In this episode of Raising Joy, we explore the incredible resource of MHMR and Help Me Grow North Texas. Miranda Holmes and Arrenia Thomas join us to discuss how Help Me Grow empowers parents and caregivers by connecting them with a network of specialists and community-based services to support their child's healthy development.

We delve into:

• Who Help Me Grow North Texas can support
• The different types of resources and services available
• How the program can address both general parenting questions and developmental concerns
• The benefits of collaboration across various sectors
• And much more!

This episode is a must-listen for any parent or caregiver seeking guidance and support in raising joyful, thriving children.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple and Spotify.

Over the past week, families have seen and heard the images of war overseas. The tragedy in Israel and Gaza hits home for many communities and families around the world, sparking fear, uncertainty, and worry. How can parents and caregivers answer their children's questions and help comfort them?

Cook Children’s psychologist, Amanda Jordan, Ph.D., is sharing some advice and guidance for parents and their families.

What advice do you have for parents who are struggling to explain the news of Israel and Gaza to their children? How should they approach this topic?

First and foremost, I just want to validate how complex of a topic this is especially with the level of violence and imagery being released.

I think one of the best ways to approach this topic is to meet our children where they are -- developmentally, cognitively, and psychologically. For example, I would approach this topic differently with a 5-year-old vs. a 15-year-old. Use open-ended questions to gain an understanding of what your child knows and thinks. 

Ask “What have you heard?” or “What have you seen?” For teens, you might ask “What do you think about what is happening in Israel? How do you feel?”

Also, if your child brings up the topic, it’s OK to take a minute (or a few) before answering to gather your thoughts. Be honest with them by saying “I really appreciate that you asked me and I want to talk about it more with you, but I would like to think about how to approach it before we talk.” Make sure the environment is conducive to this as well (e.g. not having these difficult conversations in public, loud places or with children of varying ages who may need to receive the information differently). 

How can parents encourage their children that they are safe?

Parents have to take the time to process their own emotions first before they can be able to listen to their child and provide reassurance. Parents may also have to limit their social media use and news intake in order to maintain their own well-being. For younger children, you may choose to show them a world map or globe so they are able to visualize where this is happening and provide them with a sense of safety.

What if children are afraid of doing their normal activities, such as going to school, attending church, or seeing friends?

One of the best things you can do is maintain your normal routine as this provides consistent structure and support. Reassure them and support their feelings, but also continue your schedule as normal.

How can parents protect their children from seeing information on social media, TV, etc.?

As parents, we have to take the lead and provide guidance and boundaries for our kids. I read a wonderful quote from Glennon Doyle that says “We don’t have to have answers for our children; we just have to be brave enough to trek into the woods and ask tough questions with them.”

For me, this shines a light on the fact that, as parents, we are responsible for taking the reins. This may be through deleting social media apps for a certain time period, limiting access to social media, decreasing the time spent on social media, etc.  It also means that we are responsible for asking the tough questions and engaging in difficult conversations, even if this is uncomfortable for us.

What is the best way to explain the concept of war to a child who might not know yet? How can I explain it in a way that will not scare them? What age should I be explaining this to them?

It depends on the child’s developmental level but we want to present it in a way that is factual and straightforward. Provide brief facts such as “there is a terrorist organization that is attacking a country of people” and then let your child take the lead on any questions or thoughts. Another example may include “war is when two groups of people are fighting” and it can become more complex from there if the child needs additional information (e.g. using an example of a war they have learned about in the classroom).

For teens, it may also be important to define the groups involved. This assists with not developing generalizations in our thinking. Also, remind your children that you are here to answer questions as they may arise.

What resources are available to help me talk to my child about this?

If your child has access to a therapist or school counselor, this is a great resource. There are also many reputable organizations that provide information online such as the Child Mind Institute.

How can my family support others during this time?

Focus on the helpers! Look for articles, videos, pictures, and/or organizations that are helping. Talk with your child about ways they may like to help. For example, donating to an organization, raising money, sending care boxes, etc. Continue to remind your children that they can always come to you with their questions if they feel confused about anything.

Learn more about ways you can show support:

• Find local charities that are assisting. This website helps find reputable charities: www.charitywatch.org
• Reach out the your closest Synagogue or Jewish Association.
• Find reputable news sources and articles.
  • www.unicef.org
  • The National Child Traumatic Stress Network
  • www.apa.org

Parents, remember to take care of yourself

Model healthy coping skills as children take their cues from you. Children need to see that it’s OK to express emotion. 

Effective ways to cope include speaking with other parents at school, forming/joining a parent support group, leaning on family members for support, eating nutritious meals, exercising, meditating, praying and speaking with your child’s school counselor for advice on resources or books on supporting yourself and your family.

National Parent Helpline run by Parents Anonymous to get emotional support from a trained advocate: 1-855-427-2736.

Related stories: Talking to Your Kids About Conflict in Israel and the Middle East

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! 

Cook Children’s employees Ashley Pagenkopf and Danny Peltier were in for a big surprise Tuesday when Kidd’s Kids announced their families are going on an all-expenses-paid trip to Walt Disney World!

Every year, Kidd’s Kids takes 30 to 50 children with life-altering or life-threatening conditions and their families on an all-expenses-paid, five-day trip to the magic kingdom.

Emergency medicine physician Dan Guzman, M.D., who serves as a Kidd’s Kids board member, and Cook Children's team members surprised the two families with the announcement, Disney-themed balloons and pairs of Mickey Mouse ears at the Child Life Zone.

“We’re going to Disney!” said Ashley Pagenkopf, a child life specialist in the Cook Children’s emergency department. “I can’t believe it. None of my kids have ever been and I was 12 years old the last time I went, so it’s really exciting. We wanted to take the girls but we cancelled a trip because it was just too much. None of us expected this!”

In April 2022, Ashley’s middle daughter, Averly, began having seizures and was diagnosed with a glioneuronal tumor. She underwent surgery in August and has been seizure free since. Every three months, Averly visits St. Jude Children’s Research Hospital for follow-ups.

“She’s doing awesome – clearly!” Ashley said. “She’s so crazy strong. Kids are so resilient.”

Ashley said she looks forward to experiencing moments of magic with her girls and other families on the trip.

Danny Peltier, practice manager for Cook Children’s Outpatient Psychiatry, says he also looks forward to building memories with his family at Disney World.

“It’s just something we weren’t able to make happen on our own yet,” he said. "So this is going to be a lot of fun for the family!”

Peltier and his children, Will and Evelyn, have a rare genetic condition called hereditary spastic paraplegia, which presents similarly to cerebral palsy but only affects their lower extremities.

“I’m excited to see their faces once we get through the gates and they can just take it all in,” he said. “It’s going to be a lot of fun!”

Kidd’s Kids is a nonprofit founded by the nationally-syndicated Kidd Kraddick Morning Show based on 106.1 KISS FM in Dallas-Fort Worth. The annual Kidd’s Kids trip is made possible by donations and an army of volunteers, including doctors and nurses who make the trip to help the families. 

“We take a team of physicians, nurses, paramedics, child life specialists and respiratory therapists,” Dr. Guzman said. “We go and serve the kids.”

Dr. Guzman says oftentimes the children and families who go on the trips have been patients at Cook Children's. The medical team’s goal is to make sure that the children enjoy the parks without having to worry about any medical needs. If any issue does arise, the team is there to help the children get through it safely. 

“To be there, to enjoy it, to watch their faces and see that love – ah, it’s amazing - you can’t script that at all!” Dr. Guzman said.
 

Summertime is the best time of year (in my opinion!). Schedules can sometimes be looser, we can be outside more and it’s great to have a break from schoolwork! It is common to be more relaxed with the bedtime routine.

As a parent myself, I am happy to let a strict bedtime for the school year fade away. However, a late bedtime and waking up late can end up being troublesome during this time of year when we know we have to return to a more regular schedule.

It isn’t “bad” for kids to go to bed late and awaken late, as long as they are getting the total number of hours of sleep recommended for their age. I have met a few kids that go to bed late but also wake up early so they are tired in the daytime, which can impact their behavior.

Our middle school kids are programmed to go to bed late and awaken late -- this change to the clock inside your brain is part of the pubertal process. Therefore, it can be hard to fight the return to an early morning wake-up in August.

How should you do it? Here is one method. Once a person has been going to bed late for a longer period of time, the brain becomes accustomed to that. So simply getting in bed early won’t mean that a person gets to sleep early.

It’s best to continue with the late bedtime, but get up a bit earlier (like 1 hour earlier) than usual. It’s hard to do but using sunlight exposure (sun to the face) and encouraging breakfast can help. Then kids will be naturally tired earlier the following evening since they arose earlier that morning. Some parents use melatonin (dose of 1-3 mg) given 1 hour earlier than the late bedtime to help with falling asleep as well.

Watching caffeine intake, aiming for calm play in the hours before bedtime and keeping lighting low can also help with resetting bedtime. Screen use (TV, phones, computer monitors, and video game consoles) should stop around 1 hour before the desired bedtime as well.

Remember that bright artificial light (from screens) can trick your brain into thinking it is daytime. Try not to allow afternoon naps, so kids build up their sleepiness- aiming for a reasonable bedtime.

Sometimes writing down the plan for bedtime/waketime change can help. Kids can be an ally here so involve them in the process.

Good luck with the new school year!

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.

Ahh, summer. It’s full of adventure. Or, if your kids are anything like mine — misadventure.

Barely two weeks into our summer break this year I made a visit to urgent care with my 14-year-old to have a fish hook removed from his hand. Totally worth it, he says, since he caught a bass. (Insert my motherly eyeroll and exasperated sigh.)

The summer months can be busy ones in pediatric emergency departments, urgent care centers and pediatrician offices. With kids out of school and looking for fun, they sometimes find trouble that results in injury. Tragically, some of those injuries can be serious, life-altering or even fatal.

“In the summer, kids have all day and night to be able to get into trouble, which is what kids are supposed to do. They're just learning,” said Daniel Guzman, M.D., a pediatric emergency medicine physician at Cook Children’s Medical Center. “As parents, we're just trying to manage the chaos so they don’t make any tragic mistakes.”

Drownings top the list of summertime injuries and causes of death at Cook Children’s, according to Sharon Evans, trauma injury prevention coordinator. In fact, it tops the list nationally. Drowning is the leading cause of accidental death in children ages 1 to 4. For teens, it is the second leading cause of death.

The Center for Community Health, led by Cook Children’s, offers parents and kids water safety and drowning prevention education guides and resources like water-watcher tags and life jackets through its Lifeguard Your Child program. Through this program, anyone can learn how to choose and properly fit a life jacket, how to build a water safety plan, what type of physical barriers should be in place to secure backyard pools and tips for a safe and fun swim time. 

After drownings, the top sources of summertime injuries sending kids to Cook Children’s Emergency Department include:

• Motor vehicle collisions
• All-terrain vehicle (ATV) accidents
• Dog bites
• Falls on playground equipment and trampolines

Dr. Guzman says car and ATV accident injuries are often the most tragic.

An estimated four kids are seen in U.S. emergency departments every hour for injuries related to ATV accidents, according to the American Academy of Pediatrics. From 2017 to 2022, more than 700 North Texas children, most between the ages of 10 to 14, were treated at Cook Children’s Medical Center for serious injuries involving accidents with off-road motorized vehicles.

“The most critical injuries we see from these vehicles are head injuries from kids not wearing a helmet and being ejected,” Dr. Guzman said.

Golf carts can be particularly dangerous.

“With individual ATVs, people tend to put more of the safety equipment on their children, but with a golf cart people feel more secure and protected and less threatened,” he said. “They usually are not wearing a helmet or a seatbelt, so we see these ejections. When you are riding on pavement and it’s head versus pavement, the pavement always wins.”

While common summertime injuries seen at Cook Children’s Urgent Care Centers are more minor in nature than those in the Emergency Department, the sources of injury are often similar.

“We see lots of trampoline and bicycle injuries," said Kara Starnes, D.O, medical director of Cook Children’s Urgent Care Services. “Kids get outside, they're more active and they're more likely to break things. Bicycles, hoverboards, skateboards and trampolines are a big source of fractures or sprains. Fish hooks are more common in the summer, as are lacerations because kids are playing outside more. They get more cuts and things that need to be sewn up in the summertime.”

The primary care pediatrician’s summer risk list looks a little different given their focus on non-emergency care. When temperatures rise, pediatricians see more:

• Infected bug bites
• Sunburn
• Dehydration
• Poison ivy
• Swimmer’s ear infections
• Leg fractures

“Believe it or not, I see lots of leg fractures in little kids from sliding down a slide while sitting in their parent’s lap, because their leg gets caught between the parent and the side of the slide,” said Diane Arnaout, M.D., a pediatrician at Cook Children’s Pediatric Forest Park. “It’s a really dangerous thing to do.”

Pediatricians and Their Own Kids

Given these common injuries, we asked a few Cook Children’s physicians to weigh in on what they never allow their own children to do, or never let their kids leave the house without in the summer. It’s important to note these physicians are not afraid of fun, they just see the negative outcomes of these thrill-seeking activities on a daily basis. For them, the dangers associated with some of these risky behaviors outweigh the entertainment.

Here’s what they had to say:

Dr. Guzman:

“Trampolines are a big thing that I despise. We see so many injuries from those. You get multiple kids on a trampoline and that really becomes a problem. Another thing for me is golf carts. Until kids can drive, they probably shouldn't be in the golf cart unless mom or dad is in there with them. You wouldn't let your kid drive your car. Why would you let them drive a golf cart, ATV or other off-road motorized vehicle at a young age without any experience? They just don't understand the gravity of the responsibility or have the physical dexterity to maintain a vehicle.”

Dr. Starnes:

“I would never let my kids ride their bikes without a helmet because we see some pretty severe head injuries from bike accidents. ATVs are an absolute hard no for me. Also, kids go barefoot a lot in the summer, so we'll see things get stuck in their feet more often, like glass or gravel. To avoid this, I would recommend they at least wear flip flops or some sort of shoe while playing outside.”

Dr. Arnaout:

“I never let my kids leave the house without a water bottle in the summer. We don’t do trampolines without safety nets or bikes without helmets. And ATVs are a no-go for me.”

Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Pediatrics Haslet

“Insect repellant, sunscreen and big hats for scalp protection are a must for my kiddos. Water safety is my No. 1 topic in the summer and must be the No. 1 focus of parents when their kids are in or near bodies of water.”

RELATED:

• Should My Child Ride ATVs? Cook Children's Experts Weigh In (checkupnewsroom.com)
• Sunburn Relief at Home, When to See a Pediatrician (checkupnewsroom.com)
• Pediatrician Shares Top Beach Vacation Health Tips (checkupnewsroom.com)
• Heads Up: Helmet Tips for Safer Bicycling (checkupnewsroom.com)
• Teen Driver? What to Know Before They Go This Summer (checkupnewsroom.com)

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

A case of measles was confirmed in a pediatric patient last week in Texas, according to Texas Health and Human Services. The last confirmed measles case in Texas was in 2019. Cook Children’s is sharing what parents and caregivers should know.

Measles is highly contagious. It causes severe pneumonia and can cause a progressive form of encephalitis or inflammation of the brain.

Measles spreads through the air when an infected person coughs or sneezes. You can get measles by being in a room where a person with measles has been, even up to two hours after the person has left. An infected person can spread measles to others even before knowing he/she has the disease.

Some of the more common measles symptoms include:

• high fever (may spike to more than 104° F),
• cough
• runny nose
• red, watery eyes (conjunctivitis)
• rash (3-5 days after symptoms begin)

If you think you have measles or may have been exposed, isolate yourself and immediately call your health care provider and your county health department. It is recommended to wear a face mask.

Even children who recover from measles, especially those younger than 2 years old, are still at risk for developing SSPE – delayed brain inflammation – seven to 10 years later.

Two doses of MMR vaccine provide the best protection against measles for your child. The Centers for Disease Control and Prevention recommends that all children receive two doses of the measles-mumps-rubella (MMR) vaccine – one at 12 to 15 months old and another at 4 to 6 years old. One dose is 95% effective against measles and two doses are 97% effective.

