Norovirus is a highly contagious virus that typically occurs during the winter months (November to April).   

Cook Children’s Medical Center Fort Worth and Prosper has seen a 26% positivity rate of norovirus during the week of Feb. 22 to Feb. 28. Tarrant County Public Health maintains regular surveillance of norovirus. 

What parents should know about Norovirus: 

1. Norovirus can cause SEVERE vomiting and diarrhea. Treating children with fluids and monitoring for dehydration is critical. 

2. Norovirus is HIGHLY contagious by contact with another person with the virus, eating food that is contaminated or touching contaminated surfaces and putting your fingers in your mouth. Symptoms usually develop 1-2 days after you have been exposed. 

3. Prevent infection by washing food well, washing your hands with soap and water frequently and disinfecting contaminated surfaces. 

4. Monitor for the following signs of dehydration including: dry mouth or lips, decreased activity level or decreased urine. 

If you have had a child (or you have had) with norovirus, here is a cleaning plan to help “decontaminate” your house: 

• Wash your hands with soap and water frequently.
• Wear gloves for everything (diaper changes, cleaning and handling clothes).
• Clean all toys and surfaces with a bleach solution (5-10 tablespoons in 1 gallon of water).
• Wash laundry on the hottest, longest cycle available and machine dry. 

Related Stories: 

• What's going around: How to tell if it's strep, flu, rotavirus or norovirus
• Know When to Use Telemedicine, Urgent Care, or the ER for Kids 

However, Cook Children’s School-Based Virtual Health Program is helping school nurses and parents ease some of that chaos.

“I see the benefit for my own family,” said Erwin, an LVN, IBCLC, and virtual health nurse coordinator with Cook Children’s.

Nurses in the Celina Independent School District now join 14 other school districts in offering virtual health appointments, with no upfront cost, through the school nurse’s office. A parent or legal guardian must register and consent before the visit.

The virtual health services can help diagnose:

• Earaches
• Fevers
• Coughs and colds
• Skin rashes
• Minor skin infections
• Abrasions/cuts/scrapes
• Sore throats
• Flu-like symptoms
• Pink eye
• Head lice

Autumn Morris, an APRN CPNP-PC and a virtual health nurse practitioner, met with Celina ISD nurses to train them on the program before the school year. Each campus nurse is provided with a stethoscope and an otoscope to use during virtual visits to help with diagnoses. Each item plugs into a laptop, allowing Morris to see inside a child’s ear and listen to their heartbeat, for example. In addition, each campus nurse is trained and certified to administer a flu and strep test if needed during the visit.

“It’s nice because then we can get the results right there,” said Allycia Cundiff, Celina ISD lead nurse.

Cundiff looks forward to the partnership and the impact it will have on the community. Morris will be able to determine if a child needs to be sent home or if they can stay in class, helping reduce absences.

Erwin says program data shows 65% of visits are due to a sore throat.

“We meet you where you're at because a lot of times it's really hard to get off work when your kid is sick,” said Morris.

Parents can choose to attend the virtual visit. Following the appointment, Morris will contact parents with information about the visit and post-care instructions. If a child must be sent home, an excuse note is sent directly to the school. A copy of the visit is also provided to the child’s pediatrician. 

Erwin explains that the virtual appointment does not replace a child’s primary care pediatrician but is a collaborative effort. Morris says the line of communication with the pediatrician can help determine if a child may need to see a specialist. 

“We want them to have a primary care physician (PCP) placement, and if they don't have that, we work hard to find them one with Cook Children's,” said Erwin.

Once the visit is completed, Cook Children’s will bill the parent’s insurance provider.

A visit to the nurse’s office

“Kids like it, too, because they think the technology is cool,” said Erwin. “They get to come in, they get to see Autumn on the screen and they get to talk.”

Morris works with more than 100 schools, providing care to them. She and Erwin lead the training with all district nurses in the program.

“I want them to know that I'm not just the provider who's seeing that kid at that moment, but I'm a resource to them (nurses) so they can reach out to me if there are any issues or concerns,” said Morris.

The program has been in place for eight years. Morris describes the partnership as the school nurses being her "hands" as she diagnoses a child's illness. If additional testing or care is required, she is able to refer the child to a Cook Children's Urgent Care or Cook Children's Medical Center Prosper, just a short drive from Celina.

“We always say, you don't just get me, you get a giant hospital system attached to me,” said Morris. “We are passionate employees of the system but we are passionate parents who love our kids.”

It is that confidence and reassurance that makes Cundiff excited for the partnership, not just as a nurse but as a parent herself.

 “We have a lot of parents that work for the district and it is really hard to leave work, especially if you're a teacher,” explained Cundiff.

Anatomy of a visit

A typical visit can last anywhere from two minutes to five minutes. Children will present themselves at the school nurse’s office, and a nurse will determine if a virtual visit may be helpful. If so:

• A parent or legal guardian is contacted for consent.
• The nurse will request a visit with Morris.
• The campus nurse will collect vitals.
• Virtual visit begins

Celina ISD began school on August 13. Parents can register for the program online.

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

By Heather Duge

Valerie Shorten, BSN, RN, and her son, Marquis Shorten, are no strangers to overcoming obstacles. Each one has led them to where they are today.

Marquis faced a life-changing diagnosis at Cook Children’s in 2022 – the same hospital where his mother Valerie works. She was determined to become a nurse after her brother was killed.

“I always thought about what I could have done to help him had I been there,” Valerie said. “That’s when I knew nursing was my calling.”

Nursing Journey

In 2011, Valerie found out about an open position at Cook Children’s – a place she had visited a few years before when Marquis had a minor injury while playing with his brother.

“I remember how caring everyone was and thinking with three boys it was probably not the last time I would be there,” Valerie said.

After 15 months of working in Food Services, she applied for a secretary position in the Neonatal Intensive Care Unit (NICU). In May 2021, she graduated from nursing school and started as a nurse resident at Cook Children’s -- 10 years to the day of her first day in the cafeteria. She rotated through all the ICUs and the emergency department in one year. Now she is a nurse in the Cook Children’s NICU.

