’s program.

Routine vaccinations: Immunize by 3 months old for diseases including polio, hepatitis B and diphtheria, tetanus and pertussis (DTaP). Booster shots are due for older children. The day care must keep a copy of every child’s up-to-date shot record on file.  Learn more here.

Licensed day cares are required to provide:

Caregiver training: Before they start the job, with 24 hours of additional training each year. Certification in pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) is also required. “Ongoing training provides caregivers an opportunity to learn the newest techniques for addressing children’s behaviors, to discover the latest findings on what children need as they develop, and to refresh and re-energize their skills,” the manual says.

Communication for any injuries: The day care will let you know about minor scratches and cuts when you pick up your child. An Incident/Illness Report must be filled out for injuries.

Infant safe sleep practices: Infants are always placed on their backs, by themselves, in a crib that meets federal regulations. Bean bags, waterbeds and foam pads may not be used. No pillows, blankets or soft toys can be in the sleep space. If your infant falls asleep in their car seat on the way to day care, they’ll be moved out of the seat and into a crib.

Sanitization: Toys that have been in a child’s mouth; potty chairs; sleeping spaces; table tops; anything soiled or contaminated. 

Proper handwashing: For employees upon arrival for the day; before handling food or medication; before feeding a child; after a diaper change or assisting a child with toileting; after wiping a child’s nose, mouth or sores; after their own trips to the bathroom. The children also must wash their hands frequently throughout the day.  

Guidelines for illness: Don’t bring your child to day care with an oral temperature above 101 degrees or ear temperature above 100 degrees. Other exclusions include lethargy, abnormal breathing, uncontrolled diarrhea, vomiting twice or more in 24 hours, rash with fever, or mouth sores with drooling.  A child may return after being symptom-free for 24 hours.

Safeguards on the premises: Childproof covers on electrical outlets; televisions anchored so they can’t tip over; heaters out of children’s reach; no access to firearms. Smoke detectors, carbon monoxide detectors, fire extinguishers and sprinkler systems are required. No use of alcohol, drugs, tobacco products or e-cigarettes is permitted by anyone on the property. 

Medication: In the original container, labeled with your child’s name, and not past the expiration date. The employee who administers the medicine will record the date, time and dosage given.

Safe handling for food allergies: Employees who prepare and serve food will be made aware of the known food allergies. Foods listed on a child’s emergency plan will be posted wherever food is prepared and where the child spends time.

Fluffy pillows, soft blankets and stuffed toys look cozy and cute in a crib. But they can be hazardous for a sleeping infant.

Safety experts say the only bedding to use is a tight fitted sheet around the mattress. Extra objects such as loose sheets, quilts, bumper pads and lovies pose the risk of accidentally suffocating or strangling a baby. Pillows, covers, teddy bears and decorative things don’t belong inside the infant’s sleep space.

Older used items tucked away in your closet might be subject to safety recalls. Certain inclined sleepers and other products have been taken off the market -- including the Fisher-Price Rock ‘n Play and Boppy Newborn Loungers -- due to infant fatalities reported with their use. The Consumer Product Safety Commission (CPSC) in June 2023 repeated its warning about the Boppy loungers after two more infants died since the original 2021 recall.  

Parents can take protective steps when it comes to safety during naps and bedtime. That’s why we at Cook Children’s want to emphasize the message that babies under 1 year of age sleep safest when they’re:

• On their back
• In a separate space like a crib or bassinet or play yard (not sharing a bed with parents or siblings). If co-sleeping occurs, someone might roll over on the baby.
• Atop a sleep surface that’s firm (not squishy or scooped like a hammock). Don’t use couches, waterbeds, memory foam mattresses, air mattresses or sheepskin.  An infant could get wedged between the soft surface and a wall or bedframe. 
• Atop a sleep surface that’s flat (not tilted up). An inclined surface could cause the baby’s body to slide down and their head to slump forward, blocking the airway.
• Zipped into a sleep sack. Sleep sacks provide the warmth of a blanket without the risk of covering the baby’s face.   