People at high risk for severe illness and complications from measles include:

• Infants and children aged <5 years
• Adults aged >20 years
• Pregnant women
• People with compromised immune systems, such as from leukemia and HIV infection

According to the Centers for Disease Control and Prevention, 16 cases of measles have been reported this year as of June 8, 2023. The CDC warned in November 2022 that a record of nearly 40 million children missed a measles vaccine dose, leaving them susceptible to infection.

Protection

The best protection against measles is MMR vaccine. MMR vaccine provides long-lasting protection against all strains of measles.

Here at Cook Children's, we follow the same guidelines that we recommend to our patients and their families.

• Vaccines save lives
• Vaccines are safe
• Vaccines protect those that cannot be vaccinated
• We vaccinate our own children

Nicholas Rister, M.D., of the Cook Children's Infectious Disease team, answers questions about measles and shares what parents and caregivers need to know.

What should I do if my child has only received one dose of the MMR vaccine so far?

If your child has received only a single dose of the MMR vaccine and is >4 years of age, then they are due for a second dose which can help boost their immunity.

In the meantime, the single dose they have gotten should provide substantial protection from severe disease. This is great for their safety but can make how they may present more subtle. While they may still have a fever, cough, red eyes, and a rash, these may be much more subtle or absent. However, they will still be contagious and can infect other children and adults who are non-immune.

If your child is only partially immunized and has some of these symptoms, especially a red rash that starts on the head and spreads downwards, be sure to ask your pediatrician about measles to review if testing is indicated.

How do I know if my child has been exposed to measles?

In many cases, you will not unless you are contacted by the health department. Sometimes an outbreak will occur through schools or daycares, and you will be alerted through these contacts as well. However, if your child or close contacts develop the constellation of symptoms above, be sure to discuss with your physician about the need for monitoring and testing.

How does measles transmission occur?

Measles transmission occurs via person-to-person contact as well as airborne spread. Infectious droplets from the respiratory secretions of a patient with measles can remain airborne for up to two hours. Therefore, the illness may be transmitted in public spaces, even in the absence of person-to-person contact.

Additionally, if someone is exposed to measles and is not immunized, they have a 90% chance of contracting the disease. It is highly contagious without vaccination.

What are the physical signs of measles in children?

The classic findings of measles in addition to fever and rash are cough, pink eye, and a runny nose. These are often prominent. The rash is also unique in that it starts on the head and spreads downward over the body. While other viruses can cause some or all of these symptoms, the constellation should raise the question of measles if there has been a known exposure or if a patient is unimmunized.

Where do measles come from?

Humans are the only natural source of the measles virus. While it could be spread in a laboratory setting, virtually all disease we see is from natural infection between person-to-person and airborne contact.

Information from Cook Children’s and the Centers for Disease Control and Prevention:

• CDC: Top 4 Things Parents Need to Know About Measles
• CDC: Measles
• Go here to view photos of measles from the CDC.
• What to know about vaccines and immunizations | Vaccine fact and fiction | Cook Children’s

Related content on CheckupNewsroom.com:

• Infectious Diseases Doctor Shares Why Measles Vaccination is So Important (checkupnewsroom.com)
• Infant Immunization Week Encourages Babies' First Shots (checkupnewsroom.com)
• Get Immunized for a Healthy School Year (checkupnewsroom.com)

Kids everywhere are counting down the days until they can take their first leap into the water for summer swim season, which has parents on the hunt for the perfect swimsuit. But before you purchase those cute swim trunks or that adorable suit for your little swimmer, it’s important to look beyond the latest fashion trends and consider safety, too.

Yes, a swimsuit’s color can be a safety hazard or help, according to water safety experts.

“The color of a swimsuit helps with visually keeping an eye on the child and being able to watch and make sure that they're obviously still moving and swimming in the water. Typically, we recommend bright colors,” said Kathryn Lammers, a professional swim instructor, owner of The Swim Lesson People and chair of Safe Kids North Texas - Fort Worth.

A video demonstrating the visibility of swimsuit colors in the water recently made a viral splash on social media and sparked a number of media stories. For good reason, experts say. A child’s swimsuit color is one of the many layers of protection parents and caregivers can use to help prevent drowning.

Children ages 1 to 4 have the highest drowning rates, according to the Centers for Disease Control and Prevention. Most drownings in children 1 to 4 happen in swimming pools, so it's important to be able to spot your child quickly. Cook Children’s has treated 10 drownings so far this year, one of which was fatal. 

Adult Water Watcher

Other layers of protection include teaching your child to swim, wearing Coast Guard-approved life jackets when in and around water, installing physical barriers and alarms to pools, ensuring your pool drain is fitted with a safety cover, learning CPR and, most importantly, closely watching your child when they are in and near water.

“It really goes back to that active supervision, no matter how many layers we put in place,” Lammers said. “We can teach swim lessons all day long, do CPR and have protective barriers. But those layers are there to help us if we have a lapse in supervision because, being a mom, we know that we're tasked with so many different things, and as much as we try to be vigilant and hypervigilant little things happen, but that active supervision is the most important.”

Water Watchers are adults designated to watch children who are in or around water at all times. They should have no distractions, this means no phone, magazines, books, eating, or conversing with friends.

Choosing a Swimsuit Color

Choose swimsuit colors that do not blend into the body of water in which your child will be swimming, be it a pool, lake or ocean. Consider the color of the bottom of the body of water. Is it light or dark? Think about how the swimsuit may appear or disappear both floating on top of the water or under the water when there is agitation, like splashing. Light colors, like white or light blue, tend to blend into the swimming pool, making the child harder to see.

Bottom line? Bright, contrasting, neon colors are the most visible in most bodies of water, according to tests performed by aquatic safety experts from Alive Solutions. Neon yellow, green and orange are the winners in pools with dark bottoms and in lakes. Neon pink, yellow and orange win out in light-bottomed pools.

“They just stand out better,” said Jillian Mitchell, child safety program coordinator for the Center for Community Health, led by Cook Children’s. “If they're wearing blue or green or even like a muted purple, those kinds of colors, they kind of blend in and are harder to see. So it might make a difference as far as noticing a child at the bottom of the pool for too long, or they're not playing anymore and may be in trouble.”

The same goes for life jackets, especially in the lake. It’s much easier for a boater to spot a swimmer or fallen skier who is wearing a neon orange or yellow life jacket than it is for them to see a black life jacket in murky water.

Mitchell says parents should consider a few other swim season fashion factors, too. For young children whose swim skills are still developing, choose suits without frilly and dangly design features that could become entangled in a pool toy or an old pool drain that does not meet current safety standards. Pull long hair back with a hair tie or braid to keep their faces clear while in the water.

“Think about your environment and what that entails,” Mitchell said. “If you're going to the beach, especially later in the season, the sand is hot so you want to protect your child's feet with well-fitted water shoes that are safe for that age. I'm not going to say no one should wear flip flops, but understand where your child is developmentally and what's going to prevent them from tripping and falling.”

Other tips for splashing safely:

• Before you let your child loose in the water, have them practice wearing anything they plan to wear while swimming, like water shoes and life jackets, so they get used to the fit, feel and function of the item in the water.
• If your little one wears a long-sleeve swimsuit or cover up, don’t forget to put sunscreen on their hands.
• Be cautious about allowing kids to swim in attire other than swimwear because of the drag regular clothing can cause in the water. For example, denim shorts and a cotton t-shirt are heavier than a swimsuit and will weigh a child down, making it more difficult for them to swim.
• Don’t choose one layer of safety over another. They are meant to all work together.

“Do not depend on one piece or one layer of protection,” Lammers said. “Know that these are all best practices. So even though we're promoting multiple layers, the layers work together and it's not just relying on one piece over another. If you go to the pool or the lake, don’t just rely on the life jacket or on swim lessons or on having a water watcher, but use everything in combination with each other. That is the overall best practice.”

Cook Children’s psychiatrists and psychologists are sharing some advice for parents.

How do I talk to my children?

• Ask them how they’re feeling and attempt to validate their feelings. Feelings of anxiety and sadness are normal. Reflect on what you hear and give them space to share. – Cook Children's family therapist Chris J. Gilbert, M.Ed, LPC, CCLS
• It’s OK if children ask questions that we don’t have an answer to. If you don’t have an answer, it’s OK to be honest and do what you can to help find an answer. You can follow up with “What makes you ask that?” – Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s
•  If children feel sad or uneasy, validate what they are saying. Allow them to vent and share their own frustrations and reflect that back. – Family therapist Chris J. Gilbert, M.Ed, LPC, CCLS

Should I bring it up if my children haven’t mentioned it?

• For young children, you can ask them how their day went and if they heard anything unsettling at school. – Dr. Pyrc
• For children 10 and older, parents should consider starting the conversation because they will likely hear about it from a classmate.
• It’s also OK if they are not interested or don’t show interest. – Family therapist Chris J. Gilbert, M.Ed, LPC, CCLS

How can I comfort my children?

It’s important to talk with your child about things that frighten them because it helps reduce and manage fear. It lets them know that their parents empathize and care about their feelings and thoughts. – Cook Children's Neuropsychologist Lisa Elliott, Ph.D.

The best thing you can do for yourself and your family is to connect with them, tell them you love them, and hold them a little tighter because we are grateful they were able to come home. – Kia Carter, M.D., medical director of Inpatient Psychiatry at Cook Children’s Medical Center

Some tangible items to help your child feel more comforted:

• Create a small photo frame keychain with a family picture. They can attach it to their backpack or keep in their bag.
• Create matching bracelets to remind them of the connection to you and your family. – Dr. Elliott

You and your children can also:

• Donate to a charity.
• Write a letter to the family of a victim.
• Use your faith and pray for the needs of others.

These actions allow for some sense of a healthy outlet. - Family therapist Chris Gilbert

What if children do not want to go to school after hearing the news?

Let your child have one mental health day and do a lot of pouring into them and making memories together. Talk with them about how to handle problems and let them know we can still find joy. Do not let it be more than one day or it will only exacerbate the fear. – Dr. Elliott

“Kid’s worries about gun violence are valid,” said Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s. “I have the same anxiety when I leave my house or send my kids to school. When you can, it is important to limit kids’ exposure to the news or information that is beyond their comprehension level. I hate having to have this conversation with increasing frequency because as adults we have not taken steps to adequately protect our children.”

Look for signs of anxiety

Keep an eye out for an increase in physical complaints. If these persist for more than a few weeks, seek professional help. - Dr. Elliott

• Stomach aches
• Headaches
• Change in appetite
• Nightmares
• Sleep disruptions
• Separation issues
• Panic symptoms
• Not wanting to participate in social activities

Parents, remember to take care of yourself

Model healthy coping skills as children take their cues from you. Children need to see that it’s OK to express emotion.

"It is vital for parents to take time to reflect on their own feelings before addressing their child’s fear centering around gun violence," Dr. Carter said. "We as parents have to remember to take care of ourselves first so that we can be the best parent for our children.  We encourage parents to find effective ways for themselves to cope by practicing in self-care whether it be exercising, meditation, seeking support in their religious faith. It can also be helpful for parents to consider joining parent support/community groups that can also serve as a platform to process these fears with other parents likely experiencing the same feelings. As parents, we are always modeling healthy behaviors for our children and this is a good time where we can model healthy coping skills and self-care for our children."

Effective ways to cope include speaking with other parents at school, forming/joining a parent support group, leaning on family members for support, eating nutritious meals, exercising, meditating, praying and speaking with your child’s school counselor for advice on resources or books on supporting yourself and your family through a school-related tragedy.

It's important that parents also process their feelings with other adults, support/communicate with their child's school staff and open up about their feelings and concerns.

Ways to help and ways to find support:

National Parent Helpline run by Parents Anonymous to get emotional support from a trained advocate: 1-855-427-2736

Tragedies such as these highlight the importance of donating blood. Giving blood supports nearby hospitals and rebuilds their supply for patients. Click here to sign up to donate blood at your local Carter BloodCare. Cook Children's Medical Center-Prosper is hosting its first blood drive. The drive is scheduled for 10 a.m. to 4 p.m. on May 12 on a Carter BloodCare bus. Register here.

Information from the National Association of School Psychologists about tips for administrators and how parents can talk to children about violence.

The National Child Traumatic Stress Network shares information for parents, including how to restore a sense of safety after a shooting.

For a great resource on how to speak up, visit sandyhookpromise.org.

For more on this topic:

• Sandy Hook Promise
• Cook Children's Behavioral Health
• Cook Children's Psychology
• Individual and family therapy
• Parent Education and Support
• Diagnostic Testing

Raising Joy Podcast

You can also listen to the recent Raising Joy Podcast with Dr. Jillian Peterson, founder of The Violence Project, as she informs listeners about her research findings related to mass shooters and what parents can do to help prevent the next school shooting.

Aim for Safety program at Cook Children’s

Safe storage. Safe children. Safe play.

When we have firearms in our homes, we must take certain steps to protect our children from unintentional shootings. Cook Children's Aim for Safety® initiative is designed to help reduce the number of injuries we see every year among children through gun safety education. This is not about whether guns are right or wrong. It's about taking the necessary steps to protect our children.

Safe storage: 

Parents and caretakers should always ensure safe storage in your own home and the homes you visit. Store firearms unloaded and in locked locations, out of reach of children.

• Use trigger locks and gun boxes.
• Secure ammunition separately.
• Hide gun safe and trigger lock keys.
• Keep unlocked guns in your possession.
• Make sure all guns are equipped with effective, child-resistant gun locks.

If a visitor has a gun in a backpack, briefcase, handbag, or unlocked car, provide them with a locked place to keep it when in your home.

Being a pediatrician, Dr. Bianka Soria-Olmos knows how to identify the signs of autism spectrum disorder (ASD) in her patients. When her own son was diagnosed, she learned the very personal challenges that come along with being a parent of a child with ASD. On this episode of Raising Joy, we talk to Dr. Soria-Olmos about how the diagnosis and how it has impacted her work as a doctor and as a mom.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

If you are the parent of a baby, you’ve probably been given the advice to sleep when the baby is sleeping. While well-meaning, it’s not always that easy.

As a mother of twins, now 14, I often rolled my eyes when someone would tell me this. It was hard enough getting one baby to sleep, much less two asleep at the same time long enough to catch any meaningful minutes of shut-eye for myself.

I’ll never forget one night in particular. On the way home from an outing the babies fell asleep in the car. My husband and I carried them into the house in their infant car seats and placed them by our bed. We were so tired and didn’t want to risk waking them in a transfer from their carriers to their cribs. Never wake a sleeping baby, right? Another well-meaning but not so practical or sound piece of advice.

So we left them strapped in their seats thinking they would wake on their own soon and we could move them then. In the meantime, we decided to get a little sleep, too. Hours later I woke up to find both babies still in their car seats and, uncharacteristically, still asleep.

I’ve since learned how dangerous it is to leave babies asleep and unattended in their car seats for long periods of time when not in a moving vehicle. Babies can and have died while sleeping in a sitting device like a car seat, bouncer or swing when used improperly as a sleeping location. A 2019 study that reviewed more than 11,700 sleep-related deaths over 10 years found that 3% of infant sleep deaths occurred in baby-sitting devices, most of them a car seat used improperly outside of the car.

So far in 2023, Cook Children’s Medical Center has recorded five baby sleep deaths, with one of them occurring while a baby was sleeping in a baby chair, according to Sharon Evans, Cook Children’s trauma injury prevention coordinator and car seat safety expert.

The danger lies in the positioning of the baby’s head and neck while asleep in a sitting device. The incline of the seat can cause a sleeping baby’s chin to fall and rest on its chest, closing their airway. Most newborns do not have the muscle strength to raise their heads on their own and, when in this position for too long, they can suffocate.

A seat’s degree of incline poses a risk, too. Baby sitting devices with an incline greater than 10 degrees is unsafe for baby sleep, according to the American Academy of Pediatrics. The incline makes it easier for a baby to turn over onto their belly in the seat. For those not strong enough to turn back, this can result in suffocation or injury.