“I know that no one chooses to come into this hospital,” Valerie said. “You never know what a person is going through, so I make sure I always give the kind of treatment I would want for my child.”

Shocking Diagnosis

In April 2022, Valerie was in the middle of her nursing shift when she received a text from Marquis that read “My spine hurts.” She told him to take ibuprofen since she thought it could be related to his running.

“Marquis is a runner and was No. 1 in the district,” Valerie said. “He was slated to run in the regional meet to see if he would qualify for state. I thought the pain could be from a pulled muscle or running injury.”

Valerie told him to rest and let her know if it worsened. Eventually, Marquis drove himself to the ED at Cook Children’s and at that point could not feel his right leg.

“I met him at the ED but didn’t think it was anything too severe,” Valerie said.

An MRI revealed a spinal epidural hematoma, which is like a pooling of blood on the spine, and Marquis underwent emergency surgery. If too much time passed, Marquis could have become paralyzed.

“Everything was a blur and I remember being overly emotional as Marquis continued to lose the feeling in his legs,” Valerie said. “But I knew he was at the right place.”

Marquis was quickly wheeled to the operating room where Medical Director of Neuro-Trauma, and pediatric neurosurgeon Daniel Hansen, M.D., removed the large blood clot that was compressing the spinal cord.

Recovering Physically and Mentally

Valerie became anxious thinking about Marquis's mental state when he woke up and realized all he worked for was not going to happen that year at the regional track meet, if at all. 

“A nurse pulled his father, DeMario, and me aside and told me that when Marquis woke up, he asked when he would leave that day because he had a track meet in a few days,” Valerie said. “The real pain came when all the times were posted from the race he missed.”

Valerie and DeMario helped Marquis work through his emotions but did not let him stay down too long.

“I told him he could decide to lay there and be sad or decide what’s going to happen next,” Valerie said. “My life motto is that you are the writer of your story.”

Nurses realized how hard it was for Marquis to face the reality that he missed the regional meet and was not sure what running would look like in the future. During the 10-day stay in the Pediatric Intensive Care Unit, Marquis says the nurses went above and beyond to bring him comfort. On a particularly hard day, the café was out of Chick-fil-A milkshakes, so the nurses gathered all the supplies and made him one.

“They did everything I needed before I even asked for it,” Marquis said. “They fixed my pillows a certain way, brought me the Gatorade flavor I liked with a straw, broke up pills because I couldn’t move my neck to swallow and positioned my toes for me when I couldn’t move them.”

Back on Track

Valerie says everyone was surprised at how fast Marquis progressed. Throughout his healing journey, he used a brace, walker and wheelchair. After lots of hard work in physical therapy, he was cleared to jog four months after surgery and in January 2023 ran in his first race since surgery at Texas Tech University.

“My parents kept me going,” Marquis said. “My track coaches Jesse Heard and Sa’Donna Thornton also were there for me. Coach Heard gave me a love for track and all he instilled in me is a big reason why I treat everyone with kindness. He has sacrificed countless hours just to help me succeed. Coach Thornton played a huge part in helping me gain my confidence back and keep my positive outlook on the situation. I knew God had a plan and it would turn out OK.”

A Lifelong Dream Come True

Marquis says coming back from a major surgery has only made his passion for running stronger, and he wanted to prove to everyone he was just as good. He has accomplished that and more. When he graduated high school in May 2023, he received the Optimist Award. This fall, Marquis will attend Texas Christian University on a full-track scholarship – a goal he set for himself at only 10 years old.

“Marquis decided in fourth grade that he would one day attend TCU,” Valerie said. “Jokingly, I expressed how his father and I did not budget for TCU. At the time, our fourth grader looked at me on the car ride to school and said, ‘Don't worry, I'm going to get a scholarship.’ His dreams came true.”

“The most gratifying part of my job is seeing kids through their illness to the other side,” Dr. Hansen said. “For Marquis, that means a life that is everything he has always wanted.”

Before leaving your infant with a friend, grandparent, other relative or babysitter, it’s important to make sure the caregiver practices the basics of safe sleep. It might feel like an awkward or unnecessary topic to bring up with your mother or mother-in-law or favorite auntie who provides free babysitting. But not all caregivers are aware of the safe sleep practices backed by medical evidence, as they have been updated over the years.

At nighttime and every nap – whether at home or away, with parents or sitters -- the safest way for infants to sleep is: 

• on their backs
• alone (no co-sleeping)
• in a crib or bassinet with a firm and flat mattress
• without pillows, sheets, blankets, toys or other objects

More than 3,500 sleep-related infant deaths occur annually in the U.S., according to the Centers for Disease Control and Prevention. In 2022, 25 infants at Cook Children’s Medical Center in Fort Worth died from cardiac arrest, respiratory failure or other trauma due to unsafe sleep incidents that happened at their homes. A majority of those deaths involved co-sleeping with at least one parent or caregiver who awoke to find the child unresponsive.

So far in 2023, Cook Children’s has seen nine deaths due to unsafe sleep conditions, including co-sleeping with adults. Suffocation can occur if someone rolls onto the baby or if bedding covers the baby’s face.

Juan Cocjin, M.D., of Cook Children’s Neighborhood Clinic – Renaissance, said grandparents shouldn’t assume that it’s OK for babies to bed-share, even if that’s the norm the grandparents are used to or have done in the past.

It’s a sensitive topic because sleep customs get passed down in families from one generation to the next, Dr. Cocjin says.

Some of his patients are being raised by grandparents or even great-grandparents. He occasionally hears a caregiver say their baby shares a bed with others in the family. While these conversations can be tough, it’s important to break through misconceptions that co-sleeping is safe.

“I share with them the hazards of co-sleeping,” Dr. Cocjin said.