Over a 15-month stretch beginning in January 2022, 30 infants at Cook Children’s Medical Center in Fort Worth died from cardiac arrest, respiratory failure or other trauma due to sleep incidents that happened at their homes. Factors in many of those 30 deaths involved sleeping on an adult bed, a couch or a pallet made from blankets.

Nationwide, more than 3,500 sleep-related infant deaths occur each year in the U.S., according to the Centers for Disease Control and Prevention.

“When babies are really young they’ll get their nose down into the bed or the pillow or the blanket or the stuffed animal, and they don’t have the strength to turn their head side to side,” said Stephanie Eidson, RN. “The carbon dioxide builds up, and then they suffocate.”

Helping New Parents

Eidson prioritizes the topic of safe sleep in her role as clinical education specialist at Texas Health Resources (THR). Eidson educates nurses in the THR system who work with postpartum mothers, newborns and infants in the NICU. Lessons about safe sleep are built into the curriculum Eidson uses for new employees and for continuing education. Opportunities for instruction also come up every day in the nurses’ encounters with patient families. 

“We nurses have to role model safe sleep,” she said. “When we see a parent or a grandparent put something in the bed that’s not safe, we very gently take it out. Then we educate the parents ‘This is why I’m taking this out.’ We have to over and over again be saying the same thing from shift to shift.”

Nurses at THR talk about safe sleep practices with every family on the postpartum floor. Eidson says the standard conversation hits these key points: If you’re feeling tired, put the baby in the crib, on their back, with no blankets or pillows. Booklets given to families of newborns when they’re discharged feature a section on safe sleep information.

Eidson serves on the Safe Baby Sleep Council, which encompasses Tarrant County and a few surrounding locations. Her passion for safe sleep stems from a long career in nursing. But it’s also personal; her relative’s infant, napping on an adult bed, died after becoming trapped between the bed and a wall. It can happen to anyone, she said.  

What gives Eidson hope? Young moms who embrace the recommendations of medical experts. Consistent messaging is encouraging too. Out shopping recently, Eidson spotted a statement about safe sleep posted on the retailer’s display of cribs for sale.

“Being a NICU nurse for 40-plus years now, I want what’s best for our babies and our families. The data’s out there, the research and best practices are out there. It’s part of my job and my mission to educate whoever will listen.”

More About Safe Sleep Spaces

State regulations for child care centers in Texas prohibit anything except for a mattress cover and fitted sheet in an infant’s crib or play yard.

Don’t use car seats, strollers, swings or carrying devices as sleeping spaces. If your baby falls asleep in a car seat or stroller, move them from the seat and into a crib or bassinet one you're home. If the baby falls asleep in a swing, move them to a crib or bassinet.

Make sure the sleep space your baby uses conforms to CPSC safety standards:

• Cribs -- No missing, loose, broken or improperly installed slats, screws, brackets or other hardware. Slats should be spaced no more than 2 3/8 inches apart (about the width of a soda can).  
• Mesh-sided cribs or play yards – No tears, holes or loose threads in the mesh. Side panels should be securely attached to the top rail and the floor plate.

The federal Safe Sleep for Babies Act, signed in 2022, outlaws the manufacture and sale of crib bumper pads and infant sleepers that have an incline of more than 10 degrees. Drop-side cribs have been banned by federal rules since 2011. Don’t sell or give away any item subject to a safety recall.

Sunshine, outdoor adventure, new experiences, camaraderie and memories — it’s the stuff summer camp is made of.

Each summer, more than 14 million kids and adults attend a camp. Doing so can contribute to a child’s love for nature, their willingness to try new things, social awareness, independence and resilience, according to the American Camp Association (ACA).

“Camp really provides kids an opportunity for independence and to be exposed to things they don’t get exposed to during a traditional school year,” said Katie Campbell, Child Life manager and Camps for Kids coordinator at Cook Children’s Medical Center. “It’s an opportunity to challenge themselves to try something new, to make new friends and to establish community with their cabin.”