A lot of babies are lulled to sleep while in their car seats in a moving vehicle, and that’s okay, Evans says. Who among us hasn’t driven extra miles during an outing so that your baby could finish their nap? When a car seat is properly installed in a car, it sits at the correct recline angle, which helps ensure the baby’s airway remains open. When placed on a flat surface like the floor or a table, the angle could pose a danger. Also in the car, you’re right there with your baby hearing their giggles and cries and are more likely to know if something is wrong. That’s not always the case when outside of the car where you can easily walk away, get distracted or, like me, go to sleep.

We were fortunate that nothing tragic resulted from that night of car seat sleeping, and were careful not to make the same mistake with our third baby. But, sometimes, exhaustion and desperation speak louder than reason and safety.

So what is a sleep-deprived parent to do?

Sireesha Mutyala, M.D., a pediatrician at Cook Children’s Pediatrics Plano Legacy, is a mom, too. As a working parent, she knows the exhaustion from sleepless nights followed by busy days as well as anyone. She also knows the dangers that certain factors bring to a baby’s sleep. Factors like cribs with blankets or stuffed animals, or unattended bouncy seats, and bed sharing, to name a few.

“With the alarming number of infant deaths from unsafe sleep that our medical center has already seen this year, I am so thankful that Cook Children’s is getting the word out to families about safe sleep,” Dr. Mutyala said. “It’s an issue near and dear to my heart.”

I asked Dr. Mutyala to demystify baby sleep. What’s normal and what isn’t? How can parents create a safe sleeping environment that encourages our little bundle — or bundles — of joy to sleep peacefully for as long as is appropriate for their age and development so that mom and dad can get some much-needed rest, too.

What is normal baby sleep in the first year? How long do babies usually sleep and how many times do they typically wake at night?

Usually, during the first three months, babies sleep about 14 to 17 hours per day, but in short spurts, like 30 minutes to two hours at a time all day and night. Newborns need to feed about eight to 12 times a day, so they have to eat almost every two to three hours even during the night. So there's very little continuous sleep happening in that stage.

Once they get to 4 to 7 months old, they're sleeping about 12 to 16 hours per day. Hopefully, five or six of those hours are at night, and they have three or four naps throughout the day. Those could be one to two-hour naps during the day and then a little bit longer stretch at night. At just a little under a year of age, they're still sleeping the same amount, 12 to 16 hours, but we're hoping about eight to 12 of those hours are at night, and they take about two to three naps during the day. Again, those are usually one to two-hour naps.

Typically nighttime sleep gets better as they get older. When a baby sleeps five to six hours in a row at night, we consider that sleeping through the night. Most babies will be able to do this between 3 and 6 months old.

Is it true that formula-fed babies sleep longer than breastfed babies?

That’s somewhat of a myth. Studies show that babies who are breastfed actually get more sleep throughout the night. They do wake up a little more frequently but their total sum of sleep is actually more, at least for the first few months or so. By the time babies are about 6 to 8 months old, the differences are gone and formula-fed babies and breastfed babies are sleeping much the same.

It’s important to know babies wake up for different reasons throughout the night, not just because they are hungry. They go through their sleep cycles multiple times throughout the night, so when they hit that light sleep cycle, that's when they wake up. For most that will be about four to six times a night. A lot of times they'll just go right back to sleep after a few minutes, which is why it's good not to rush in to them and automatically assume that they need to be fed every time. If you know they are safe, give them some time to fall back to sleep, especially if they're over 3 to 4 months of age. They will never learn to fall asleep on their own if we don't give them a chance to do it!

How should parents set the stage to encourage their baby to sleep?

Most importantly, make sure that it's a safe sleep environment. For every stage of infancy, babies need to sleep flat on a firm surface in a bassinet or crib and on their back. Close by is good, but definitely not in a bed with anyone else.

Most babies will sleep in a bassinet near the parents’ bed in the same room as them until they're about 3 months old. Then, they usually have to move from a bassinet to a crib. I wouldn’t wait too much past three months to move into a crib because it becomes really hard for a baby to change sleep environments after that age. A lot of families will keep the crib in the parents' room for maybe the first six to 12 months. The American Academy of Pediatrics recommends babies sleep in the parents’ room but on a separate surface for at least the first six months and up to one year, ideally.

Whatever you do, consistency is key. End the night where you started it. If your baby is in a crib, start the night in the crib. Keep the lights dim and the noise low from the beginning of the bedtime routine all the way through the night. That helps signal to them that it's nighttime.

Also, one of the things I really try to talk to families about is making sure that the baby's getting enough of their eating and drinking done during the day. Try to meet all those calorie needs during the day so that the baby understands that daytime is for eating and nighttime is for sleeping.

A lot of families do give babies a bath in the evening, give one last feeding, clean their gums or teeth and maybe read a bedtime story. Reading to them is important even at this early age as it helps with language development. Then, place the baby in the crib while they are sleepy, but still a little awake and have them fall asleep there.

Speaking of routine, how important is routine for a baby? Does it impact their sleep?

I find that routines really help babies understand what's happening around them and what to expect. You might not be able to do an actual schedule with exact times, but you can have an order and pattern to things. I liked having a pattern of eat, play, and then sleep for the baby. Even from the newborn period you can start establishing that pattern. Keeping a similar time for waking up in the morning and falling asleep at night actually helps them sleep better in general, too. It may be counterintuitive, but we don't want to make them overly tired by taking away naps in order to try to get them to sleep more during the night. Overtired babies can have a more difficult time falling asleep or staying asleep.

Look for their sleepy cues, too, like rubbing their eyes. Every baby may be different in what they do that signals they are tired, but look for those behavior patterns. When they start displaying those sleepy cues, that’s a good time to start getting them to sleep. If you wait too long, they’ll get past the point of tiredness and sleep will be harder.

There are a number of books written about different sleep training techniques. What do you recommend to parents about finding one that works for them?

Every baby is different, and so is every family. Sleep training can be very personal based on the parents’ comfort levels, their cultural practices and beliefs and a whole bunch of other factors. Families just need to be realistic in using a technique that they're going to actually be able to stick with and continue for a consistent amount of time.

Most of the common themes in these techniques is making sure the baby gets sleepy and then putting the baby down in their crib while they are drowsy but awake so they can learn to fall asleep on their own. This way, if they do wake up in the middle of the night, they look around and know that they are in the same place they fell asleep. They will be more comfortable going back to sleep again instead of being shocked that they're not in their parent’s arms or wherever they fell asleep initially.

I’d say the biggest difference in each of the techniques is what you’re supposed to do when the baby starts to cry during sleep time. Just remember it's not always hunger when they do wake up in the middle of the night, so don't rush in to them just because they're waking up. Give them a few minutes, and you might find they’ll put themselves back to sleep on their own.

The biggest thing that we find is parents say it doesn't work, but they're not sticking with it and being consistent. Give whatever method you are using a good solid two weeks of implementing it and continue with it as long as the baby is healthy.

I do not recommend any sleep training method before three months, as newborns need to eat every two to three hours for their growth and development.

What is sleep regression and how can parents get their baby back on track?

Sleep regression is when a baby who was previously sleeping well all of a sudden has trouble either falling asleep or staying asleep, and it can last a few weeks. A lot of times it can be triggered by things like growth spurts, teething, changes in routines like traveling or the baby starting a new daycare, or an illness. Reaching a new developmental milestone, like learning to roll or sit, can also cause a regression. We see it a lot around four months and then again at six months and nine months.

To get over the hump, you want to stay consistent with that bedtime routine, avoid letting them get overly tired and always give them a few minutes to try to go back to sleep themselves before you jump in there. Sometimes you do have to go back to your original sleep training method for a couple of weeks if you used one. It does tend to be much easier the second, third and fourth time around with that sleep training.

What is the most important thing you want parents to know about baby sleep?

Have your baby sleep in a safe sleep environment, flat on their back and alone in a bassinet or crib with a firm mattress every single time. This is healthy for the baby and really helps the family sleep soundly, too, knowing that the baby is safe.

When we are consistent with our baby's bedtime routines and have them fall asleep on their own, they tend to sleep so much longer and better. That continues on through early childhood and through those transitions with school bedtime routines. It really fosters good, long-term sleep habits. They grow better when they sleep well. They eat better when they sleep, and it translates to all sorts of healthy habits during the day, too.

Building healthy sleep habits is a marathon, not a sprint. We really need to remember that, even when we're exhausted, we've got to do what is going to be best in the long run and not just what is easiest to get us through the night. Healthy sleep habits are built over time and we just need to be very consistent with them. 

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.

Since the school shooting in Nashville last week, Lisa Elliott, Ph.D., psychologist at Cook Children’s, has seen an increase in conversation about school shootings with her patients and their parents who need help as well.

“It’s on everyone’s minds,” said Dr. Elliott, who has been a psychologist for 29 years. “Many of the moms have brought in their kids and asked for help themselves in navigating this.”

Dr. Elliott relates to these moms. School shootings now hit differently as her son is a middle school principal.

“Prayer gets me through,” she said.

We asked Dr. Elliott how to help children process this tragedy, along with tips for parents themselves. 

You can also listen to the recent Raising Joy Podcast with Dr. Jillian Peterson, founder of The Violence Project, as she informs listeners about her research findings related to mass shooters and what parents can do to help prevent the next school shooting.

What advice do you have for parents who are struggling with how to share the news of the school shooting with their children? How do they know when it is appropriate to talk with them?

The most critical part of reacting to this in front of children is to stay calm and always be honest with your responses.

To begin with, it all depends on how the kids process and handle emotions. You can wait to see if they say anything about it, and if they do, address it right away. I can tell you that late elementary, middle and high school students are talking about it. Do not minimize their concerns and immediately correct any inaccurate information. Let them talk first and lead the conversation, finding out what issues they want to talk through

Walk through the worst-case scenarios and talk to the school if needed, letting your child know all the safety measures in place. For some children, this kind of information empowers them.

Also, help them to know how to be observant – to be the helpers. We have to instill hope – Fred Rogers from Mister Rogers shared that his mother told him to “Always look for the helpers” in times of sorrow, tragedy, fear and anxiety, because if you also see the helpers you know there is hope.

At home, reinforce ideas of security and safety and maintain routines, with frequent check-ins.

How can parents reassure their children if they are struggling themselves to feel that everything will be OK?

Remember that to be the best parent to your child, you have to take care of yourself first – just like the airplane scenario with oxygen masks when parents are told to put their mask on before their child. It is important to model healthy coping as children take their cues from you. They need to see we care, and it is OK for them to see you express emotion, however, you do not want to overwhelm them. 

Effective ways to cope include speaking with other parents at school, forming/joining a parent support group, leaning on family members for support, eating nutritious meals, exercising, meditating, praying and speaking with your child’s school counselor for advice on resources or books on supporting yourself and your family through a school-related tragedy.

How do parents know when their child’s anxiety is beyond what they are able to help with and they need to pursue professional counseling?

Watch for these symptoms – an increase in physical complaints such as stomachaches or headaches, change in appetite, nightmares, sleep disruptions, separation issues, panic symptoms, not wanting to participate in social activities, and increased anger.

If any of these persist for more than a few weeks, seek professional help.

How do we shield our children from too much information with social media, TV, etc.?

Do all you can to limit your child’s exposure to the news, and even adult conversations, as children are always listening. We know from trauma research that violent images can cause secondary trauma. And parents need to model that as well by limiting exposure.

What if children do not want to go back to school after hearing the news?

Let your child have one mental health day and do a lot of pouring into them and making memories together. Talk with them about how to handle problems and let them know we can still find joy. Do not let it be more than one day or it will only exacerbate the fear.

What are some tangible ways parents can provide comfort to children?

Keychains with a small photo frame where you can place a family photo have helped many of the parents I see comfort their children. Attach it to your child’s backpack or lunchbox so they feel close to family while at school. Matching bracelets they can wear also help – anything that makes them feel connected to you and your family.

The rising prices of eggs, meat and other foods can make the cost of groceries hard to swallow these days.

But knowing some tricks for savvy shopping could help cut your grocery bill without sacrificing the nutritional value of the food you buy.

There’s no better time than National Nutrition Month -- in March -- to talk about the importance of fueling children and adolescents with the optimal foods for the growth and development of their bodies and brains. What we eat impacts energy, the risk for obesity, certain diseases, blood sugar levels, learning and more. 

Guidelines from the U.S. Department of Agriculture lay out the core elements that make up a healthy diet: Vegetables and fruits of all types and colors; whole grains, dairy including milk, yogurt and cheese; proteins including lean meats, seafood and nuts; and oils including vegetable oils. Children and teens need a variety of nutrients, such as calcium for strong bones, protein to build muscles, iron for oxygen-rich blood and fiber for easier bowel movements.

Kaitlin Smith, M.S. R.D. L.D. meets with patients in the Cook Children’s Endocrinology Clinic for issues such as diabetes and obesity. Smith and her dietitian colleagues at Cook Children’s provide education on weight management, counting carbohydrates and other nutrition-related topics.

In recent months, she said, more families in her consultations have voiced concern about inflation driving up the price of healthful foods. When the subject comes up, Smith coaches those families on affordable ways to eat nutritiously.

“It doesn't have to look like you're buying grass-fed beef or free-range chicken. That's what a lot of people picture, is we have to buy these expensive health foods or have top-of-the-line everything, and that's not true,” she said.

Smith outlined a few strategies for nutritional value at lower cost:

• Buy frozen or canned vegetables and fruits. “You're still getting good nutrients. They’re going to last longer, and it’s usually cheaper.” Look for fruit cups with fruit juice, not syrup.
• Seek out the more nutritious versions of food – for instance, brown rice instead of white rice, whole-grain pasta instead of pasta containing refined flours. “You're getting more nutrition for your dollar.”
• Eat more beans. “Beans are so affordable and nutrient dense. Beans of any kind are a great source of protein, fiber and iron.”
• Stock up and freeze meat when it goes on sale.
• Buy generic. Name-brand labels tend to cost more for foods with the same nutrient components as the generics.

The Academy of Nutrition and Dietetics points to additional key steps for preparing nutritious meals on a tight budget. How? Stick with a shopping list. Incorporate meatless meals a few days each week. Buy nonperishable staples, such as dried beans and lentils, in bulk. Use produce and other perishables first. Eat leftovers the next day for lunch. Freeze what you won’t eat right away.

“The key to smart, budget-friendly grocery shopping is planning ahead,” according to the Academy. “Plan meals around fresh produce, lean protein foods and low-fat dairy items that are on sale and in season to save money while eating healthy.”

Take breakfast, for example. Smith recommends oatmeal with a little milk and fruit as a low-cost option. Lunch could be turkey and cheese on whole-wheat bread, with a side of carrots or fruit.

“We have protein, we have fiber, we have fruits and vegetables available, and that's way cheaper than if you picked up a sandwich at a drive-through place,” Smith said.

For dinner, Smith suggests stir fry using a bag of mixed vegetables and a little chicken or beef over noodles or rice. Frequent dinners in her home consist of burrito bowls made with brown rice, black beans, avocado and cheese – affordable, and yummy to her young son.

Families can stretch their food dollars by turning to recipes such as Slow Cooker Vegetarian Chili Mac - Kristine's Kitchen (kristineskitchenblog.com), which yields six servings at a cost of $1.66 per serving. Smith pointed out that a fast food meal for one person costs $6 or $7 on average. 

“For the amount of money that you're spending on fast food or convenience foods, a much more nutritious option can be made at home. You’re getting less calories, less fat, less salt from not eating as many of those highly processed foods,” she said. “And if you're cooking at home, there are usually leftovers that you can eat throughout the week, which saves you money. It’s an all-around better option.”

Smith encourages families to take small steps to improve their nutrition routine. Changing too much all at once probably won’t establish a lasting habit, she said.

“Healthy eating does not have to be perfect,” she said. “Even if we swap out one to two fast food meals per week, that is still progress. Incorporate a vegetable into one meal every day, and then just build off of that. Just try to make realistic goals that are attainable for your family.”