Creating a safe sleep environment for your baby takes consistent practice until it becomes automatic. Dr. Cocjin urges grandparents to seek out reputable sources of information and have an open mind about what the experts say. As he puts it: You can’t stick with unsafe habits hoping “maybe it’ll be OK.’’

Communication

Cook Children’s social worker Lorie Palacios, LMSW spreads the word in English and Spanish as a Safe Baby Sleep Council member, a coalition of partners including the Cook Children’s Center for Community Health. She shares safe sleep education at injury prevention at community events.

Palacios emphasizes the importance of sharing your safe sleep plan with everyone who cares for your baby. If mom and dad don’t live together, for instance, they should communicate about their baby’s sleeping arrangements in both residences. Ask if your baby’s caregivers have a crib or bassinet.  

“We want to make sure that conversation is happening,” she said. Transparency and communication are key.

Palacios pointed out that licensed day care facilities in Texas are required to follow protocols for safe sleep. That’s not the case when a friend or family member volunteers to watch your infant. And if a parent feels indebted to the babysitter, she said, they might worry that they’ll be seen as critical or questioning the sitter’s abilities if they speak up about safe sleep.

“If you’re dependent on a family member, especially a grandparent, that’s a very difficult conversation to have with someone you love and trust,” Palacios said.

When Palacios’ children were little, their grandmother kept them while Palacios worked. One day she found her 3-month-old daughter sleeping on the grandmother’s bed with a pillow and blanket.

“I had a playpen. I had a bassinet,” Palacios said. “All these things were available, but those were not the things that my mom used when she was raising her babies. To her, the bassinet felt awkward.”

Prior to that day, Palacios said she and her mom had only touched on the topic of safe sleep.

“The toughest thing is this idea that you’re questioning your elders,” she said. “I wasn’t really pushy because I wanted to maintain my respect.”

After that day, Palacios clearly and specifically told her mom her expectations for the baby’s sleep environment going forward. The words weren’t easy to say; but her mom respected Palacios’ wishes.

When you rely on a network of relatives or neighbors to help care for your baby, she said, you need to stand your ground on matters of safety. A caregiver might mean well but be misguided.

“It definitely takes a little more courage to find your voice when you’re part of a big village,” Palacios said. 

--------------------------------

More about safe sleep from Cook Children’s Checkup Newsroom:

• Safe Sleep Starts With Babies in Their Own Separate Sleep Area (checkupnewsroom.com)
• Safe Baby Sleep: Keep Decorating 'Extras,' Blankets Out of Infant Cribs (checkupnewsroom.com)
• Pediatrician's Advice: Straight Talk About Sleepless Nights (checkupnewsroom.com)

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

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.

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

Family-centered care is a pillar of Child Life Services and holds high value within our Cook Children’s system. We must consider each person in a patient’s family.  The idea of family systems theory is that when one person is affected by a circumstance, the whole family is affected. Everyone feels the experience in some way.

Recently, my family had the opportunity to receive services from an organization that serves patients and families with ongoing health care needs. This organization sends a box each month for a year to the patient, but they also include items for the patient’s parents and siblings. The first box we received had T-shirts for all of us with individualized cards and small gifts. My girls each received an envelope from this organization full of Valentines from lots of people.

This organization connected us with another organization that provides birthday cakes for patients and their siblings. Each of my daughters received the most stunning cakes donated by local bakeries for their recent birthdays. Both of these organizations encompass the true meaning of family-centered care, by caring for the whole family.  

Child Life Specialists focus their care not only on the patients that we serve each day but also on the other children in their families. It may be siblings, cousins, best friends, or others. Whoever may be impacted by the experience of the patient should also be cared for and receive services. Often, Child Life Specialists will provide the assessment, preparation, support, education and play for siblings and other children within a patient’s support system.

The emotional safety of the whole family matters. We want to consider where each person finds themselves during the current experience. Family dynamics, past medical experiences and traumatic experiences, the family’s beliefs and more help child life specialists provide the best services to each family member. While the patient may be coping very well with their current circumstance, it is possible that a sibling or parent is having a very difficult time and their needs may be different than that of the patient.

Years ago, my youngest daughter was admitted to the NICU following her birth. At the time I had a 2-year-old and a 4-year-old at home. My oldest was allowed to come up and visit, meet and hold her newest sister, but my middle daughter was too young for the visitor guidelines in the NICU. We did everything we could to make that time better for everyone. The girls would come to the hospital and eat meals with me while I stayed at the hospital. We frequented Build-A-Bear and made the most of the indoor and outdoor playground.

When one family member has a medical crisis, the rest of the family juggles to handle it all. My middle daughter really struggled because, at the time, she was almost fully potty-trained, but this time caused her to regress.  She was so ready to meet her sister and have her mom back at home. She melted down at every good-bye and every greeting. This is the perfect circumstance for Child Life Specialists to help create some bridges for the family. We took pictures and shared them with her and told her exactly what her sister was experiencing. She drew pictures for her baby sister and helped build her a bear at Build-A-Bear. Each thing that we did, helped us acknowledge that she was a part of this family unit even when we couldn’t all be together.

Supporting caregivers, parents and siblings

In addition to the patient, we want to provide preparation and support to the caregivers and siblings of each family as well. We want everyone to understand the steps and reasons for the medical care we are providing. When the patient is getting an IV, it is important for the sibling observing to also know what is happening and receive some preparation and support around this procedure. When a family member visits the ICU for the first time, it is helpful for child life to prepare them for what they will see and hear in the unit.

It is also important for caregivers and siblings to be educated about new diagnoses and understand at the same level as the patient. Child Life Specialists can provide medical play and education to siblings or close family of a patient. Child Life Specialists can include siblings in debriefings of traumatic experiences and often in bereavement situations while helping them process what they may be feeling and experiencing.

We also want to provide normalization to the family as a unit, such as utilizing volunteer services while a caregiver attends a sports function for a sibling. We also provide developmentally appropriate play for siblings while they are visiting to make sure that activities are available not only to patients but to their siblings and families as well.