But sending your child off to camp can be scary. How do you know it’s a safe place for them physically, mentally and emotionally? Are the people you are trusting to care for your child at camp qualified?

Choosing a Camp

The ACA is a good place to start when determining what to look for in a camp, according to Megan White, camp director of Camp John Marc, a residential Dallas-Fort Worth-based camp serving children and families living with a chronic illness and physical challenges, and a Cook Children’s Camps for Kids partner. The ACA is an accrediting body for camps and is considered the industry’s gold standard for best practices when it comes to safety, staff training and risk management.

“It's a resource that is intended to be used for any parent at any stage to learn about the camping industry,” White said. “I would definitely encourage parents to read up on and learn about our best practices in the camping industry and to find out the qualifications and accreditations of the camp before you send your children to one.”

What makes a good camp? According to a study commissioned by the ACA, campers who experience a sense of belonging, supportive youth-staff relationships and learning that is both experiential and reflective report the most positive attitudes and outcomes from camp.

But safety should be a top priority, too, White says.

“The two most important things that I would say are what are their abuse prevention and camper safety protocols as it relates to mitigating risks at camp.” White said. “One thing that we always say here at Camp John Marc is we can have the best camp cookies, the most comfortable camp beds or the coolest camp store, but if our campers aren't safe, then we’re not doing our job to the best of our abilities.”

While some of this information can be found on a camp’s website, White says to never be afraid to pick up the phone and talk directly to the camp director about their protocols and policies.

“Sometimes this will give you a more honest read on how important these things really are to the camp than what you can get from a manicured website,” White said.

Tips for Parents

If you are preparing to send your child off to camp, be it sleep away or just for the day, White and Campbell share the following tips for making the experience a positive one for you and your camper. 

●       Don’t be afraid to ask questions about certifications, camper-to-counselor ratio, staff training, camp schedule, etc.

“Communication is key. Ask questions about the schedule the camp follows, where they get their staff and the ratio in regards to campers and counselors. That's important information that needs to be pretty easy to get and for families to inquire about. Don’t assume that it's a popular camp so it will be safe, but make sure that, for those things that are important to you around your child's safety or knowing who will be taking care of them, you get an answer.” – Katie Campbell

“I encourage parents not to get distracted by all of the cool amenities but to focus on the two most important things of how do they train their staff as it relates to preventing child abuse, and what are they doing to ensure a culture of safety. What does that look like for all of their employees, including their kitchen and housekeeping staff and their facilities team? What is their camp culture of safety? These are questions any camp director should easily be able and willing to answer.” – Megan White

●       Make sure your child understands personal boundaries and how to ask for help if they feel uncomfortable.

“I really think that parents should have a conversation with their kids at any age about appropriate and inappropriate touch. We teach that a camper should never be touched anywhere that their swimsuit would cover. For males and females alike, that is a good benchmark for their physical safety. I also encourage parents to have a conversation with their kids about asking for help and give their children permission to tell someone they are uncomfortable — whether that's someone in my cabin is making me uncomfortable or an adult that is in the area is making me uncomfortable. Give your children the permission and language to find another adult they trust and ask for help.” – Megan White

●       Include your child in the process of choosing and preparing for camp.

“Camp is good for everyone, but not every camp is good for every child. You have to find the right camp for your son or daughter to make sure it's meeting their needs or their interests.” – Megan White

“I think it’s important to involve kids in the whole process of shopping or gathering what is needed for camp and allow them to help pack their bags so that they understand the packing system you are using. This makes them more confident about the new experience.” – Katie Campbell

●       Be prepared for outdoor activities and weather changes. 

“One minute it could be hot and 100 degrees and the next it could be storming. Make sure that your child has everything they might need for the week, even if it seems random. We don't necessarily always need a rain poncho in Texas in July, but just having it and other little things like a flashlight might turn out to be really useful.” – Katie Campbell

“Pack plenty of sunscreen and a water bottle. We always recommend closed-toe shoes so that you don't stub a toe or get a splinter in your foot.” – Megan White

●       Send them with things that will make them feel more at home.