National Nutrition Month highlights the importance of wholesome foods – and the dietitians who help children and teens make informed choices about what they eat. 

“I love simplifying healthy eating for my patients and reminding them that it doesn't have to be about a fad diet or expensive supplements or expensive health foods. I just love when I can empower people to take ownership of their health and make those small consistent changes to reach their overall health goals.”

We would love to hear from our listeners. This short 1 to 2 minute survey is anonymous and intended to help guide Cook Children's Joy Campaign and the podcast.

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The Raising Joy podcast is part of the Joy Campaign, which launched in April 2021 as a suicide prevention communication initiative, and aims to reach parents through honest conversations about the mental wellbeing of children and teens.

The Raising Joy podcast is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

They grow up so fast. One minute you’re rocking your baby in your arms and breathing in their sweet baby smell from the top of their head, and the next you’re carting them off to the doctor for their teen physical and wellness check.

In many ways, for both parents and kids, it feels like an altogether different experience from their yearly infant and child well-checks. But, in reality, it’s not different at all, save for the fact that your baby has matured into a teen who now values a certain level of modesty and privacy when it comes to their bodies. This can make the routine check of the genital area which is a part of every physical a bit “cringey,” as your teen might say. Let’s face it, it’s uncomfortable for parents, too, as they come to terms with their child’s increasing independence.

“I think parents think they're different and I think the only reason that they feel it's different is that, of course, the teenager at this point now does a lot of stuff on their own, meaning they have their privacy,” explained Bianka Soria-Olmos, D.O., Medical Advisor for Digital Health. “The parent isn't in full knowledge of things like bowel habits or genital development and abnormalities because they’re not changing a diaper or helping with bath time every day.” 

What to Expect

When Dr. Soria-Olmos examines the genitals during a patient wellness check — be it for a baby, child or teen — she says she is inspecting for the same things. Is the child following a normal developmental path? Are they entering puberty too early? Are there any visible abnormalities of the genitalia? These exams are general visual inspections. Nothing invasive.

For boys, pediatricians examine the penis, testicles and scrotum. When inspecting the scrotum, they may ask your child to turn their head and cough as the pediatrician feels the scrotal sac.  This helps reveal inguinal hernias or tumors. Slightly embarrassing for your teen? Yes, but absolutely necessary. Undetected inguinal hernias can rupture and be very painful, or even dangerous, for your teen.

Inguinal hernias are particularly dangerous for teen boys playing sports, as a direct blow to the genitalia could lead to hernia rupture. This is why most teen boys are required by their school to have physicals prior to playing contact sports, but they’re important even if your kiddo isn’t suiting up each week for Friday night football.

“I remind my parents of kiddos who say, ‘I'm not playing sports, so I don't need that check,’ that we still need to make sure that we have a normal anatomy and that we don't have a hernia,” Dr. Soria-Olmos cautioned. “Because an undiagnosed hernia, even if not playing sports, can be dangerous.”

Girls will also undergo a visual exam of their genitals to make sure their development is coming along at a normal pace. Unless there is a complaint of pain or other concern, Dr. Soria-Olmos says teen girls do not need an internal gynecological exam. The American College of Obstetricians and Gynocologists recommends women begin having regular Pap smears at age 21.

Alleviating Embarrassment

You can help your teen gain some level of comfort with these exams by talking to them prior to their physical about what to expect and why these checks are necessary. Dr. Soria-Olmos makes this discussion a regular part of her patients’ yearly wellness checks as they grow and mature. She also uses it as a springboard to talk about body safety and the difference between an appropriate medical exam under the consent and supervision of their guardian versus inappropriate touching.

In addition to a genital exam, all of the normal body system checks occur, too — ears, eyes, nose, throat, mouth, abdomen, back, legs, arms and thyroid glands. You’ll hear the same questions about your teen’s nutrition, sleeping habits and physical activity as you did when they were younger. If mom or dad has expressed concerns or the doctor detects any red flags about mental health, sexual activity, alcohol use, drug use, smoking, signs of an eating disorder or other risky behaviors, your pediatrician may broach these subjects with you and your teen.

“We only talk about this when the physical is done,” Dr. Soria-Olmos said. “And then always gauging the parent’s comfort for allowing their teen to have a conversation with or without the parent in the room.”

If you have a concern about your teen, or feel they may be more comfortable talking to the doctor about an issue, it’s okay to alert your pediatrician ahead of time so that they are aware your teen might have something they want to discuss.

“Ideally, I try to foster this type of open communication,” Dr. Soria Olmos said. “We are all here together to help the child. It’s important that mom, dad and doctor are all on the same page about what is going on with their teen.”

While this new phase of life may be tricky to navigate and, at times, uncomfortable for both you and your teenager, it shouldn’t deter either of you from getting these important health checks. In addition to protecting their health, it teaches your teen to be responsible for taking care of their bodies as they move out from under your wings and into adulthood.

By Ashley Pagenkopf, MS, CCLS, Child Life Specialist at Cook Children's

The last few years have been filled with collective challenges. The pandemic seemed to touch every single person in some way. It was the first experience of my lifetime that seemed to affect every single person I know.

We seem to be coming out of the grief and fog, but some lasting changes and effects will forever remind us of this time. Yet, in the middle of a pandemic, life continued to happen. Babies were born. Family members received new diagnoses. Some of us said goodbye to those closest to us. Joy and sadness shared space just like they always have and always will. 

When 2022 began, I filled out my yearly “dream guide” and walked into this year with joy and excitement to leave the intensity of the past two years behind. I wanted a break from the hard and literal constant changes. For our family, this year was a mile-marker year. My husband and I celebrated 15 years of marriage, and I entered my fourth decade of life. I was ready – ready to celebrate at every turn and really enjoy this year.

Grief and Grace

At the end of March, our world changed yet again. My middle daughter had a seizure and was diagnosed with a brain tumor. Time stood very, very still. Only a week after her first seizure, my grandfather (who I truly believed would live forever), died unexpectedly. We found out about her tumor two days before my grandfather’s funeral. 

I’ve never really known grief like I knew that weekend. It was physically painful. I remember wondering if the pain would ever subside or if it was going to be my new normal. There were many moments I could not breathe. My girls were devastated over the death of their great-grandfather, and we still had to tell them about a tumor. I just thought that pandemic was hard. This was a new level.

For the next several months, my daughter endured tests and imaging, and we talked to countless doctors to decide our next steps. We spent the summer in many, many consults and trying to make huge decisions.

At the beginning of August on our way to our summer vacation, I found myself completely void of any hope. I was shutting down. The moment I realized I was not okay was in the security line at the airport with the unkindest person that ever existed. 

After several very difficult shifts in the ER where many families lost their precious babies coupled with the intense decisions we were making for my daughter, the one lady working security caused me to completely fall apart. I wondered if she had recently lost someone or watched someone else grieve their child or if her child had a new diagnosis… I had to ask myself this so maybe I could give her some grace. I really had nothing left, though. 

I sobbed as I put my shoes on. My kids stared as I didn’t even try to hold it together. My husband was angrier than ever. I made my way to Starbucks, barely able to catch my breath and not even attempting to hide my hot, alligator tears. Once on the airplane, I proceeded to sit on my coffee that I had set down to put a bag away. Things felt completely hopeless. Life felt unraveled.

Have you looked at this past year and wished it would just end? Have you had one too many phone calls from the school with your kid as the subject? Has your kiddo been diagnosed with a new illness? Did you think that you were done with treatment, only to find yourself back in hard? Has your job felt like it is robbing you of all your energy and sanity? Have you lost someone dear to you this year? Has your world felt like it was ending, and you couldn’t see a way to stop it? Have you had a moment like mine in the airport where you had nothing left for the mean person and then you sat on your coffee?

Embrace Hope Now

I’ve heard a lot of people say recently that they are ready to have 2022 in their rearview mirror. I would be lying if I said I didn’t feel the same way. But I’ve spent a lot of time thinking about this. I am the first to embrace new beginnings. I love the New Year – new goals, new resolutions, new starts. But I have been reminded often that hope is here, now. It is at this very moment. In my desperate desire to leave this year behind and start over, I may miss the very moment where hope meets me now.

Literally, in every hard moment of this year, something beautiful has shared space with it. That something beautiful has often reminded me that hope is here. Hope is defined as “confident expectation” or “forward-looking faith.” Hope reminds us that there is good coming and beauty to be had.

Yet, this year, what I’ve always hoped for has met me in every hard moment. The hope for people who would support me, the hope for strength to shine in my kids in the face of adversity, the hope that I would be able to be present for my family when we faced pain and the hope that I could still find comfort and peace amid grief… All those hopes have been real this year. Thank goodness for those few sips of Starbucks before I sat on it. (Starbucks has provided a great deal of hope in the middle of hard this year.)

While on the said vacation, a wonderful photographer captured our family on the beach of Lake Tahoe. Hope that we could still smile and laugh and find joy met me in those moments. When tears streamed down people’s faces as they shared their prayers and hopes for our family, hope met me there. When my Cook Children’s family extravagantly showered our family with gifts and love, hope was tangible. When my very best friends drove seven hours for my daughter’s surgery and surprised me, hope met me. With every letter and encouragement and tear, I met hope.

What would happen if we could embrace hope now? Hope – the beauty that is to be had – doesn’t have to be next year. Hope is here, now. 

You can be hope to someone, and you can find hope in the simple. You can hand that bag of essentials out the window to the next man or woman you see on the corner and offer them hope. You can pay for the car behind you in the drive-thru and be hope for them. You can smile and ask your cashier how their day is and be hope for them at that moment. 

You can offer the beauty that is to be had – the hope – to those around you. And you can find hope in your next cup of coffee that warms you up. You can see hope in your kiddo that chooses kindness towards their sibling. You can experience hope in the next phone call or text message or next hug that comes your way. You can experience hope the next time your kiddo is brave like you never knew. You can see hope in the way that one tiny candle lights up the darkest room. Hope is here, now.

Wind chills are expected to be below zero degrees on Thursday, according to the National Weather Service. Be sure to dress warmly, cover up any exposed skin and limit your time outdoors. Hypothermia begins when our body temperature drops two to four degrees. 

By Thursday night, low temperatures will fall into the single digits across most of the Dallas-Fort Worth region. By Friday morning, temps will be in the teens or possibly in the single digits with high wind gusts.

People exposed to extreme cold are susceptible to frostbite in a matter of minutes. Areas most prone to frostbite are uncovered skin and the extremities, such as hands and feet.

Take these tips from MedStar on what a winter weather plan should include:

• Make sure that you have important phone numbers, including for your health care providers, pharmacy, and veterinarian.
• Assure you have enough medication for several days on hand.
• If you rely on medical devices in your home, have a backup plan in case you lose power for an extended period of time, such as a backup generator or battery pack and backup oxygen bottles.
• Have a communication plan for your family.
• Know how to get reliable information during the storm.
• Gather supplies in case you need to stay home for several days without power.

Carbon Monoxide

If the power does go out, be very cautious of carbon monoxide.

During the Texas winter storm in February 2021, Cook Children’s treated 13 patients for carbon monoxide poisoning in one night. Sam Selby, D.O., worked the overnight shift in the emergency department on Feb. 15, 2021 and saw families use propane or diesel-burning engines that are meant for outside use with adequate ventilation.

Dr. Selby described how families used generators inside or too close to their homes or garages to keep warm. Generators emit fumes and can cause carbon monoxide poisoning.

“Carbon monoxide poisoning prevents your blood from being able to bind to or carry oxygen. You suffocate while you are still breathing,” Dr. Selby explained. 

Here are some additional ways to keep your family safe during this time:

• Don’t use anything such as a BBQ grill or propane tank to heat your home.
• Don’t run a vehicle inside of a garage attached to your home.
• Don’t heat your home with a gas oven or stovetop.
• Don’t burn charcoal inside of your home. 
• Do seek medical attention if you suspect carbon monoxide poisoning.
• Do ensure the carbon monoxide detectors in your home are properly functioning and installed in areas that will wake you if it alarms.
• Do check for local resources, such as warming shelters, to keep your family safe. 

Coats & Car Seats

Don’t strap your children into their car seats with their heavy coats on. In a crash, padding from a coat or thick layers will flatten out, leaving room under the car seat harness. This increases the risk of a child slipping through the straps and being thrown from the car seat. Instead, dress your child in thin layers. Once buckled up, slip the coat on backward with the sleeves on the child’s arms. This way, the coat acts as a blanket and doesn’t affect the fit of the harness.

Pack an emergency bag for your car. It’s a good idea to have blankets, warm clothing, hats, and gloves available in case you become stuck in winter weather. You’ll also want to have nonperishable snacks packed away.

Dressing Warmly

When Outside

• Make sure newborns are dressed appropriately. "A good rule of thumb is to dress newborns in as many layers as you're wearing," said Diane Arnaout, M.D., Cook Children’s Medical Advisor for Digital Health. "That includes covering their heads, hands and feet. Those areas can lose a lot of heat and be harder to keep warm."
• For the most warmth, dress your little ones in wool instead of cotton. Essential winter items include hats and gloves, as well as sweatshirts or T-shirts that can be layered under overcoats or jackets.
• Blue skin, shivering and a cool chest and stomach are signs that children may be dangerously cold. If you see these signs, take action immediately to get kids out of the cold. Seek immediate medical attention if you're not able to warm the body.

Recognizing Hypothermia

According to the Centers for Disease Control and Prevention (CDC), hypothermia, or abnormally low body temperature, "is a dangerous condition that can occur when a person is exposed to extremely cold temperatures." To learn more about the warning signs of hypothermia, click on this site from the Centers for Disease Control and Prevention (CDC).

Warning signs for adults include:

• Shivering, exhaustion
• Confusion, fumbling hands
• Memory loss, slurred speech drowsiness

Infants:

• Bright red, cold skin
• Very low energy

Victims of hypothermia can include babies sleeping in cold rooms.

Want to know more about winter weather safety? 

Check out these articles from Checkup Newsroom contributors:

• Cold Weather and Kids. How to Keep Your Family Safe at Home, Outside and in the Car. 
• Bracing for Freezing Weather: Plan Ahead to Protect Your Family on the Road
•  Common Winter Mistakes Parents Make
• Cook Children’s Sees Spike in Carbon Monoxide Poisoning Patients During Freezing Temperatures

By Ashley Pagenkopf, MS, CCLS, Child Life Specialist at Cook Children's

I have a middle schooler in my home for the first time this year. I have spent a great deal of time over the last couple of months deciphering the BIG emotions that middle school inevitably brings. It can take some time to get to the real emotion, the real issue. But once we do, I am often reminded of how hard middle school is and that none of it makes sense. Still – all these years later – middle school is still dumb. The only thing left to do is to agree with my daughter about how dumb it really is. So that’s what I try to do – I try to validate her very big emotions…most of the time.

What is validation?

If you are wondering what validation is, that’s OK. We are all learning as we go. (This is an example of validation.) The dictionary defines validation as the “recognition or affirmation that a person or their feelings or opinions are valid or worthwhile.”

Validation plays a significant role in children feeling known and understood and creating an emotionally safe environment in the healthcare setting and at home. When a child can feel understood and heard, they have space to begin to cope with the emotion they are feeling. Without that space, it is very easy for any of us to get wrapped up in the emotion and not be able to find our coping skills. Once we can help children name their emotions more effectively and affirm that their emotion is valid, we will begin to see children regulate their own emotions more effectively. 

Often our children’s big emotions and feelings are met with our own big emotions or feelings, not validation. It is easy to be frustrated and overwhelmed by others’ emotions. As we explore emotional safety among our children, we have to recognize the importance of validation. Children cannot feel emotionally safe if we dismiss their emotions.

I work with children and families in an environment where emotions are always big – the emergency room. All areas of the hospital and doctor’s offices can produce big emotions in our kiddos. It may be helpful to hear what is *not* validating and does not promote emotional safety in the healthcare environment or at home.