At Cook Children’s, we strive to provide family-centered care in all areas of the medical center. From sibling support groups to camps to parent mentors. We also have several ways that we support families and siblings.

Family Centered Care programs and resources at Cook Children's

 Family Centered Care at Cook Children's provides many programs, including the Parent Mentor Program, the Family Resource Library and our Parents as Partners program.

Our parent mentor program provides visits and phone calls to inpatient parents and caregivers to offer support and fellowship. Our Parents as Partners program includes our Family Advisory Councils that you will find throughout the medical center in different areas and departments. Involved families can help guide and direct our initiatives utilizing their own experiences. Parent support groups are also returning post-COVID. Cook Children's also has a new initiative for self-care for families.

We also have a whole program for siblings called Sib2Sib created by Child Life Specialists. This program provides so many opportunities for siblings and they are currently working on creating a website just for siblings. We have resources that include a sibling tour of the hospital led by Brie and Steve, two of our facility dogs. We also have information available for developmentally-based sibling needs. There is also the upcoming opening of a Sibling Support Center dedicated solely to the siblings that we serve every day. For questions about sibling services, you can contact Sib2Sib at sibprogram@cookchildrens.org.

Child Life Specialists advocate and strive to ensure the emotional safety of the entire family unit. These experiences touch each person in some way, and it is important to acknowledge each individual’s needs as well as the needs of the family unit. Cook Children’s is dedicated to providing family-centered care in every situation.

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! ;)

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!

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! 

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.

Due to inflation, families across the country are facing higher costs for gas, energy, housing, groceries and other goods.

Teams and leaders who work across Cook Children’s Health Care System have seen the extra stress this has caused patient families. Cook Children’s has resources to assist parents and caregivers through these challenging economic times.

“Needing help is really common, especially due to the pandemic,” said Anu Partap, M.D., M.P.H., Physician Director of Health Equity at Cook Children's. “Lots of families needed extra help or support so that their children would be OK. Reaching out for help can last a lifetime.”

Between one-third to half of all parents in Texas have needed help with food, housing, or their own mental health over the last few years, Partap said.

The Center for Children’s Health, led by Cook Children’s, conducts a Community Health Needs Assessment to guide community programs and collaborations. The 2021 assessment includes surveys of parents, caregivers and community leaders in our service region of Denton, Hood, Johnson, Parker, Tarrant, Wise, Collin and Grayson counties. The assessment also includes focus groups, interviews and secondary research.

The most recent assessment, fully completed in April 2022, showed that food security, mental health care, preventive care, dental care and transportation were some of the major obstacles for many parents and caregivers.

“Parents and community leaders shared that much of that was from COVID-19 and now the ripple effect is inflation, which we’re all experiencing,” said Becki Hale, Assistant Vice President of The Center for Children’s Health, led by Cook Children’s. “Families have been struggling so much for so long because of COVID-19. Jobs were impacted and we had all of these issues. Now here’s the aftermath of all of that. It’s another wave of struggle. It’s definitely concerning.” 

In 2021, many children went without necessary care, including medical, dental or mental health care, according to the parent assessment.

“Affordable housing, food insecurity – these may impact a child’s ability to learn and ability to receive the health care they might need,” Hale said. 

Providing Programs and Community Outreach

The Center for Children’s Health has many programs and resources for community health outreach to children and families in our service area, including programs for oral health, injury prevention, asthma, mental health and adverse childhood experiences. 

The Build-a-Bridge program at the Center for Children’s Health aims to help communities in Fort Worth overcome barriers to health care. Build-a-Bridge community health workers said they have reached out to parents who are struggling as inflation ramps up the cost of living, especially for groceries. 

“So many people don’t have as much as they used to,” said Community Health Worker Clerbela Valcourt.

Dora Garcia, Program Coordinator for Child Wellness, commended local food pantries for continuing to serve people in need, especially as costs have risen.

“I think people are just spent from the pandemic, and they don’t even have a chance to catch their breath,” Garcia said. “We’re already starting at a negative due to the pandemic and the needs to be addressed. Inflation is keeping us where we’re at. We’re stuck, yet our community partners continue to be there for families as best they can.”

According to the 2021 assessment, 55,750 local children were living in households that “sometimes” or “often” could not afford enough to eat.

“Food insecurity was an issue before, but COVID exacerbated that,” Hale said. “Now with the rising cost of food, I think that will continue to be a major concern.”

Resources for parents and caregivers are available at 211 Texas; Tarrant Cares and TXT 4 Tarrant Cares. TXT 4 Tarrant Cares is a community texting service that makes it easier for local families to find the help they desperately need, close to home. Text the word FIND to 67629 to access a list of nearby organizations to contact and ZIP code-specific resources.

Rising gas prices have made it harder for families to take essential trips, whether it’s getting resources or taking children to an appointment.

“Diapers are expensive even when they’re not at an inflated cost, but then you add another cost of transportation to go to a diaper bank and then you have another barrier for access to basic needs,” said Dawn Hood-Patterson, Ph.D., program manager of Community Health and Adverse Childhood Experiences at the Center for Children’s Health.

Cook Children’s Case Management Social Work team provides resources for families on the inpatient floors, emergency department, on-campus Specialty Clinics, and Specialty Programs. Some resources may include access to meal assistance, transportation assistance and lodging assistance. Social workers have continued to see how rising inflation has impacted families of all income levels and they have adjusted some of their resource support to offset the additional financial stress families may experience.

Any family of a Cook Children’s patient is eligible for resources and assistance from a social worker.

“The nation is being impacted which may also affect some of our patients and families more than others,” said Karaya James, Social Work Manager at Cook Children’s. “It is OK to ask for help and our team is ready to have these important conversations with our Cook Children’s families. If we cannot meet the need with our resource support at Cook Children’s, we work to find a solution in the community to better meet the family’s needs.”

This year, James says she has noticed an increase in requests for Cook Children’s medication assistance program and travel assistance, including lodging and gas assistance.