“If there are things from home that help kids feel safe — a stuffed animal, a favorite blanket or something like that — make sure those things are included.” – Katie Campbell

“I encourage parents to send their child with a journal or give them a place or a tool to help them reflect and write about their experience. A Polaroid camera can be great for this, too. A lot of times children get home and parents ask about camp and their campers are too tired or can't remember what happened. So give them at least some tools to record their memories and experiences.” – Megan White

Autism spectrum disorder (ASD) is a life-long neurodevelopmental disability characterized by communication and social skills deficits, in addition to restrictive and repetitive behavior. Recently, the Centers for Disease Control and Prevention updated their estimates, which now show that one out of every 36 children in the US has ASD. If your own family has not been directly impacted by ASD, chances are you know someone who has.

Autism impacts many different areas of an individual’s life, and Cook Children’s Child Study Center offers medical, psychological, behavioral, speech, and academic services to help address the unique needs of each individual child with ASD.

Perhaps the most fundamental skill affected by ASD is a child’s ability to communicate. Less than half of children with ASD will develop fluent speech by age 8, and approximately ¼ will remain nonverbal, relying on an alternative form of communication to interact with others.

Regardless of how your child speaks, you can help bolster their ability to communicate by focusing on four critical areas of language development.

What is CLEaR Speech?

Research on language development has identified four critical areas of communication that may require systematic intervention: Conversing, Labeling, Echoing, and Requesting (CLEaR). You can help your child develop CLEaR speech by practicing each of these language domains during their everyday play. For example, suppose your child enjoys playing with a toy train:

Conversing: Can they say the name of the toy when it is described? Ask your child to fill-in-the-blank using a description of a toy that they are not currently playing with. For example, say, “Choo, choo goes the ….”

Labeling: Can they say the name of the toy when it is present? Ask your child to say the name of the toy they are holding. For example, give the train to your child and ask, “What is that?”

Echoing: Can they say the name of the toy when you name it? Ask your child to repeat the name of a toy that they are not currently playing with. For example, say “Say, ‘Train.’”

Requesting: Can they say the name of the toy when it is absent? Ask your child to say the name of the toy they want to play with. For example, hide the train from your child and ask, “What do you want?”

Note that you have asked the child to say the word train four different times. It is the different contexts that make each word unique. Many children with ASD have some ability to label or echo, but struggle with conversing and requesting. Others may only speak when requesting preferred items. The goal of CLEaR speech is to help the child understand the different contexts in which a word can be used, and to gradually develop their language abilities in each area through a process called abstraction.

Abstracting CLEaR Speech

^[1] Mario is not a real child, but an amalgamation of different patients treated in Autism Services.

To demonstrate the process of abstraction, let me introduce you to Mario^[1], a 4-year-old boy receiving early intensive behavioral intervention through Child Study Center’s Autism Services department. Mario’s parents noticed his lack of eye contact early on, and had trouble engaging him when he was an infant. 

As a toddler, Mario did not respond to sounds (e.g., he did not look up when called by name), and his parents suspected hearing loss. They were surprised when he received an ASD diagnosis at age 3. Though Mario sporadically repeats phrases from his favorite TV shows, he lacks the ability to express his basic wants and needs. He may lead mom to the refrigerator when he is hungry, but often resorts to tantrums until his parents can guess what he wants. Mario’s parents use CLEaR speech to help him learn to request his favorite things. 