1. Threatening is not validating. As parents, we love the “if you don’t _____, then ____” statements. One we often hear as child life specialists is “if you don’t stop crying, they will give you a shot.” This does not help anyone. Not only does this break trust with the health care professionals trying to help your child, but it also intensifies fear amid a child’s already high emotions. Health care professionals are there to help, and a shot may be necessary at some point. Shots are not punishment. We don’t want to punish children in any way for their emotions. Instead, we want to teach them how to cope with them.
2. Promising things is not validating. It is a basic rule in the health care environment not to make promises. Honestly as a parent, there is little that I can promise will or won’t happen. Statements like “If you just do this, then we will go home” does not validate your child’s emotions. This only establishes an expectation that no one in the room can promise. It is not wrong to want to promise these things to try to de-escalate your child, but this also can break trust and give children false hope when a promise cannot be met.
3. Disengaging or leaving is not validating. Often when our children are expressing intense emotions, it is super easy to check out – emotionally or physically. We don’t want to engage the emotions either out of embarrassment, fear of making it worse or we feel the same way and cannot control our own emotions. However, what we communicate to our kids when we disengage is that they are too much and that we can’t be there for them.

These are all responses that happen as we struggle to know what to do as parents. We are desiring to de-escalate the moment, and truthfully we just want to be on the other side of it.

Let’s explore how validation can not only de-escalate the moment, but it also gives our children language to their feelings. It creates a space between the emotion and the moment which allows them to regulate their own emotions more effectively.

• Let your presence be validating. The way you show up for your child matters. Practice being with them amid their emotions. This does not mean matching your child’s emotions. This means staying, listening, and hearing them. It means comforting them and engaging them in the midst of their big emotions. Even if you don’t understand what they are feeling, you can be there to recognize and affirm their emotions.
• Let your words be validating. You can use normalizing language like “It is OK to be scared, worried, etc…” or “Most kids feel anxious about…” or “I remember feeling nervous about…” When you can normalize how kids are feeling, it reminds them that they are not alone and that others have felt these feelings and still been able to keep going. I often remind kids that it is totally normal to feel afraid of an IV or needles. Most kids have some amount of fear of getting an IV or poke. This one statement of validation often changes the tone of a room. Also, let your language be reflective. You can reflect back to them what you are seeing and hearing. “I see that you are feeling nervous about this…” or “This is a lot of information to process. I bet you are feeling a little overwhelmed.” If your child is telling you their emotions, you can reflect back on what they are saying to you. “You are wishing that you could go home” or “You don’t want to do this again and you are totally over this.” Just the recognition of emotion allows room for emotional regulation and being able to put the emotion in its proper place.

Validation is not difficult, but as a parent and caregiver, it does take practice and intentionality. Often it does not come naturally. However, the more time that you spend practicing validating your child, you will find it easier and easier. Validating our kids can be hard, but you’ve got this! ;)

The sunny personalities and determination of Sophie Worsham and Libby Sponsler shine through as the girls and their families deal with the physical challenges and developmental delays of Down syndrome. 

Sophie, who is 15 months old, has low muscle tone due to Down syndrome and her premature birth. But she can play, babble, smile big and roll wherever she wants to go. Thanks to exercises and occupational therapy, Sophie is learning to sit up on her own. 

Libby, who is 2½ years old, uses lots of words but receives speech therapy to improve her pronunciation. Occupational therapy helped her to start walking just before her second birthday. Libby is a doting big sister who loves to dance, snuggle and express her sassy charm. 

Both girls had their diagnosis of Down syndrome confirmed through genetic testing at Cook Children’s. Both also underwent surgery as infants at Cook Children’s – Sophie for intestinal blockage and Libby for a heart defect. They come in for checkups as they grow and hit milestones.

October is Down Syndrome Awareness Month, and we at Cook Children’s want to share information about the condition, which happens very early in development when the embryo’s dividing cells have three copies of chromosome 21 instead of two. About 5,000 babies are born in the United States each year with Down syndrome, also called Trisomy 21. Characteristics vary but typically include distinctive facial features and some degree of developmental and cognitive delay.   

Cook Children’s geneticist Alexandra Garza Flores, M.D. said people with Down syndrome can have frequent ear infections and hearing loss, obstructive sleep apnea and thyroid dysfunction. Because of their low muscle tone, many babies with Down syndrome need extra support in feeding. Heart defects are common, occurring in 40-50% of newborns with Down syndrome and representing one of the most serious medical problems in early life.  

“With our current medical advances and proactive medical surveillance, people with Down syndrome have the potential for happy, healthy, productive and rewarding lives,” Dr. Garza Flores said. “Things will be challenging and different at times, but we will be with their family every step of the way to help keep their loved one healthy and to ensure that they have access to necessary resources.”  

Dr. Garza Flores outlined the scope of Down syndrome services at the Cook Children’s genetics center, which includes geneticists, genetic counselors, nurse practitioners, case managers, social workers, a dietitian, medical assistants and insurance specialists. 

The genetics team coordinates the diagnostic testing, screenings and consultations, and provides long-term follow-up care. Additionally, children ages 2 and up have the option of periodically attending a special multidisciplinary Down Syndrome Clinic, which is offered every other month. 

Down syndrome occurs in about 1 in every 700 births, she said. Doctors often recognize the signs through physical examination, but confirmation is recommended. “The gold standard is a karyotype analysis,” Dr. Garza Flores said, referring to the blood test that makes the extra copy of chromosome 21 visible.  

Children with Down syndrome share a common chromosomal abnormality. But each child is also unique. Celebrating their resilience and zest for life, we want to feature two perspectives. Let’s meet Libby and Sophie.

Libby’s story

Liberty Joy “Libby” Sponsler weighed 8 pounds, 12 ounces at birth. First-time parents Joshua and Madison Sponsler thought their daughter’s face possibly had features of Down syndrome - a surprise since they had not done a prenatal test. While the rates of Down syndrome babies run higher for moms over age 35, Madison was just 21 years old. The midwife at their birthing center recommended the Sponslers take Libby to the pediatrician the next day. 

The following morning, during the drive from their Bedford home to the doctor’s office, the bluish tinge in Libby’s hands spread to her whole body. They rushed to the Cook Children’s Emergency Department, where Libby received oxygen and was admitted to the Neonatal Intensive Care Unit (NICU) for a week of medical support and numerous tests. She indeed had Down syndrome, and also a hole in the heart called an atrioventricular canal defect. 

Cook Children’s cardiologist Gregory Barker, M.D. explained that the defect involves several heart structures, causing excessive blood flow to the lungs. 

“This results in symptoms such as trouble breathing and poor feeding,” Dr. Barker said. “If left unrepaired, it would lead to irreversible and severe damage to the lungs.”

At 6 months old, Libby returned to Cook Children’s for surgery to repair the walls between her heart chambers and to create separate tricuspid and mitral valves out of one large valve. It’s a complex procedure, Dr. Barker said. 

“The good news is that with appropriate surgical intervention, patients go from having essentially fatal heart disease to having a healthy cardiovascular system,” he said. “Most of our patients get to the point of requiring cardiology follow-up only every one to two years.” 

“We quickly saw a huge change,” Madison said of the surgery’s outcome. Libby no longer needed the medication that stabilized her oxygen level. Libby become more alert, ate better and began to gain weight. She visits Dr. Barker for checkups. 

Texas Early Childhood Intervention (ECI) provides speech therapy and occupational therapy to Libby at home. Occupational therapy helped her learn to crawl and walk. Her therapy these days focuses on the consistent management of stubborn behavior. 

“A lot of it is figuring out what works for Libby and what doesn’t work for Libby,” her mom said. 

Madison said she and Joshua first reacted with shock to the Down syndrome news. But they soon found other families who provided support and helped them adjust their expectations. The diagnosis was scary and overwhelming early on, Madison said, but not anymore.

“The community helped me process everything. Once I was able to process, I was able to enjoy my baby, and it went really well from there,” she said.

Madison acquired the mindset that Libby might not follow certain timelines that other children do. And that’s OK. Libby likes to hold her little sister Ember. She enjoys playdates and music. She demonstrates that people with Down syndrome are capable of reaching their goals, Madison said.

“If she’s trying to stack blocks and having a hard time with her fine motor skills, I tell her ‘You can accomplish it if you want to accomplish it.’”

Sophie’s story

Prenatal screening indicated Down syndrome about 12 weeks into Brooke Worsham’s second pregnancy. Brooke and her husband Mark were already parents of a healthy toddler. But this second pregnancy had more complications: A scan revealed that unborn Sophie had a digestive disorder called duodenal stenosis. At risk for stillbirth due to low flow between the umbilical artery and placenta, Brooke spent six weeks in the hospital under close monitoring. 

Sophie Elaine was born via C-section at 33 weeks, weighing 3 pounds, 8 ounces. The Worshams had pre-selected Cook Children’s as their destination for the surgery Sophie needed. Cook Children’s pediatric surgeon Thomas Rothenbach, M.D. operated when Sophie was just one day old, creating openings to bypass the obstruction in her small intestine. 

About 25% of babies with duodenal atresia (complete obstruction) or duodenal stenosis (partial obstruction) also have Down syndrome. The duodenum, or the first section of the small intestine, fails to develop into a hollow tube in babies born with the condition. 

“Because of this, nothing can pass from the stomach to the small intestine,” Dr. Rothenbach said. “The atresia has to be fixed for the baby to be able to eat.”

Sophie was also born with a hole in her heart that is now considered functionally closed without the need for intervention. Doctors can hear a slight murmur, but for now her heart is not a concern. 

For six weeks in the Cook Children’s NICU, nurses and speech therapists helped with Sophie’s feeding challenges. Then after discharge to her home in Fort Worth, therapists from ECI stepped in. The therapy has helped Sophie learn to eat pureed foods supplemented by infant formula.

Occupational therapy, meanwhile, puts Sophie in poses to improve her strength and endurance. Tools for therapy include pillow props and toys to attract Sophie’s attention while she practices. Brooke calls the therapy a workout. “If we put her in position, she can hold it, but she’s not able to independently sit right now.”

The Worshams are hoping that Sophie can enroll next August in the KinderFrogs intervention program at Texas Christian University, which serves children with Down syndrome and other developmental differences. She’s on the waitlist.

Brooke describes her daughter as social, easygoing and adored by big brother Graham. Sophie is enamored by the ABC Song and her favorite light-up owl, and she’s fierce in striving to accomplish whatever she puts her mind to. She recently started grabbing her bottle and spoon.  

“She’s going to do all the things, but just not in the rate that Graham did it. And so you just sit back and take it day to day and be patient. It’s going to take a little longer, and we don’t feel rushed.” 

Kids with Down syndrome have the same interests, desires and emotions as other children, she pointed out. They want to be included but might need more help or a longer time to finish a task.  

Like Libby’s mom, Sophie’s mom says the diagnosis was scary at first. Her advice? Find a group of other parents raising children with Down syndrome. Tap into their experience and support. Don’t look too far into the future. Be ready for the joy that Down syndrome children exude.   

“Everyone she meets loves Sophie. She fits right into our family. Since she was born, everything has worked out, and our life is not any more complicated than just adding another child.” 

By Ashley Pagenkopf, MS, CCLS, Child Life Specialist at Cook Children's

Recently I was helping one of my daughters prepare for surgery. We were up before dawn to do what is called a chlorohexidine bath the morning of her surgery. This is just a bath that helps to prevent infections and cleanse the skin of bacteria before surgery. We were standing in the bathroom, and I could slowly see her face changing. She burst into tears and uttered the only thing she was feeling – “I am so scared.” To which I burst into tears at almost 40 years old and replied, “I know you are, and I am too.” We both just sobbed as we finished the “bath.” Honestly, this was the first time in months of knowing about surgery that she had expressed fear or shed a tear. They were needed and necessary tears.

As a child life specialist, I am very comfortable with tears. The hospital is a combination of a new environment, painful procedures, and difficult experiences so tears are something that naturally flow. However, there is a stigma around tears and much of the world is not comfortable with or even accepting of them. 

We hear a lot of things about tears and children crying from parents, caregivers and medical staff. At the first sight of tears, an adult may say: “Don’t cry. Be brave,” “You’re a big kid. Don’t cry,” or “Crying isn’t helping anything.” As we explore emotional safety within the healthcare setting and elsewhere, we need to first establish that crying is OK. Not only is crying OK, but it is also actually beneficial and a needed part of the human experience for kids and adults. 

Let’s explore some of the truths about crying that may help us as parents, caregivers and staff as we respond to kids and their tears.

Crying is coping. 

Coping is how we handle difficult or stressful situations. Often crying is viewed as a sign of weakness or a negative way to cope with emotions. However, while there are many negative coping behaviors (anger, addiction, impulsivity, hysterical crying), crying itself is not a negative coping skill. It is a way of self-soothing and often helps our bodies relax. It can actually help kids find their bravery in the midst of challenging moments. Following crying, kids can move past that initial overwhelming feeling of “I can’t do this!”

While excessive crying (multiple times a day) can be a sign of depression and hysterical crying can create more stress, it is important to acknowledge that crying during a difficult or stressful experience is an appropriate coping mechanism and should be welcomed. Distraction, guided imagery, counting and many other things can be used to cope. However, tears can be trusted as a positive coping skill also, and accepting tears amid difficult experiences promotes an emotionally safe environment.

Crying does actually help. 

Often as a parent, our first thought when we see our kids cry is “Stop crying. That is not helping anything” as we are thinking of what they actually could do to help themselves. The truth is, though, that crying does actually help. Research tells us that crying releases oxytocin and endorphins. 

Oxytocin is a hormone that once released can immediately help lessen stress and anxiety. Its release can also help us to regulate our emotions more effectively. Also, when endorphins are released, they can help naturally lessen pain. Both of these effects of crying can help greatly during stressful or difficult experiences within healthcare, home or school. Research has also shown that when we over-restrict our emotions and hold in tears, it can contribute to poor emotional regulation in the short and long term. It is clear to see that crying can definitely help someone and often does.

Crying is not just something babies do. 

I’m sure you’ve heard an adult say in response to tears, “Don’t be a baby.” While in the early months of life, crying is a baby’s only means of communication, crying is not only meant for babies. Crying is a natural part of the human experience even into adulthood, and is developmentally appropriate at all ages. When we respond empathetically to tears, it can help our relationships with others. Between a parent and a child, a positive attachment can be established by responding compassionately to your child’s tears. 

Research has shown that a parent’s response to a child’s tears affects how the child can regulate their own emotions. Over time, if the response from the parent is consistently negative, the child will ultimately have poor emotional regulation. If we as parents can respond and validate our child’s tears, we have a better chance of also helping them establish good coping and emotional regulation over their lifetime. Some things that you could say are: “It’s OK to cry. Let’s also take some deep breaths,” “I know this is super hard and overwhelming. I’m sorry you have to do this. I am here with you,” or “This is super hard, but you can do hard things.”

It is also OK for you to cry. Something I witness often is a parent telling a child not to cry while also crying or attempting to hold back tears themselves. Sometimes parents or caregivers will leave a situation because they are crying. While a parent or caregiver crying can be unsettling to a child, it is OK for you to cry. I will say that this is only helpful if you can regulate your own emotions and communicate with your child what you are feeling. If your crying becomes hysterical or overshadows the person experiencing difficulty, it is not helpful or compassionate. True empathy and tears can validate someone else and make space for them to feel emotionally safe with their own emotions.

So, as we strive for an emotionally safe environment for our kids, let’s remember that crying is OK. We are encouraging positive and appropriate coping skills when we allow children to cry. Tears can be physically and emotionally helpful amid difficult and stressful experiences. Babies, kids and adults all experience emotions that lead to tears. As I think about the times in my life that have been stressful and challenging, tears have accompanied all of those times even now as an almost 40-year-old woman. We shouldn’t fear tears. Crying is a natural and helpful part of the human experience that allows us to grow in compassion and empathy and cope with this crazy life. Cheers to tears!

Since 2017, Cook Children’s Emergency Department has treated more than 300 children and teens for gunshot wounds. One of those children, a 4-year-old boy, changed the life of Daniel Guzman, M.D., forever. While Dr. Guzman couldn’t save this child from his fatal injuries, he vowed to do everything in his power to save other children from the same fate.