Children with special health care needs or complex needs can be affected if a family is struggling financially. It could be harder for the parent to fulfill their needs, such as driving to appointments or providing a copay.

Supporting Parents and Caregivers

Dr. Partap says it’s important that families are open with their health care providers about how they are managing.

“When we hear that it’s going to be really hard for a family to participate in therapy or medication because of cost or distance or time, we can suggest or look for lower cost or sometimes free options,” Dr. Partap said. “It’s not easy at first, but it’s important for your child’s health.”

The 2021 assessment data show that most parents said that they are experiencing more stressors and are having a harder time coping.

According to the assessment, 57% of children ages 3-5 have a caregiver who would say they are coping “very well” with daily parenting demands, which is lower than the national percentage of 63%. The local rate in the eight-county service area is also lower compared to Texas benchmarks before and during the pandemic.

The assessment also showed that fewer parents have a source of emotional support. One out of seven children in the region has a caregiver who does not have a source of emotional support to help with parenting, an estimate of 171,000 children, according to the assessment.

Common sources of emotional support are other family members, close friends, spouses or domestic partners, places of worship, religious leader, health care provider or a support group.

“When hardships extend into basic needs, like we’re going to lose our home, or we’re not going to have as much to eat, families often feel embarrassed or shy or reluctant to reach out for help,” Dr. Partap said. “Asking for help is brave, strong and loving because then we’re in a position to listen for the sake of our patients.”

Dr. Partap says that during economic hardship, it’s important that parents and caregivers prioritize providing emotional support to their children.

“When things are tough, all kids really want to feel is that they’re connected with their families, they’re loved, they’re safe, they’re valued,” Dr. Partap said. “That is something we can do no matter what our financial situation is. It’s hard, but we have to remember to pause, breathe and then bring that sense of security to our children, even when we are feeling more stressed.”

One of the most important things a parent can do is to find help from friends, family, professionals and faith or church support, Dr. Partap said.

“No matter what the hardship is, it comes back to how do we as parents, families and the community create a buffer or layer of protection around children, no matter what is happening,” Dr. Partap said.  

Go here to view community resources from The Center for Children's Health, led by Cook Children's. 

While you’re having fun by the pool this summer, ensure your pool safety plan includes a Water Watcher: an adult who is designated to watch children around the pool at all times. Drowning is silent, so it’s vital to designate a Water Watcher when children are around all bodies of water - swimming pools, kiddie pools, lakes, or the beach. Kids can drown in just 2 inches of water.

Cook Children’s created a wearable Water Watcher tag to ensure that the adult wearing the tag is in charge of watching the children in or near water. Fifteen-minute shifts are recommended for the Water Watchers. During that time, the designated Water Watcher should have no distractions, this means no phone, magazines, books, eating, alcohol or conversing with friends. The only time a phone should be used is during an emergency to call 911. After 15 minutes, pass the tag to the next adult in charge.

Cook Children’s Medical Advisor for Digital Health, Diane Arnaout, M.D., explained the importance of having an assigned adult at all times, especially now that summer is in full swing and social gatherings are held around bodies of water.

“I have a pool myself and we love to have friends over," Dr. Arnaout said. “It’s so easy to talk yourself into thinking your children are being watched when you’re in a group of 12 people because six adults certainly seem like more than two adults watching the kids, so certainly it’s more secure. But the problem is it’s actually less secure.”

Dr. Arnaout also noted that it does not have to be the official Cook Children’s tag, yet the rules remain the same. People can use a rubber band, bracelet or a hair tie as a substitute.

“By using the Water Watcher tags, it basically says the wearer of this does not play on their phone, does not drink, does not talk to other friends at the time - their sole job is to watch children at all times,” Dr. Arnaout said. 

Water Watchers add an extra layer of protection to prevent children from drowning. Swimming lessons are just one layer of protection and do not guarantee safety. Even strong swimmers can drown, so always designate a Water Watcher.

Other extra layers of protection include maintaining barriers to and around the pool, keeping pools clear of toys attractive to little ones when not in use, having a designated water watcher and wearing a life jacket.

A Water Watcher tag can be found in many of Cook Children’s pediatrician offices. Call your pediatrician to get one to use next time you're at the pool. You can also reach out to the Lifeguard Your Child department and one will be mailed.

When wearing the Water Watcher tag, you have one job and one job only - Lifeguard Your Child. 

To get a Water Watcher tag of your own, send an email to safe.kids@cookchildrens.org or follow this link: Water Safety Product Order (jotform.com)

The Centers for Disease Control and Prevention has identified and received reports of a cluster of pediatric cases of significant liver injury with positive adenovirus infection since November 2021. The CDC says the cause of hepatitis (inflammation of the liver) impacting the children is not known.

There have been 246 children who are under 10 years old with hepatitis cases of unknown origin included in the CDC's investigation since Oct. 1, 2021. It's not unusual for the cause of hepatitis in children to remain unknown; some estimates suggest 30-50% of all hepatitis cases in children are from unknown causes, the CDC says.

A possible association between these pediatric hepatitis cases and adenovirus infection is currently under investigation. Lab tests showed “adenovirus type 41” infection in several of the cases under investigation. Adenovirus type 41 is primarily spread via the fecal-oral route and predominantly affects the gut, the CDC says. It is a common cause of pediatric acute gastroenteritis typically with diarrhea, vomiting and fever, often accompanied by respiratory symptoms.

There have been no reported deaths since February 2022, and the proportion of patients requiring liver transplants has gone down from 15% to 9% since May 5, the CDC said on May 18.

So what does this news mean for your child? Nicholas Rister, M.D., of the Cook Children's Infectious Disease team shares what parents and caregivers need to know.

It’s important to note that severe hepatitis in children remains rare. However, we encourage parents and caregivers to be aware of the symptoms of hepatitis – particularly jaundice, which is a yellowing of the skin or eyes – and to contact their child’s pediatrician with any concerns.

How concerned should I be as a parent about this cluster of hepatitis cases? Why do some patients need transplants?