They begin by letting Mario choose what he is going to talk about, by simply allowing him to select a toy or snack. Whenever his interest shifts, they will direct his speech toward the new activity. Throughout his play, Mario’s parents alter the different environmental configurations that support Mario’s CLEaR speech. Mario picks up his toy car and rolls it down a ramp. His parents use the following sequence to help strengthen Mario’s ability to request by purposefully changing the non-critical details of requesting across each step:

CLEaR: After the car goes down the ramp, Mom picks it up. She shows it to Mario (labeling), and says, “Drive the car” (echoing), “Drive the …” (conversing). When Mario requests, “Car,” she enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

LER: After the car goes down the ramp, Dad picks it up. He shows it to Mario (labeling), and says, “Car.” (Echoing). When Mario requests, “Car,” he enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again. 

CLR: After the car goes down the ramp, Mom picks it up. She shows it to Mario (labeling), and says, “Drive the …” (conversing). When Mario requests, “Car,” she enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

CER: After the car goes down the ramp, Mom picks it up and hides it. She says, “Vroom, vroom goes the car” (echoing), “Drive the …” (conversing). When Mario requests, “Car,” she enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

LR: After the car goes down the ramp, Dad picks it up. He shows it to Mario (labeling). When Mario requests, “Car,” he enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

ER: After the car goes down the ramp, Mom picks it up and hides it. She says, “Car.’” (Echoing). When Mario requests, “Car,” she enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

CR: After the car goes down the ramp, Dad picks it up and hides it. He says, “Drive the …” (conversing). When Mario requests, “Car,” he enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

R: After the car goes down the ramp, Dad picks it up and hides it. When Mario requests, “Car,” he enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

The order of the steps is less important than the variation of supports across steps. Children with ASD may rely heavily on a particular aspect of their environment, like the presence of the toy. We can use that feature to help support their language development, while also helping the child become more responsive to changes in their environment. 

The presence of the toy is necessary for labeling, but it shouldn’t also be necessary for requesting. It may take repeated practice with one step before your child is ready to move onto the next. Similar abstractions can be arranged to strengthen conversing, labeling, and echoing skills. While language development comes naturally for many children, others require targeted intervention. If you have questions about your child’s language development or concerns that your child may have ASD, speak with your pediatrician and contact Early Childhood Intervention or your local public school to find out what services are available to your family.

Editor's note: This story was originally published on Nov. 4, 2021.

Results are in for the 2021 Community Health Needs Assessment parent survey conducted by Cook Children’s Center for Children’s Health and one thing is clear—the mental health of children is top-of-mind for parents, particularly during the pandemic.

Half of all children ages 6 to 17 living in Cook Children’s eight-county service area have a parent who is concerned that the pandemic will have a negative impact on both their child’s education and mental health, according to the survey. The impact of COVID-19 was also noted by parents and guardians as one of the top three barriers to children receiving necessary health services, along with a lack of insurance coverage and the scarcity of needed services available in the area they live.

These barriers played a role in 137,000 children not getting needed medical care, more than 180,000 kids being deprived of needed dental care, and 63,120 kids going without needed mental health care. When compared to the same demographics from the 2015 and 2018 parent surveys, all of these numbers represent an increase in children not getting the health care they need.

The survey revealed that parents need support, too. More than 30,000 children have a caregiver not coping “very well” or not “well at all” with the day-to-day demands of parenting, and 24% of children live with someone who has a mental illness, or is suicidal or depressed.

“Parents of teens score lower when it comes to coping well with the demands of parenting than those with kids ages 6 to 11,” said Blair Williams, community health analyst at the Center for Children’s Health. “So the question becomes what do we do for parents to help them grapple with those daily parenting demands and the really tough topics that they face with their teens that are relatively new to us adults and changing almost every day.”

These results, along with many other survey data points, were shared Tuesday at the Virtual Children’s Health Summit presented by the Center for Children’s Health. Nearly 300 community members representing a number of area schools, health agencies and community organizations attended the summit.

“We recognize and acknowledge that Cook Children's isn't the only one working to improve the health of children and families in our communities,” said Becki Hale, director of Child Health Evaluation within the Center for Children’s Health. “We have such strong community partnerships and these issues around children's health are so complex that it can't just be one entity. It has to be all of us working together. We're so grateful that we have such a strong community that comes together to support one another to help families.”