Later that year, he launched the Aim for Safety program at Cook Children’s, which focuses on preventing gun injuries in children and teens. On this episode of Raising Joy, Dr. Guzman (who is a gun owner himself) explains how parents can protect their children, regardless of whether or not they have a gun in their home.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

Join us for the first LIVE recording of the Raising Joy podcast on Thursday, September 29 at the historic Downtown Cowtown at the Isis Theater in the Fort Worth Stockyards.

This event, which is being hosted in partnership with The Center for Children’s Health led by Cook Children's, will bring mental health leaders in the community together to hear an inspiring talk by author and renowned speaker Andrew Solomon, Ph.D. Solomon is a Pulitzer Prize finalist, National Book Award winner, TedTalk presenter, as well as a professor of Clinical Psychology at Columbia University.

Registration is required to attend. Click here to register! 

We all know sleep is important, but that doesn’t mean we get enough. And when it comes to kids, sleep is especially critical for their development and mental health.

So what should you do if your child has trouble sleeping? Hilary Pearson, M.D., is the medical director of the Sleep Center at Cook Children’s Medical Center. On this episode of Raising Joy, Dr. Pearson talks to us about sleep aids, the impact of electronics on sleep and when you should seek help for your child from a medical professional.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

Join us for the first LIVE recording of the Raising Joy podcast on Thursday, September 29 at the historic Downtown Cowtown at the Isis Theater in the Fort Worth Stockyards.

This event, which is being hosted in partnership with The Center for Children’s Health led by Cook Children's, will bring mental health leaders in the community together to hear an inspiring talk by author and renowned speaker Andrew Solomon, Ph.D. Solomon is a Pulitzer Prize finalist, National Book Award winner, TedTalk presenter, as well as a professor of Clinical Psychology at Columbia University.

Registration is required to attend. Click here to register! 

Child Passenger Safety Week is Sept. 18 through Sept. 24. National Seat Check Saturday is Sept. 24, 2022.

Choosing a car seat for your baby can be overwhelming. There are so many different colors, styles and price points. But there’s one more thing to keep in mind – these popular brands are being knocked off to create counterfeit car seats.

These knockoffs may be cheaper, but are less likely to protect your child in a crash. Some parents don’t even know that their seat is a knockoff, due to ecommerce sites or purchasing car seats on social media. The dupes are eerily similar.

Last month, a Cook Children’s Child Passenger Safety Technician found a fake brand car seat, which was a dupe of a popular brand. There were a few differences that could be easily overlooked, unless you know what to look for. 

Cook Children’s has Certified Child Passenger Safety technicians (CPST’s) who know how to properly use and install car seats within the Medical Center to ensure our patients ride safely.  Under the Center for Children’s Health and Safe Kids North Texas there are also CPST’s who work in the community and have partnerships with fire departments, police departments and other community agencies to help educate the communities around us. “My fear is there is going to be more and more fakes out there and parents really need to be vigilant to make sure they have a true crash tested safety seat that will protect their child in the car at all times,” said Sharon Evans, RN, BSN, CPN, CPSTI, trauma injury prevention coordinator at Cook Children’s.

Cook Children’s Child Passenger Safety Technicians educate caregivers/patients/families on car seat safety and know what is required for car seats to meet the Federal Motor Vehicle Safety Standard 213. On the authentic seat, safety warning labels are much more informative with detailed, written information, which are required by law. The fake car seat had safety symbols and pictograms, but no wording.

Fake car seats may have incorrect features altogether, such as strap width, which when placed on authentic car seats will protect an infant or toddler’s fragile bodies in a crash.

The knockoffs do not meet federal safety standard guidelines set by the National Highway Traffic Safety Administration.  Authentic car seats have passed rigorous safety standards and crash safety tests.

Parents and caregivers who shop online will want to stay extra vigilant for fake car seats. The best way to ensure your child’s car seat is authentic is to buy directly from the manufacturer or from a reputable retail store.

Red flags:

• Great deal on a car seat. If it’s “too good to be true,” it probably is.
• Do not purchase from someone on social media.
• Do not purchase from ecommerce sites, which allow for third-party sellers and can lead to a counterfeit car seat.

What can I do? Is my child’s car seat authentic?

• Call the manufacturer. They can help you determine if it’s a knockoff. Sometimes they will ask you to submit photos.
• Take your car seat to be checked by a certified child passenger safety technician. They are trained to help determine if it’s fake.
• Find a Child Passenger Safety Technician: Welcome! | National CPS Certification (safekids.org)
• The National Highway Traffic Safety Administration maintains a directory of many inspection stations.
• Additional information about car seat safety from the Texas Department of State Health Services

Car Seat Check Saturday: Sept. 24, 2022. Events are scheduled across Fort Worth and Willow Park areas.

• Register and view upcoming events at www.freecarseatcheck.org 

Did you know?

Car crashes are a leading cause of death for children, according to the U.S. Department of Transportation. On average, two children under 13 were killed and an estimated 374 were injured every day in 2019 while riding in cars, SUVs, pickups, and vans.

• 608 child passenger vehicle occupants died in traffic crashes in 2019.
• 38% of children who died in 2019 while riding in passenger vehicles were unrestrained, compared to 33% in 2018.

There hasn't been a “death-free” day on Texas highways since 2000, that's more than 78,000 deaths. #EndTheStreakTX (txdot.gov)

• This year so far 2,839 deaths, as of Sept. 14, 2022
• 2021 had 4492 deaths
• 2020 had 3897 deaths (10.5/day)
• 2019 had 3623 deaths (10/day)

The family finished eating dinner when the girl told her mother, Katie Jacobsen, that she swallowed a button battery that was from a toy. They had extra honey packets on hand, which helped ease the battery through the girl’s stomach.

Button batteries and lithium coin batteries are dangerous for children if ingested. These small, shiny batteries are found in remotes, key fobs, thermometers, toys, and many other devices found in the home.

When a child swallows a button battery, the saliva triggers an electrical current. This causes a chemical reaction that can severely burn the esophagus in as little as two hours, according to Safe Kids Worldwide.

If a battery is ingested, parents should immediately call 911, and seek medical attention at the emergency room. If your child is over 12 months old, Cook Children's experts confirm that parents can offer the child honey, if available.

LaQuatre R. Rhodes, D.O., says battery ingestions are seen a couple of times per month by the Cook Children’s Gastroenterology team in Prosper.

“Ingestion of button batteries can cause severe complications including respiratory difficulty, injury to the respiratory tract, injury to esophagus, stomach, or intestines, bleeding, and even death so it’s very important to seek immediate medical attention and ultimately prevent ingestion,” Dr. Rhodes said.

She says if a mucosal injury is present, monitoring is required after removal. Repeat endoscopy and imaging are done on the patient to assess for complications. Long-term follow-up may be needed depending on the severity of the injury, Rhodes said.

From 1997 to 2010, an estimated 40,400 children 13 years and under were treated in hospital emergency departments for battery-related injuries, including confirmed or possible battery ingestions, according to the Centers for Disease Control and Prevention. Nearly three-quarters of the injuries involved children 4 years and under; 10% required hospitalization, the CDC said.

Dr. Rhodes answered more questions for us about coin battery ingestions:

What are the symptoms to look out for that might indicate that my child swallowed a button battery?

Abdominal pain, bleeding, cough, breathing difficulty, sore throat, chest pain, fever, and weight loss are symptoms to look for if a child swallowed a button battery.

What should parents do if their child swallowed a battery?

Seek medical attention: call 911 or head to the emergency room. For children over 12 months old, give Carafate or honey soon after ingestion. This may help improve injury to the esophagus and stomach, but do not delay seeking medical attention. The National Battery Ingestion Hotline is available at 800-498-8666, 24 hours a day, seven days a week.

How soon should you give honey or Carafate to your child after swallowing a button battery?

Immediately and ideally less than 12 hours of ingestion. However, do not delay seeking medical attention to administer honey.

How do honey and Carafate help prevent injury? How much should I give?

Honey and Carafate coat the battery, which limits electrode activity and neutralizes generated hydroxide. This prevents damage and perforation to the esophagus and stomach.

Carafate is a prescribed medicine that coats and covers the mucosa of the esophagus and stomach to help protect it from injury.

Recommended doses for both honey and Carafate:

• For children over 12 months old,  give 10 ml or 2 teaspoons every 10 minutes with a maximum of 6 doses of honey and 3 doses of Carafate.
• However, do not delay medical attention to administer.
• Do not induce vomiting. Do not delay emergency care to look for honey.

What can medical professionals do if my child swallows a battery?

1.    Check vital signs and evaluate to see if stable.

2.    An X-ray is done to identify the location.

3.    If the battery is in the esophagus less than 2 hours after ingestion, then immediate endoscopic removal. It will be removed by Ear-Nose-Throat or GI depending on location.

4.    If the battery is in the esophagus less than 12 hours after ingestion, the child is stable and able to swallow and ingest consider honey (>1 years) or Carafate while waiting for endoscopy. But do not delay endoscopy to give it.

5.    Beyond esophagus and symptomatic (abdominal pain, bleeding, cough, breathing difficulty, sore throat, chest pain, fever, weight loss) or magnet co-ingestion less than 12 hours of ingestion immediate endoscopic removal if in the stomach. Consult surgery if in the small intestine or colon.

6.    Beyond esophagus and asymptomatic less than 12 hours of ingestion repeat X-ray in 7-14 days or sooner if develops symptoms. If no passage, proceed to endoscopic removal.

7.    If it's been more than 12 hours of ingestion, your child may need an endoscopy, CT scan or endoscopic removal.

8.  If it's been more than 12 hours of ingestion, in the small intestines or colon, and asymptomatic repeat X-ray in 7-14 days or sooner of develops symptoms. If no passage, consult surgery.

What else should parents and caregivers be aware of?

The presence of an ingested button battery is considered a medical emergency, so do not delay seeking medical attention.

Make sure battery compartments are secured and screwed properly. Button batteries are shiny and attractive to children so avoid leaving loose batteries around.

Keeping Children Safe at Home from the American Academy of Pediatrics:

Crawling infants, toddlers and young children often put things in their mouths. Because of this, there are a few things you can do to reduce the risk of accidents.

• Look for batteries in child-resistant packaging. There is one type of lithium coin battery with a bitter coating to discourage swallowing.
• Make sure battery compartments are secure, especially for commonly used items like remote controls and key fobs. Consider taping them shut for an additional layer of security.
• Know what items in your home contain button batteries and lithium coin batteries, including older siblings' toys, calculators, and games.
• Store items that use these batteries out of reach, and out of sight if possible. For example, keep thermometers or remote controls in a secure drawer or cabinet when not in use. Hang keys up high on hooks. If someone receives a musical card, make sure to throw the card out when done or remove the battery before allowing children to keep it in their room. Remind older siblings to keep their stuff off the floor.
• Make sure childcare providers and family members are aware of the safety concerns. Post the number for the National Battery Ingestion Hotline (800-498-8666) with other emergency information in your home.
• Throw out or recycle old batteries right away. Even batteries that are "dead" can be dangerous. To safely dispose of button batteries and lithium coin batteries, wrap them in tape and place them in an outside garbage can.
• Talk with your children about safety. We teach kids to hold hands and look both ways when crossing a street and that a stove is hot. In the same way, we can teach them that handling batteries is for grown-ups. Talk to older children as well to make sure they keep track of items responsibly.

If a child ingests a button battery, immediately call for help, either through 911 or the National Battery Ingestion Hotline at 800-498-8666, which is available 24 hours a day, seven days a week.

Our relationships with our parents during childhood have a wide-reaching influence over the course of our lives. On this episode of Raising Joy, we talk to one of the leading experts in this field of research, known as attachment theory.

Casey Call, Ph.D., LPC, is the associate director of education at the Karyn Purvis Institute of Child Development at Texas Christian University in Fort Worth, Texas. She tells us how her background as an educator led to her passion for improving systems of care for children. We also explore how different attachment styles impact our children and ourselves.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

By Ashley Pagenkopf, MS, CCLS, Child Life Specialist at Cook Children's

I truly cannot believe that the summer is over. The summer months typically provide respite and regrouping for families. That is true for our family, but it is about this time that I start feeling ready to begin the new routine and move through the awkward first weeks of school.  One of my kiddos will have major surgery the second week of school and another kiddo starts middle school this year so my mom heart is extra anxious!

Summer months typically provide some respite at the hospital too. We see less illness and historically a fewer number of patients. I don’t think that any of us would say that this summer felt restful, though. While there is less illness in the summer, the number of traumas tends to increase, and we see a great deal of tragedy over the summer months.  This summer has been no exception. 

What is the well-known saying? We need a vacation from our vacation. I can’t imagine that I’m the only one feeling that at the close of this summer. Just like the beginning of a new year, we can all appreciate the reset that a new school year can bring. But we can’t ignore the intense emotions, anxiety and stress that a new school year inevitably brings to kids and families.

The weeks before and the first few weeks of school, the emergency room experiences an uptick in the number of kids coming in for behavioral health needs. There are so many stressors to starting something new, and post-pandemic we are needing more than ever to be aware of this and address it in every environment a child encounters – home, school and healthcare.

The Association of Child Life Professionals recently began an initiative nationwide addressing emotional safety within the healthcare environment. Emotional safety is defined by the ACLP as “an intentional, interdisciplinary practice to promote resiliency, healing and trust for pediatric patients and their families during medical experiences.”

This means that when a child walks through the doors of the hospital, we are all working together to be trustworthy adults that help a child recover more quickly from difficult experiences and help them work towards emotional, physical, and spiritual healing. While child life specialists promote and advocate for emotional safety, it is the job of the entire multidisciplinary team to provide this high level of care to patients and families.

When I look at this definition of emotional safety, I am reminded as a parent that this is what I want for my kids within my own home. I want my children to be able to recover quickly and withstand the storms of life. I want them to trust themselves, peers that are trustworthy, and adults that are trustworthy. I deeply desire for my girls to experience a balanced, healed life physically, emotionally and spiritually.

I don’t know about you, but as a mom, I am certain that I am not always promoting emotional safety within my home. I always desire it, but I know that I can often get in the way of my children feeling emotionally safe. In my exhaustion and selfishness, I can forget to really take the time to process the difficult emotions and validate my girls’ feelings. I often want them to just get over the hard without ever acknowledging how hard it may be. (And just in case you aren’t aware, things have been HARD over the last couple of years – especially for our kids.)

I have three girls that often cry in response to hard things. Even I cry often in response to hard things, but I can still find myself being annoyed at their tears. When in reality, the expression of our emotions often leads to healing and tears are needed.

I have also found that my kids need me at this time in their life to be their cheerleader and their advocate. My kids count on me to fight for them and to help them feel safe in all situations. Even my oldest, who is learning to advocate for herself, needs me to be there to help her when her school world or friend world is crumbling around her. 

As a child life specialist, emotional safety is extremely important to me in the healthcare environment. It is a right of every human to feel safe in every way while they are receiving healthcare services.

As a parent, it is also my responsibility to provide an emotionally safe home. This provides the framework for my girls to know what emotional safety is. When our children can understand what emotional safety is, they will be able to advocate for it not only in their healthcare experiences but also at school and at their jobs.

As we begin another new school year, I want to challenge you as parents and grandparents to consider this definition of emotional safety. Consider how you can promote resiliency among your kids and grandkids. Take some time to be with your kids in the next few days and weeks.  Allow them to really express their emotions to you (tears and all), validate their emotions and cheer them on towards the next right thing. Our kids need us to model in our homes what an emotionally safe environment should look like so that they can truly expect that level of safety in their all encounters.

Talking about hard things isn’t easy, especially for a child or teen. It’s scary to be vulnerable. But talking can bring clarity. Sharing your hurts, struggles and stress can be a release, and leaning on someone you love can lighten your mental and emotional load.