These cases remain rare despite adenovirus infection being very common. This is reassuring that the vast majority of children are likely to have no issues. However, in these rare cases, the inflammation in the liver is so severe that the liver is unable to recover and requires a transplant. This is somewhat remarkable since healthy children typically possess a large capacity for their liver to recover on its own after injury.

How is hepatitis spread?

The cause of hepatitis determines how it is spread. Damage to the liver from toxins (alcohol or drugs) or autoimmune disease does not spread between people. Infectious hepatitis depends on the type of infection. Hepatitis A and E are spread through body fluids and contaminated foods/surfaces. Hepatitis B, C, and D are spread through blood (injection drug use) and rarely through sexual contact.

However, most viruses, including adenovirus, can cause some degree of hepatitis and are spread through combinations of close contact and respiratory routes. Adenovirus is typically spread through respiratory droplets and/or contact with bodily fluids.

What are hepatitis A, B, C, D and E? Which is related to this outbreak?

Hepatitis A-E are grouped together because they all primarily cause liver issues but are very different infections otherwise. Hepatitis A is a diarrheal illness. Hepatitis B and C are chronic infections that often go unnoticed for decades following IV drug use (or due to blood transfusions in the past although we screen blood supply now) but eventually lead to liver failure and cancer. Hepatitis D and E are less a consideration in the general population. Hepatitis D can cause problems for folks if they are already infected with other types of hepatitis and hepatitis E is a cause of bad liver disease in pregnant women.

What is adenovirus?

Adenovirus is a common viral cause of febrile illness in children. Many different types lead to different diseases that are all common in children. These include conjunctivitis (pink eye), upper and lower respiratory infections, and diarrhea. The vast majority of adenovirus types have not been linked to this hepatitis outbreak and most children with adenovirus type 41 do not develop severe hepatitis. However, the infection remains suspected and is being investigated in these rare cases.

What can my family do to protect ourselves?

Hepatitis A and B have vaccines that are given to all children as part of the routine vaccine series.

Otherwise, let your pediatrician know immediately if you note yellowing of the eyes or skin consistent with jaundice which can be an early warning sign of liver disease.

Continue healthy habits like hand hygiene, covering coughs and avoiding people who are sick.

What is jaundice?

Jaundice is a buildup of bilirubin in the soft tissues of the skin/eyes. Bilirubin is secreted by your liver into your intestines as a part of bile normally. When the liver is sick, bilirubin can build up in the blood and soft tissues leading to discoloration.

Watch for symptoms of liver inflammation:

• jaundice (yellowing of the skin)
• fever
• fatigue
• loss of appetite
• nausea
• vomiting
• abdominal pain
• dark urine
• light-colored stools (poop)
• joint pain

Keep your child up to date on all their vaccinations.

Help your family prevent disease:

• wash hands often
• avoid people who are sick
• cover coughs and sneezes
• avoid touching the eyes, nose, or mouth

The rising number of COVID-19 cases in North Texas is due to the delta variant, which is more contagious than other strains of COVID-19, and a significant number of unvaccinated people. With Texas doing away with virtual learning this school year and the COVID-19 vaccine not yet available for those under 12, many parents and children are understandably feeling anxious.

Amanda Jordan, Psy.D., a licensed psychologist at Cook Children’s Alliance, can relate. She has a child starting kindergarten in the fall and is experiencing similar feelings.

“I want parents to understand you can’t take care of others if you don’t take care of yourself first,” Dr. Jordan said. “You have to check in with yourself first to see how you’re feeling because you don’t want your children to pick up on your negative energy.”

As for parents, Dr. Jordan says it is important to engage with other parents, make sure to create and maintain their own schedule, talk with their partner/spouse and seek professional help when necessary.

Dr. Jordan says once parents have worked through their anxiety, it is good to start preparing children for their ‘new normal’ as early as possible. She says it’s important to pose open-ended questions such as, “I wonder what your first day will be like?” or “I wonder who your teacher will be this year?” These types of questions allow your child to open up about how they’re feeling and can lead to other questions or concerns they may have.

Dr. Jordan also stresses the importance of establishing a routine as school beings again because many children have been off of their schedule for more than a year. This routine includes bedtimes, meal times, changing eating habits, etc.

“There has been so much flexibility with virtual learning,” Dr. Jordan said. “Children have been going to bed and waking up later than normal, and could do their work at their own pace.”

She says starting a ‘school year’ routine before school officially starts can help ease some of the anxiety on the parents and children.

Another technique Dr. Jordan recommends to parents is called ‘Name it to tame it.’

“It is important to help children put a name on their feelings,” she said. “As parents, we want to fix things and say things like ‘don’t be scared’ or ‘you’re going to be fine,’ but you must validate their feelings.”

Dr. Jordan says to respond to children by validating their feelings and letting them know you understand how they feel and let them know they always have a safe space to express their feelings.

Along with the anxiety of returning to school, medical professionals at Cook Children’s are also getting questions about children wearing masks in the classrooms. Alice Phillips, M.D., a Cook Children’s pediatrician at Cook Children’s Cityview says she stands behind the recent recommendations from the American Association of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), that all children K-12 should wear masks in classrooms this school year.

“I believe children need to be in school for their social skills, mental health, and other key personal connections,” Dr. Phillips said. “I recognize it’s a hot topic, but for students to stay in school without shutdowns or quarantines, we must do it safely.”

Dr. Phillips says the new delta variant is spreading rapidly in our unvaccinated population. At Cook Children’s we have seen a rise in the number of children testing positive for COVID as well as an increase in the number of children being hospitalized. For this reason, she believes it is even more important to make sure all children have masks on in the classroom, no matter their vaccination status.

“Parents have to begin modeling mask-wearing behavior at home, and support their children if they feel pressured to do otherwise by their peers,” Dr. Phillips said.

To prepare children to wear masks in the classroom, she says it’s important to explain to children the reality of doing ‘hard things,’  for our friends and communities. Equally important is providing encouragement to children when they're doing the right thing.