Every three years the Center for Children’s Health surveys parents and guardians within its service area, including Denton, Hood, Johnson, Parker, Tarrant and Wise counties. This year the Center added Grayson and Collin counties into the surveyed region in preparation of meeting the needs of children served by the new Cook Children’s-Prosper, slated to open in late 2022. It also increased the child age range from 0 to 14 to 0 to 17.

A total of 5,715 surveys were collected from a sample of households across the surveyed region at large, not just Cook Children’s patients. Surveys were also collected from parents of special underserved populations via partners within community shelters and other local aid agencies. The results are weighted to represent the actual population of children living in the service area. That means data percentages are translated into the actual number of children within the population the percentage represents.

“We use this data to see how we might need to adjust our current programs to best address the needs we already know exist within our community because of what we see within Cook Children’s Health Care System,” Hale said. “Mental health is a good example. Because of what we are seeing in our health system data around self-harm and suicide, we’re particularly looking a little closer at what the survey reveals about mental health knowing that there may be some opportunity to adjust our programming to address that issue, especially within the adolescent and teen population. It’s another piece of the puzzle to help us figure out how to best support families and children.”

Parents reported that 19% of children ages 6 to 17 have been told by a health care provider they have anxiety, and 10% have been told they have depression. That’s higher than the national numbers of 13% and 6% respectively. In addition, Cook Children’s has recorded a record number of suicide attempts by children within the last 12 months.

“The survey reinforces what we have seen over the past year with skyrocketing numbers within our mental and behavioral health services,” said Rick W. Merrill, President and CEO of Cook Children’s Health Care System. “In 2022, we’ll dive deep into mental health access and behavioral health services. We owe it to the hurting children in our community to continue to make this a top priority.”

In addition to addressing mental health, the Center for Children’s Health will work with its community partners to explore new and innovative approaches for increasing access to food, personal health care providers, insurance, oral health care, parent support networks, injury prevention education, and opportunities for physical activity.

“The information we shared at the summit was just the tip of the iceberg,” said Chris Pedigo, senior vice president of system planning, health analytics and the Center for Children’s Health. “We’ll continue to dig deep into these issues to understand how to join with our community partners to best address these needs.”

Other notable findings include:

• 55,570 children are living in households that “sometimes” or “often” can not afford enough to eat.
• 57% of children ages 3 to 5 have a caregiver who is coping “very well” with daily parenting demands, which is lower than the national percentage of 63%; and 51% of children ages 6 to 17 have a caregiver who is coping “very well” with daily parenting demands, also lower than the national percentage of 61%.
• 70% of children ages 3 to 5 are ready for school according to their caregiver, which is slightly lower than the national percentage of 75%.
• 8 in 10 children have “excellent” or “very good” health.
• 9 in 10 children had continuous insurance coverage for 12 consecutive months prior to completing the survey.

In February, the Center for Children’s Health will release part two of its Community Health Needs Assessment, which will include a report of the “why” behind many of the survey results learned from parent focus groups and community leader interviews. That information will be combined with the parent survey results as well as the results of a community leaders survey to complete the Community Health Needs Assessment, which will be released in spring 2022.

But, driving to work the last few weeks and seeing all the standing water already starts to make my skin itch. Mosquitos are on the way. And I suspect it’s going to be a terrible year.

Mosquitos can cause a variety of problems:

1. Simple itching and discomfort-small bites which can lead to infection when scratched
2. Large local reactions-which can be very itchy, even quite painful (See more at Skeeter Syndrome).
3. Serious systemic illness such as West Nile Virus, Zika virus or Chikungunya.

But our kids don’t have to suffer. There are great options for preventing mosquito bites and warding off some of these miserable consequences.

DEET

N,N-Diethyl-meta-toluamide sounds like a little bit of a scary name for a chemical we can put on babies as young as two months. But DEET has been extensively studied and consistently shown to the safe and effective as a mosquito repellant in children. Recommended concentrations of 10-30% provide great protection with 30% lasting around five hours.