“Feelings really are visitors trying to tell you a story,” said Denise Coover, LCSW, a trauma informed care specialist at Cook Children’s Medical Center. “If you ignore the story it just keeps building and building and will demand to be heard. Think of holding in feelings like a trash compactor. You keep pressing it down, pressing it down, but eventually it explodes like a volcano. Usually with frustration, anger and aggression and that’s the danger. These things need to be expressed within a safe environment and relationship. That is key.”

Kids need adults—parents, teachers, counselors, pastors and mentors—to create an environment where they feel secure and free to unpack the things that weigh on their minds and hearts. Trusted adults can help release the pressure on the trash compactor, so to speak.

“By talking with someone we trust, we are able to process our feelings as they arise,” said Marissa Benners, Ph.D., LP, a psychologist at Cook Children’s. “It makes it easier to manage the everyday demands of life without the pressure of unresolved feelings weighing us down. Sharing our feelings with others gives us an extra person who can help us problem solve and figure out the best coping strategy.”

Michael Garcia, MS, LPC, is a trauma specialist for the Fort Worth Independent School District where he works with children in crisis every day. Without a trusted adult, he cautions that a child’s development could be influenced by less positive sources.

“A child who is struggling wants to be comforted and feel safe,” Garcia said. “A loving and caring adult provides the necessary attachment a child needs to learn how to effectively communicate needs, meet those needs and manage emotional regulation. A positive and connected caregiver greatly influences the child’s ability to navigate difficult challenges.”

But many parents have their own hurts, experiences, worries, commitments and unfulfilled expectations that are barriers to being a sounding board and source of strength for their kids.

“Parenting isn’t easy,” Garcia said. “As a matter of fact, it’s my most challenging undertaking. It’s not always easy to listen to our children with empathy and compassion when our heads are spinning with finances, deadlines, relationships, piles of laundry and a myriad of daily speed bumps.”

On the flip side, kids don’t want to be a burden to their parents who they see juggling the demands of daily life.

“Kids often tell me the adults in their lives don’t care, are too busy, have their own problems and they don’t want to cause more problems,” Garcia said. “A lot of kids are empathetic to what their parents are going through and don’t want to be another burden.”

In a recent focus group conducted by Cook Children’s, several teens said feelings of fear and insecurity also get in the way of opening up to others. They are unsure how their message will be received, and are afraid of getting in trouble, being misinterpreted and, especially these days, being canceled.

When adults allow the complications of daily life, difficult pasts, fear of other’s perceptions and shame to lead, the unwritten no-talk rule sets itself up as the standard in the home and muzzles any opportunity for communication, connection, teaching and healing. It’s one thing for a child to suffer. It’s another for them to suffer in silence. Pushing hard issues under the rug, or ignoring a child’s emotions—a natural sign that something is going on—won’t make things go away. Instead, it teaches kids to hide their struggles and sets up a breeding ground for shame, guilt, rejection, lack of trust and hopelessness.

So how can parents, teachers and child advocates be a trusted adult that welcomes the hard conversations? How can trusted adults encourage communication that sheds light on the root of the issue and helps them guide kids to problem solve through a situation?

Take stock. Garcia said we can’t be a trusted adult when we feel like we have nothing left to give. Ask yourself what you need as a parent so that you can be truly present with your kids. If you need help with your own struggles, reach out. Equipping yourself will help you take care of and equip your children.

“We are all doing the best we can, and we can do better,” Garcia said. “Kids need us to be present, loving, comforting, empathetic, compassionate and honest. They need to know that they can trust us with whatever storm is raining down on them. We have to take care of ourselves so that we can take care of our children.”

Harness your own emotions. Parents have emotions too. It’s easy and natural for those emotions to surface, especially when it comes to your children. But harnessing those feelings like anger and frustration in the moment can help you see and respond to the reality of the situation, rather than getting caught up in the emotion. Responding out of anger will only frustrate a child, but responding out of love, patience and wisdom will teach them important coping skills that will benefit them for life.

 “One of the most important factors in creating a safe space is responding to your child in a calm and compassionate manner,” Benners said. “When adults regulate their own emotions during conversations, it helps those around them feel more at ease or relaxed. Parents can help foster open conversation by being honest about their own feelings. By calmly expressing our feelings during periods of stress, for example saying, ‘I’m feeling very frustrated at the moment and I need a few minutes to calm down,’ we help normalize feelings and we teach our kids an adaptive way to express them and to ask for help.”

Watch their cues. Kids will demonstrate they need to talk through their emotions and behavior.

“When we bottle our feelings up, they tend to come out in other ways,” Benners said.

Stomachaches, headaches, fatigue, difficulty concentrating, sleep problems, irritability, meltdowns and oppositional behavior are all indicators that your child might have something weighing on their heart and mind.

Listen. This is the most important thing an adult can do for a child, according to Garcia.

“Trust comes from actively listening without judging,” he said. “Listening with empathy, compassion and curiosity is how we encourage kids to share openly.”

Embrace your child’s communication style. Kids communicate in different ways. The key is to figure out what works best for them at their current age and stage of life and go with it.

For younger kids, play is always a good communication tool.

“What kids can do in play, they can do in life,” Coover said. “I like to give a young child a toy, like a dinosaur, and throw out a scenario. Maybe T-Rex is bullying and saying you’re green, fat and ugly and pushing. If the child doesn’t have good coping skills, the dinosaur will just sit there.”

That’s when you can start talking to them about how they would handle the situation. Ask questions that help them think through how to respond. Could you tell mommy dinosaur? Can you walk away?

For older kids, especially teens, seizing the moment while you are doing another activity together is a great way to set the stage for conversation.

“I'm a big fan of asking kids questions when you're on a car ride,” Coover explained. “There's something about that side-by-side movement where they don't really have to look at you. Maybe music is playing. You get the vibration of the car. You're not really looking at them because you're concentrating on the road. Then, all of a sudden you can get all of this information from them.”

Striking up a conversation around the dinner table is another good way to check in. Coover suggests asking your child what was one thing that made them mad, sad, happy and worried that day to get the conversation flowing.

When a child can’t find the words to speak, let them draw it or write it.

“Some kids either don't have the verbiage to be able to say it or they're feeling insecure or are afraid you're going to get mad,” Coover said. “So they'll feel more comfortable writing it. I really like notebooks for pre-teens and adolescents. Like a regular composition book. Nothing fancy.

Tell your child, ‘if there's something going on you can write it and put it right here and I'll read it and respond to you.’ With little kids, if you have them come home and just draw about their day, it’s amazing what you’ll find out.”

Be an equiper, not a fixer. It’s easy for adults to want to fix a problem for a child. That takes a lot less time than letting a child express what they are thinking and feeling, but that’s not always beneficial.

“When we constantly fix things for our kids, their brains don't grow,” Coover said. “They become adults who can't manage any kind of problem in life because they've never had to. Someone has always stepped in and just took care of it for them. So their brain didn't grow in that way. They didn't create those neural pathways to know how to consider their solutions. I think it’s important that parents know that they don’t necessarily have to fix that feeling, but actually ask if their child wants advice or insight.”

Encourage them. Help them think through the issue, and make sure they know that you are here to help them figure things out.

Check in. No matter how you communicate with your child, it’s important to check in with them regularly.

“Allocate designated time with your children on a weekly basis,” Benners said. “Put your devices away and just focus on having fun together. Teens often feel like they don’t have much control over their lives, so allow them to choose an activity that appeals to them. During this time, don’t be overly intrusive by asking questions. Instead, follow your child’s lead and you may find that they will eventually open up on their own.”

When your kids know that you can be a trusted sounding board and source of wisdom for them, you’ll have the opportunity to equip them with the life skills they need for healthy living, hopefulness and resilience.

When I graduated from my pediatric residency 11 years ago, I knew there would be questions from parents daily about their child's growth, development, illness, behavior, etc. 

"What’s this new movement?"

"Is this behavior normal?"

"What should I be doing about this rash?"

But there are seriously some things I get asked about that make me chuckle every day – not because they’re silly, as no question for your doctor is unimportant – but because I never knew I’d be answering them so often!

Here are seven of the most uncommon, common questions asked by parents: 

1. "Is this much earwax normal?” – The answer is probably yes. We make earwax daily, some of us more than others, and in all types of colors and textures. Earwax protects our ear canal and prevents infection.
2. “Is my baby’s teeth grinding normal?” – Yes! When they get those fun new chompers, it’s really common for them to click and grind them as they explore that new feeling in their mouth. I remember it setting off my baby alarm sometimes at night because it was so loud…
3. “Why does my baby have rosy cheeks?” – Sometimes babies get rosy cheeks. It’s often due to dry skin or cold weather. But sometimes, babies just have beautiful, well-circulated cheeks. And 99% of the time it bothers parents more than the baby.
4. “What is this little bump at the bottom of my baby’s skull?” – Okay, I know this is oddly specific, but there are two little lima bean-shaped/sized lymph nodes on the back of the skull, top of the neck area. They are called occipital lymph nodes and nearly everyone feels them on their baby’s scalp at some point, especially after that first bath and shampoo. They’re normal and as long as they’re not growing or more are showing up, you’re okay to just observe them.
5. “Every time I pick up my baby, her shoulder/hip/arm joints pop! Is this normal?” – Yes. Growing joints mean popping joints. As long as your baby isn’t crying in pain, totally fine.
6. Toenails. Toenails. Toenails. Baby toenails are weird. Some have wings. Some are flat. Some are curved. I never knew I’d dedicate so much time to toenails in check-ups!
7. And finally… “Is his penis color normal??” – Baby penises are different from adult penises, including the color. Some are blue. Some brown. Purple, pink, orange. As long as your baby does not appear in pain and that color hasn’t changed recently or suddenly… just go with it.

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. 

Parents can help by making sure that children plan accordingly for testing days at school. Find out from your children and the school how they’re doing and the likelihood of not performing well on tests. This will help alleviate fears by pacing preparation for the tests, creating a plan to help kids succeed and encouraging them to problem-solve their worries.

Here are steps you can take to help your child during this stressful time:

1. Ask for help. If your child is especially anxious about test taking, set up a meeting with the teacher and school counselor to come up with a plan to ease fears on test day.
2. Go online and get sample items of practice tests from previous years and, if needed, practice with your children at home.
3. Practice deep breathing exercises at home. Then on test day, they will be able to put these practices into action.
4. Make sure your child gets plenty of rest. Studies have found that people who get eight hours of sleep before taking a math test are nearly three times more likely to figure out the problem than people who stay awake all night.
5. Control your children’s anxiety by making sure they are prepared. Focus on good study habits and the importance of not waiting until the last minute to cram before the test. There’s still time. Also, make sure your child has everything he or she needs going into the test. Even if it’s a new sharpened pencil. Make a check list the night before to avoid stress.
6. Stay away from entertainment as test time approaches. It’s not easy, but your child needs to study and not spend all night watching TV, looking at Facebook^® or being on the computer. You can wait on that until after the test.
7. Help your child keep mistakes in perspective. Everyone makes them and nobody is perfect. As you move closer to tests and studying, use wrong answers as a learning opportunity.
8. Eat right. Make sure your child has had enough sleep, exercise and healthy food. Avoid heavy food or desserts that may upset the stomach. Avoid  high sugar foods that may keep your child up all night and  make sure your child has a healthy breakfast (low-sugar cereal or oatmeal) the morning of the test.
9. Expect distractions. Let your child know someone in the class will have sniffles. Some kid will be banging his pencil on the desk. Someone may be humming. Those kids have their own stress. Just warn your child this is going to happen, but don’t let it be a bother.
10. After testing is completed, create ways to celebrate with your child. What you want to focus on in this celebration is the success of managing their stress, and not whether they passed or failed, which they won’t know for weeks.

In August of 2013, Joshlynn was diagnosed with Ewing’s Sarcoma, an aggressive bone cancer, occurring mainly in childhood and adolescence. Suddenly the 19-year-old single mom faced a whole new set of challenges.

“I was afraid my life was over,” she said. “I was afraid of what would happen to my daughter if I wasn't there. My little girl is my life. I thought, ‘Why me?’ Everything you could possibly think of went through my head. I had no idea how bad or what it was until we did tests and scans. I learned no matter what to be positive and you will make it.”

Joshlynn knew she wouldn’t go through her journey alone. In her home of Mineral Wells, Texas, she has her parents and four siblings. Although, they’ve been there for her, Joshlynn said her diagnosis placed a strain on everyone.

“At first it was really hard for everyone to accept that I had cancer,” she said “Everyone was afraid to talk about it or even ask questions because they didn't know how I would feel about it. But for me, talking about it helps me. And now my family, my closest friends and I are closer than ever and they really support me.”

While family and friends supported her, only those with similar experiences could truly understand Joshlynn. She struggled with the news of the cancer and mainly the impact it would have on her little girl.

“Being away from my daughter so much for treatment has been the toughest part,” she said. “Zoey is still young so she doesn’t quite understand why I'm gone all the time and it really hurts me. It’s hard when I’m home too because I’m sick and not able to do things by myself like I use to.”

Joshlynn found not only treatment for her cancer, but support from peers at Cook Children’s. She describes her physician, Karen Albritton, M.D., as “absolutely amazing.” Dr. Albritton is the medical director of the Adolescent and Young Adult (AYA) Program in the Hematology and Oncology Center at Cook Children’s.

“Dr. Albritton truly cares and understands all her patients,” Joshlynn said. “Cook Children’s is an amazing place. They gave me strength and courage to beat this. Everyone in the AYA program has helped me out so much. They have changed my life. It's really amazing to have people that know what you’re going through and understand you, when sometimes your family can't.”

For now, there’s one family member that doesn’t understand everything that Joshlynn’s going through and that’s just fine with her. Zoey will someday understand how her mommy battled cancer.

“It's really hard at times. Having cancer and doing treatments and being gone so much never gets easier,” Joshlynn said. “My daughter makes me want to fight and beat this even more. You have to keep a positive attitude, and know that no matter what, just believe in yourself.”

After all, that’s the attitude that makes fighters great.

We cannot give into fear. We need to be prepared. Know the signs. Have a plan.

Before the storms even start it is important that you have a plan for your family’s safety.

You need to pick a safe room in your home where your family can gather. The safest place is a basement or storm cellar but these are pretty rare in North Texas so you need to pick an interior space in your house on the bottom floor like a closet, bathroom or hallway where there are no windows. You want to put as many walls between you and the storm. The biggest source of injury in a tornado occur from being struck with flying debris so if you can pull a mattress into your shelter space or cover with heavy blankets or sleeping bags you will increase your protection. Contrary to popular belief you do not have to pick an area in the southwest corner of your house. Just pick the safest area in your house. Also you do not have to open or crack windows to equalize the pressure in your house. You are just increasing your risk of getting hit by flying debris.

If you live in a mobile home get out! People are 15 times more likely to die in a mobile home than any other location. Try to take shelter in a permanent structure if you can. As a last resort if you cannot find a permanent structure for shelter then go to a low lying area like a ditch and cover your head.

If you are at work, take shelter in an interior room, stairwell, or bathroom on the first floor and away from windows. Your office should have an inclement weather plan and remind employees of it twice a year.

If your child is at school they will be instructed to follow the school’s tornado plan. Schools will go on lockdown mode and move the children to the safest area possible. Follow your school’s tornado and inclement weather plan. It is the best way to ensure your child’s safety as well as your own. Your child has gone through numerous safety drills at school and knows to follow the schools plan. Reassure them that this is the safest thing to do. Remind your children to follow what their teachers have taught them. The best way to reassure your child is to help them understand the importance of following the direction of the adults who are caring for them.

If you are outside, try to find shelter in a permanent location. If you cannot find structural shelter get in a low lying area and cover your head with your hands and arms. Try to pick a spot away from trees and other potential projectiles.

If you are in your car and cannot get to a structural shelter, the American Red Cross recommends staying in your car. They recommend pulling off the road. Leave your seat belt on and crouch down away from the windows. Try to cover your face and head with a coat or blanket is possible. They do not recommend trying to take shelter under an overpass or bridge. Do not try to flee a tornado that is moving toward you. They also note if your car is near a low-lying ditch or culvert it may be safer to leave your vehicle and get to the lowest point possible. Always remember to cover your head with your hands and arms.