“I understand that it’s hard to be brave sometimes,” Dr. Phillips said. “The best we can do is encourage, support, and validate children’s feelings and let them know the ‘why’ behind masking and the importance of keeping themselves and others safe.”

Dr. Phillips says her advice to all adults is to get vaccinated and be an example. She advises all adults to wear a mask when they are in the grocery store and other public settings as recommended by the current CDC guidelines, 

“If parents are vaccinated and their children are not, I still advise the entire family to mask up to support the child and protect them,” she said.

If you have any questions about preparing for your children to head back to the classroom or need guidance for masking, contact your child’s pediatrician.

Read more about preparing for the upcoming school year here:

Cook Children's 10-Point Guide for Safely Reopening Schools

Should My Child Wear a Mask to School this Fall? 

But I hear from my patient families all the time that it's anything but relaxing.

The American Academy of Pediatrics recommends doctors ask parents three questions about mealtime:

1. How anxious are you about your child’s eating?

2. How would you describe what happens during mealtime?

3. What do you do when your child won’t eat?

When offered a healthy, well balanced meal with fresh fruits, vegetables, and lean proteins, kids will stop eating when they are full. Children will naturally refuse to eat when they are not hungry. We often describe these as normal appetite slumps. We can disturb children’s natural satiety cues by either forcing them to eat or by offering foods high in added sugar or salt when they won’t eat. This results in a child who will “only eat chicken nuggets.”

Parents are most successful in feeding their children more fruits and vegetables when they model healthy eating, set appropriate limits, and have a positive attitude at mealtime. “The parent determines where, when, and what the child is fed; the child determines what to eat.” ⁽¹⁾ In other words, “parents provide and kids decide”. ⁽²⁾ 

Here are some tips on eating mindfully and encouraging your kids to eat in a manner that gives them more energy and helps them avoid chronic disease. These are easy ways to change your lifestyle that don’t involve a ton of work and expensive supplements.

1.Drink more water. Kids should not drink juice or soda except on special occasions.

2.Drink milk with meals. Children from age 1-2 should be on whole milk. After the age of 2, low fat or skim milk is recommended.

3.Vitamin supplements are not needed unless your child does not drink milk. Vitamin D is essential for bone health and immune function and may play a role in prevention of chronic disease.

4.Serve 5-9 servings of fruits and vegetables daily. Encourage your children to at least take a bite of everything you serve. Remember that children will need to taste a food 10-15 times before they decide they like it. Lean protein like fish and baked chicken might be better accepted if you add ketchup as a condiment.

5.Add healthy protein likes nuts (for older children) and legumes. Peanut butter is fine for younger children and new allergy immunology guidelines suggest that early introduction of peanut may actually decrease the risk of peanut allergy.

6.Eat more meals at home. Keep staples such as eggs, whole grain pasta, pasta sauce, yogurt, carrots, frozen vegetables, chicken breasts, and fruit stocked at all times so that in a pinch you could throw together a simple meal.

7.Double your recipes and freeze 1 meal at the same time that you cook the other meal. This will save you from making a trip to a fast food restaurant when you have that go to meal in your freezer.

8.Serve only whole grain breads and pastas.

9.Avoid buying, eating, or serving processed foods (chips, cookies, cakes).

10.Avoid fried foods and fast foods.

To read more about nutrition needs of children at different ages, I highly recommend the book “Nutrition: What Every Parent Needs to Know" available on the American Academy of Pediatrics (AAP) online bookstore.

See choosemyplate.gov for more information about how your child’s plate should look at meal time.

Realize that children’s tastes will change over time. They will sometimes refuse foods they readily accepted in the past, and they will readily accept foods that they refused in the past. Involve your children in shopping and meal planning. Let them help in the kitchen! Take them to a local farmer’s market and let them choose something new for everyone to try.

Take a matter of fact and pleasant approach to meal times and ENJOY YOUR FAMILY! Create wonderful childhood memories.

References:

1. “A Practical Approach to Classifying and Managing Feeding Difficulties” Pediatrics Volume 135, number 2, February 2015

2.Nutrition: What Every Parent Needs to Know. AAP

Maybe not and that’s OK, at least for your baby. You, on the other hand, may need some rest.

Let's start with your baby. Does their lack of sleep pose any risk to their health or development?

A recent study in Pediatrics looked at the percentage of babies who were sleeping through the night (6 to 8 hours of uninterrupted sleep). The study went on to further explore the relationship between sleeping through the night and future development.

The bad news

At 6 months, about 4 out of 10 babies are still not sleeping 6 consecutive, uninterrupted hours. At 12 months, it’s still close to 3 out of 10 babies that are not sleeping 6 straight hours.

If you change the definition of “sleeping through the night” to 8 hours, the numbers get even worse.

So, if you have a newborn or you’re expecting soon…prepare yourself for the possibility that you won’t be getting a great night’s sleep for a while.

The good news

The study also didn't find an association between maternal mood and baby’s sleep.

This contradicts two potential misconceptions about sleep and a mother’s moods:

1. Mom’s mood can be affected by lack of sleep. While this might be true for an individual mom, the study did not show it across the study population.
2. Mom’s mood could be affecting the baby’s ability to sleep.

The best news

One of the major concerns about babies who don’t sleep well has been whether it has any effect on their development. Results showed that the lack of sleeping through the night had no effect on their later mental development. So, while it may be frustrating and exhausting, at least you don’t have to worry about negative effects in development later in life.

But what about you?