Picardin or Lemon Eucalyptus Oils

Multiple alternatives to DEET have been tried. Studies have shown that these two alteratives can be as effective as 10% DEET and thus last around two hours. Reapplication will be important if there are plans to be outside longer than two hours.

Here are some important facts about applying insect repellant:

1. Spray a thin layer over clothes and exposed skin. Thick layers do not make it more effective.
2. Use your hands to apply repellant to the face rather than directly spraying.
3. Spray in open areas to avoid ongoing inhalation.
4. Assist young children with application to ensure coverage and safety.
5. Avoid combination sunscreen products because reapplication of sunscreen needs to be done more frequently.

Having a healthy and fun summer should include TONS of outdoor play. Keeping your child safe from mosquitos is one part of making sure nothing spoils the fun.

Read more: 

'Skeeter Syndrome': Is My Kid's Bug Bite Infected?

An Infectious Disease Pediatrician Explains Differences and Similarities between West Nile and COVID-19

Everything You Need To Know About DEET and Protecting Your Kids From Mosquitos

Why Do Mosquitoes Bite Me and Not You?

 Chiggers Myths Parents Need To Know

Medical Director of Infectious Diseases, Suzanne Whitworth, M.D., hosted a Q&A with reporters to answer questions about this change. 

Why does Cook Children’s need to reinstate this visitation policy?

We have been keeping a close eye on community numbers for COVID-19 and we know that they have gone up dramatically over the last five or six days. In thinking through that, we want our patients in the hospital and our staff to have less exposure to the community. So this, conceivably, has 200 less people in the building during the day, which is going to reduce exposures. That's really the main goal.

How difficult was it to reach this decision?

It’s terrible to reach this decision because we're all parents, and we are doing our best in a really difficult time to try to keep everybody safe. The adult hospitals have had no visitors and I don't know how they did that. These kids will at least have a parent or a relative at the bedside 24 hours a day if they want to. They won't be alone. We just feel like this is the safest thing for everyone.

When will this restriction be lifted?

We are going to lift the restriction when we feel like it's safe for our patients and families to do so, and also safe for our staff. So it would have to be at a time when community transmission is much lower than it is now. I don't have a number about that at this point, but we will wait and look forward to going back to having visitors when we feel like it's safe.

Are there exceptions for this rule?

We have exceptions for the emergency room and for end of life situations.

How is the morale of the staff at Cook Children’s?

I think everybody is doing really well. I think that we go to work with a goal and a mission. All of us want our lives back, me included. There’s still a sense of ‘When is this going to be over?’ But I think we're really lucky because we work with children who make you laugh and I think we all enjoy our jobs. So, I think generally, just being around the hospital, making rounds and having clinic, I think we're doing pretty well.

Oh, there she is, over there checking out Facebook.

Are you nervous every time her kid climbs up the ladder he might fall down and injure himself?

She’s still playing Candy Crush. Ok, let me rescue her kid from the top of the slide.

There’s new evidence to suggest that there may be some truth to your concern.

A recent study from Yale Economics professor Craig Paulson showed that, from 2005-2012, unintentional injuries in children aged 0-5 increased. He was able to correlate the increase in injuries with the expansion of 3G cellular networks across the country. Many of these injuries occurred during times of parental supervision (not day care or with other caregivers). There was no similar increase in injuries of children aged 6-10.

This trend is the opposite of the overwhelming decrease in unintentional childhood injuries since the 1970s.

While there could be other explanations of this trend, clearly distracted parenting is becoming more of a problem in today’s world.

Here are some things to think about:

1. You will underestimate how long you will be looking at your screen. Even if you look away for one task, that task will take longer than you think and you are likely to get sidetracked by something else.
2. Injuries in children often take mere seconds to develop. There may be no build up from independent play to dangerous predicament in the time it takes to read and respond to a text.

In any situation, you should be aware of how much time you are spending with your smartphone.