It is important to know the difference between a TORNADO WATCH and a TORNADO WARNING.

TORNADO WATCHThis means that the conditions are present that make a tornado possible over the next several hours. This does not mean a tornado is about to occur. It is a caution to be vigilant as you go through your day.

TORNADO WARNING

This means an actual tornado has been spotted or that meteorologists have picked up rotation on their Doppler radar. Your city’s safety alert siren will sound if a tornado warning is occurring. This is a sign to go to your safe area.

I highly recommend you get the American Red Cross app for your phone. This is a free app that will alert you if a TORNADO WARNING is occurring in your area. It also has excellent tips about tornado preparedness and the ability to set up a blast message you can send to friends and family to let them know that you are safe. It will send the message via email, Message, Twitter, and Facebook.

It is a good idea to create an emergency- preparedness kit. The American Red Cross recommends you include the following basics:

• Water – at least a 3-day supply. One gallon per person per day.
• Food – at least a 3 day supply of nonperishable easy to prepare food
• Flashlight with batteries
• Battery powered or hand crank radio
• First aid kit
• 7 day supply of all necessary medications
• Copies of personal documents
• Family and emergency contact information
• Extra set of clothing and study shoes
• Sanitation and personal hygiene items

You have a Plan.You know the signs. Be safe. Have Faith.

Sandra C. Peak, M.D.

Learn what you shouldn't do during a tornado here.

“Prom, graduation and end-of-the-school-year parties are exciting times for teens,” said Lisa Elliott, Ph.D., licensed psychologist and clinic manager with Cook Children’s Denton Behavioral Health. “Parents have a right to know their teen’s plans and to find out whether alcohol or drugs will play a part.”

Having discussions with your teen about drinking and sex can be difficult, so don’t wait until he or she is slipping into formal wear. Let your son or daughter know that safety and trust are very important to you and you want him or her to make smart decisions.

“As teens firm up their prom plans, parents should get a detailed itinerary of exactly where they’ll be throughout the night and get any emergency numbers they might need,” Elliott said. “This includes the numbers for adults in charge of after parties or post-prom activities. Parents and teens need to be informed, and the more informed you are, the better! Teens can create safe, happy, lasting memories just by opening up the dialogue and making smart plans."

Elliott suggests the following checklist to make sure your teen’s prom is memorable for all the right reasons:

1. Get those digits. This includes the numbers of a friend’s house or the after party at a local venue. Make sure you have any contact numbers and addresses you might need. Make sure the cell is charged up for the night.
2. Know the code. Let your teen know to call you at any time, especially if he or she is in an uncomfortable situation. Decide on a code word or phrase ahead of time so your teen won’t be embarrassed if he or she needs to call.
3. Offer street-smart tips. This could be the first “adult-like” event your teen attends without your presence. Talk about things that can happen – from getting a wallet or cell phone stolen to having a drug slipped in his or her drink – and discuss what to do if the teen makes a bad choice to drink or experiences a problem.
4. Play the name game. Know who your teen will be with. If your teen has a date, call his or her parents and talk about your children’s plans for the night so you will all be on the same page.
5. Take driving out of the equation. Many teens may want to drive themselves to the prom, but hiring a limo can be a great way to keep your teen from getting behind the wheel and make the prom more memorable. If your teen is going in a group, ask the other parents if they would be interested in splitting the cost. If your teen does drive, remind him or her to wear a seatbelt and to not get in a car with anyone who has been drinking.

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.

Step 1: Groundwork

This phase is really a pre-step. Ideally, it should happen prior to the merger. Both parents need to take the time to learn and understand their own parenting styles and preferences. Whether you take a quiz online or read a 300 page book, it doesn’t matter as long as you understand your style well enough to be able to talk to your partner about your style of parenting. It may also be helpful to plan an "observation" date where you can watch your partner interacting and parenting his (or her) child. Afterward (not in front of the child) you can ask questions of your partner and discuss your differences and similarities. Be careful not to openly challenge your partner’s style. This is an opportunity to learn about each other, not to criticize.

Another very important part of the self-discovery phase is to check for emotional baggage. Most blended families are the product of divorce or the death of a parent which often involves intense personal emotions. Be sure your parenting style is not going to be affected by guilt, anger or defensiveness. Many parents feel so guilty subjecting their children to the turmoil of divorce that they parent out of guilt and become more permissive. It’s a myth that children need a break from discipline and structure following an event like this. They often need more structure and will find comfort in the predictability of your consistent parenting.

Step 2: Rebuilding

Bringing two families together creates an opportunity to craft something new. You and your partner get to construct a new household. Depending on the age of your children, this may be the perfect time to make new rules and establish new consequences. Having regular family meetings is particularly helpful and gives parents an opportunity to lay out details of the new plan while fielding the "But why…." and "How come…." questions. Even with proper explanation and clarification, details of the new plan are likely to be challenged and tested in the days, weeks, or months following the merge. This leads us to the final and most challenging step.

Step 3: Settling

You planned ahead, you laid it out, and now it’s time to let it settle. Some parts will work like a charm and other parts will seem like a complete failure. This is part of the parenting process and isn’t unique to blended families. However, blended families often come with circumstances that may make the settling process a little rough. There may be joint custody arrangements with your ex-spouse which make it necessary to think through rules and consequences you set in your home. You can’t ground your child from video games if he is going to be able to go over to his mother’s house and have unlimited play time. It’s better to set consequences you know you can enforce.

Another significant issue that might arise during your well-planned settling phase involves your child’s emotional and behavioral reaction to the divorce. If your child displays uncharacteristic behaviors such as sleep difficulty, appetite changes, poor school performance or social withdrawal it may indicate the development of an adjustment disorder, depression or anxiety. If this is the case, you and your child may need a mental health professional to steer you through the settling process. These issues can’t be addressed through consistent parenting alone.

Following these three steps does not ensure a perfectly blended family. It does, however, ensure that you will have established a foundation of open communication, compromise and flexibility that will enable your new family to weather any storm.

The screaming-leg-hanger-on-er

I know there are parents who are terrified of how their child will do on their first day of school. They are picturing their children crying and hanging on to a leg shouting, “Mommy! Don’t leave me here!” My heart goes out to those families because that must be really difficult. It seems painful for the child and is probably the most painful on mom or dad who is attempting to pry themselves away. Then, they have to spend the whole day worrying if their child is OK or building a need for therapy from their mounting sense of abandonment.

Here are some tips:

1. This behavior might be demonstrating some separation anxiety Talk through the drop-off period and the day with your child until you are both sick of talking about it. One of the best methods for combatting anxiety is to be prepared.
2. If possible, send the parent who is less likely to cause this reaction early on. Sometimes it’s mom and sometimes it’s dad. If your child can make an easy break with one, but not the other, let that parent try to help during those early days until the child sees that school isn’t such a terrible place.
3. Make a quick break. Trying to coerce children to say they love you and give you 1,000 kisses only makes things worse. A quick goodbye and we’ll see you soon should suffice.

A quick note of support: Ultimately, you may do everything right and this may still happen to you. Try to remember that their behavior at this extremely stressful moment does not define your ability as a parent. Teachers are used to seeing this. Most of them probably see it every single year in a child or two.

The quiet, but compliant child

I would bet that many kids fall into this category. They aren’t exactly sure what to think about school. They are a little annoyed about their first day of school outfit and a little more annoyed about the fact that they had to take pictures wearing it, holding a sign that says “First Day of School.” (What’s Instagram mom?) They are not openly upset about you leaving them, but they may seem a little anxious.

Here are some tips:

1. They might appreciate it if you walk them into class the first few days and see what they have been up to for a minute or two.
2. Let them know what they are feeling is normal. “It’s OK to be afraid. But every day you go, it will get easier.”
3. This is another instance where a quick, clean break is good. After the child is settled in, say goodbye and leave. No need to make every drop off day sappy … just treat it like it is no big deal.

The “see you later, dad; or not. Whatever it’s cool” child

My child might fall into the previous category, but I have a pretty strong feeling he will fit here. He seems really excited about school and I hope that is actually the case on the day of. I plan to give him lots of latitude to change his mind that day because with 5 year olds, you never know what to expect.

For this child, these tips are more for mom and dad:

1. Keep it together yourself, if you can. Your big boy or girl is growing up and independent. That is actually the goal of parenting. No one wants their college age child to be holding onto their leg at the dorm so you can check that off your parenting accomplishment list.
2. Don’t take it personally. They still love you (for now) and still want you around (occasionally).

There are many more first day of school personalities that your child could show, these are just a sampling. The best advice I can give from hearing back to school stories for years is to be flexible. Come back next week to see if I can follow my own advice. I’ll try not to cry the first day he asks me to stay in the truck while he walks in …

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Carbon monoxide is known as the ‘silent killer’ because it’s an odorless, colorless, tasteless gas. The Texas Department of State Health Services says, “Several household sources, such as gasoline-powered tools and generators, produce carbon monoxide. Anything that burns can produce carbon monoxide. The fumes are extremely hazardous and can cause sudden illness or death.

Carbon monoxide is especially dangerous to infants, women who are pregnant and their unborn children, the elderly and people with heart or breathing problems.

The Centers for Disease Control and Prevention (the CDC) recommends taking the following steps to preventcarbon monoxide exposure:

• Do have your heating system, water heater and any other gas, oil, or coal burning appliances serviced by a qualified technician every year.
• Do install a battery-operated or battery back-up CO detector in your home and check or replace the battery when you change the time on your clocks each spring and fall. If the detector sounds leave your home immediately and call 911.
• Do seek prompt medical attention if you suspect CO poisoning and are feeling dizzy, light-headed, or nauseous.
• Don’t use a generator, charcoal grill, camp stove, or other gasoline or charcoal-burning device inside your home, basement, or garage or near a window.
• Don’t run a car or truck inside a garage attached to your house, even if you leave the door open.
• Don’t burn anything in a stove or fireplace that isn’t vented.
• Don’t heat your house with a gas oven.

I, and I’m sure many others who care for children, were excited by the news. It was with great interest that I read the news article and began to examine the story more closely. The news while exciting deals with a relatively small number and specific population of children.

The study examined obesity rates in pre-school children, age 2-4 years old whose families received WIC assistance (The Special Supplemental Nutrition Program for Women, Infants, and Children). Not all of the states submitted information. Of the 41 participating states, 18 states showed modest declines in the number of obese preschoolers from information collected from 2008-2011. The remainder of the 41 states showed no change or even increases in obesity rates.

The challenge is understanding what this information means and placing it in the proper perspective. Experts in the field of childhood obesity believe the positive numbers reflect changes in the WIC program beginning in 2008. The program was changed in an effort to increase fresh fruits and vegetable purchases as well as other health options such as whole grains and low fat foods. Additionally, encouragement of breastfeeding is thought to help contribute the improvements.

The news validates the central importance of healthy eating in weight management. I believe that fresh ingredients and home preparation of meals is a major key in overall health and weight management. I have slowly continued reading the book, Salt, Sugar, and Fat, and am increasingly convinced of this belief.

As discussed in the article, challenges remain. One in eight pre-schoolers remain obese. And unfortunately, the likelihood is high for these children that obesity will persist into adulthood.

For more information:

• Cook Children’s Endocrinology and Diabetes Program
• Obesity where we live
• The Center For Children’s Health
• Checkup Kitchen
• Overweight and Obesity
• Keeping Portions Under Control
• How Can Families Be Healthier?

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.

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.

Diagnosis through discussion

For a pediatric endocrinologist, getting a complete medical history of the child is the important first step in arriving at a diagnosis. Next, by asking basic questions such as:

• When did you first see signs of puberty?
• How rapidly are you seeing changes of puberty?
• What specific changes of puberty are you seeing?
• Is your child growing too fast?
• Does your child have any other health problems?

The answers provide important clues to any underlying causes of a child’s precocious puberty.

Children with a history of neurological symptoms such as headaches or changes in vision cause concern for puberty problems that may be coming from within the pituitary gland or brain. We’ll ask if the child has access to birth control pills, estrogen creams, or testosterone creams to see if hormone exposure is the culprit of a child’s precocious puberty.

We also look at diet and clues: Phytoestrogens (a compound found in plants that can mimic the effects of estrogen) eaten as part of a high soy diet may lead to premature breast development. Obesity from too many calories can lead to early pubic hair and body odor in some children.

Careful tracking of height and weight on a growth chart is the cornerstone in the physical assessment of precocious puberty. Seeing rapid or even subtle changes in growth patterns can indicate the need for immediate intervention.

A thorough skin examination sometimes reveals the tell-tale sign of Café au lait spots (shown above) that we know are linked to two conditions, Neurofibromatosis and McCune-Albright syndrome. Both of which can spur on precocious puberty.

Diagnostic testing

After taking the child’s medical history and physical exam, next comes medical testing that includes blood work, imaging studies, or other special medical procedures.

A bone age x-ray (example on right) is perhaps the most useful test in helping to evaluate the progression and severity of precocious puberty. The bone age study looks at the appearance of the growth plates in the hand to see if the bones have matured earlier than they should.

A measurement of hormone levels in the blood is used to help confirm early theories on the cause of early puberty as well as evaluate its severity. Hormones measured in testing could include any of the following:

Androgens – hormones made by the adrenal gland that cause pubic hair and body odor

1. Gonadotropins – hormones made by the pituitary that activate puberty
2. Thyroid hormone – thyroid hormone has a role in regulating puberty
3. Estrogen – the female hormone responsible for breast development
4. Testosterone – the male hormone responsible for pubic hair and body odor

Sometimes, specialized stimulation testing is needed to help further evaluate our suspicions. We order these tests when a child is in early onset of precocious puberty and blood hormone levels don’t show a definite pattern or in cases where all the information combined fails to give a clear enough picture. Stimulation tests involve more comprehensive blood work combined with IV medications to stimulate temporarily higher hormone levels. Stimulation testing can help in assessing adrenal function to rule out subtle forms of congenital adrenal hyperplasia as well.

Radiology scans such as an MRI of the adrenal glands or ultrasound of the pelvic area may be prescribed to determine the size of the adrenals, ovaries or testes. An MRI brain scan will indicate if the hypothalamus and pituitary gland are normal and often occurs at the end of the testing process when confirmation of a preliminary diagnosis is required.

Treatment

Once the source of puberty is identified, the options for treatment are then discussed. Sometimes not treating precocious puberty is an option. This happens mainly during cases of idiopathic central precocious puberty. After careful consideration of the risks and benefits, some families simply wish to allow nature to take its course and not intervene.

Today, we are fortunate to have medicines called GnRH (Gonadotropin-releasing hormone) agonists that are effective treatments for the majority of children. They work specifically to stop the progression of central precocious puberty by telling the pituitary gland to ignore the GnRH signal it is receiving from the hypothalamus and tells it to lower or stop the level of sex hormones it is releasing. This countermeasure will also stop bone maturation and help the child reach his or her anticipated adult height. These medications are given by monthly injection or by an implant under the skin.

Helping your child to cope

A diagnosis of precocious puberty and its imposing physical trauma can be emotionally unsettling for any child. The good news is that with the right treatment, both physically and emotionally, a youngster experiencing early puberty can enjoy a normal, happy childhood and grow into a well-adjusted adult.

No child likes to be viewed as ‘different’ than their friends, so it is important for every young person to understand that puberty is a normal process in life that everyone will experience—some earlier than others. As children develop self-esteem and behave according to how they are treated, pay close attention to your child’s interactions with others. If you sense or know that your child is being teased or bullied about the changes in his or her body that puberty has initiated, it’s important that you try to get him or her to talk to you or another trusted adult or medical professional who can offer sound advice on how to cope with what’s happening.

All children need to be taught how to care for their personal hygiene and with this condition, they may also need to change sizes in clothing more frequently. It’s also important to make other adults in your child’s life aware that they should treat your child according to his or her real age, no matter what age they may look like.

Previous articles:

Precocious Puberty (Part 1)

Precocius Puberty (Part 2)

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.