So if your baby isn't sleeping through the night, how are you doing? You're already exhausted from taking care of your newborn, now you just want to get some rest. Here are 5 tips that might help you when your baby isn’t sleeping through the night:

1. Do your best to rest or sleep when your baby is sleeping during the day. Sometimes this isn’t possible because of older siblings or housework, but it saves a lot of frustration during those long nights when you can.
2. Don’t rescue your baby at the first stirring. Give them a second to calm themselves down. They might just surprise you.
3. After your baby is established in their growth, you don’t have to feed them for every nighttime awakening.
4. Get help. If it’s a partner, grandparent or friend-having a one night break from getting up can seem like a life saver for an exhausted parent.
5. Turn off your monitor, if your baby is close enough for you to hear if they get really upset. Having the monitor turned off (or at least down), so that you don’t wake up to their every stirring can also help you get a better night’s sleep ... even if they aren’t sleeping through the night.

How do I know parents shame themselves?

First, I know that parents shame themselves because I AM a parent, and I do it. For example, in the spirit of full confession I will tell you that—once when my son was a toddler— we went to a playdate at a pebble-layered park during which I completely failed to notice his slipping a little handful or two of said pebbles into his mouth. I thought I might’ve seen him sneak something stealthily into his mouth, but I convinced myself otherwise (clean tongue, no dirt on his face). Two hours later at home, he awoke crying from a nap and vomited a pile of pebbles. “I burped, Mommy,” he said, pointing to that which he ejected. Guilt for allowing him to ingest choke hazards followed. “Bad Mommy,” I told myself. Another time, I got confused about the date and time of a much anticipated birthday party. We rang a family’s doorbell with gift in hand only to be told the party had been the prior week. Quiet tear-fall on my daughter’s cheeks ensued. “Bad Mom,” I told myself. These are just two examples, but you get the drift, right?

Second, I know that parents shame themselves because, well, I’ve got this gig as a pediatrician. In this line of work—in which I am fortunate enough to be privy to many joys and happy events among my patient families— not a day goes by that I don’t also see and hear parents judge themselves as “unworthy.” I often see tearful new parents in the midst of extreme sleep deprivation with their wailing and yellowing jaundiced neonates put to breasts that aren’t yet fully cooperating with the nursing plan. “Bad Mommy,” the moms tell themselves, for not satisfying their babies at the breast. “Bad Daddy,” the dads tell themselves, for not being able to better comfort and support their wives and new baby. I have seen many parents fret when I have diagnosed their baby with an ear infection after a rough night of letting their little one “cry it out” in sleep-training. “What bad parents, not going to our crying baby in a time of need,” they tell themselves. Parents have come to me after hearing from a teacher that something was less than great about their child’s performance. They have often internalized this problem or flaw as something they might have prevented “if only we were better parents.”

Honestly, I’ve seen parents— I’m talking about wonderful and oh-so-very well-meaning people— stack everything their child does less-well or more slowly or less confidently or less joyfully than others onto their own backs as their burden to bear in self-flagellation. And self-flagellation doesn’t feel good! The time has come, my friends, for us to stop this abuse of self. Together let’s take steps toward self-preservation, realism, self-acceptance, and love.

Step One: Silence the Self-Critic

Amy Poehler, the awesome one of SNL and Parks and Rec, has a chapter in her book Yes, Please called “plain girl vs the demon” in which she refers to the voice in each of us that “talks badly to us.” She writes that the demon might say to one’s self, “I am too fat or too skinny or too tall or too wide or my legs are too stupid and my face is too smiley or my teeth are dumb and my nose is serious and my stomach is being so lame.” And, on the flip side, another critical voice may then retort (to itself, yourself), “I am so ungrateful— I have arms and legs and I can walk and I have strong nail beds and I am alive and I am so selfish and I have to read Man’s Search for Meaning again and call my parents and volunteer more and reduce my carbon footprint and why am I such a self-obsessed ugly [bleep].”

This is the same self-critic I am suggesting we silence. It is the very one that tells us we are not the model parent we had hoped to be. It says, “You stink, you enabler of pebble-eating, failure-at-exclusive breastfeeding, and non-responder to ear pain— you are a Bad Parent!” In the name of self-preservation and positivity, we must kick this nasty voice out of our consciousness—STAT! Plug your ears and say, “Lalalala,” because the inner demon is a bully.

In addition, our inner demons often talk crazy — that is, their comments aren’t grounded in reality. By way of illustration, imagine I am looking at myself in the mirror after donning my best fancy attire with grooming and make-up quite beyond my usual jeans and T-shirt, around-the-house look. I just might look at myself and think— “Hey, I like this dress— it’s nice to get dolled up sometimes, and I like the way I look today.”

But what would happen if instead an inner crazy-talking voice then pointing out to me that “Nope, Supermodel ___(blank)____(insert the name of your supermodel of choice) would look a lot better in this dress— you actually look bad.” If I listened to that voice, I might feel pretty deflated, as —let’s face it—it is true that any supermodel would look better than I in any dress. My point, however, is that I should not listen to that voice, as why would I compare myself to a supermodel anyway? And even supermodels say that their Perfect 10 appearance in pictures is not their “real” look and is much helped by Photoshop and make-up artists and the like.

The point is that the self-critic is a bully who encourages unhealthy comparison to unreachable ideals. And this brings me to the next step.

Step Two: Recognize and Reject UnREALISTIC Expectations

These days, we parents often burden ourselves with unrealistic expectations for how we will rear our children. Parent and parenting author/blogger Bunmi Laditan summarizes things well and humorously:

“How to be a parent in 2020: Make sure your children’s academic, emotional, psychological, mental, spiritual, physical, nutritional, and social needs are met while being careful not to over stimulate, under stimulate, improperly medicate, helicopter, or neglect them in a screen-free, processed foods-free, GMO-free, negative energy-free, plastic-free, body positive, socially conscious, egalitarian but also authoritative, nurturing but fostering of independence, gentle but not overly permissive, pesticide-free two-story, multilingual home, preferably in a cul-de-sac with a backyard and 1.5 siblings spaced at least two years apart for proper development, and don’t forget the coconut oil.

How to be a parent in literally every generation before ours: “Feed them sometimes.”

Many of us lucky enough to have had supportive and loving parents strive to be like them. However, in many cases societal expectations (safety seats, seatbelts, no smoking, etc) and also our own expectations complicate the mix. Perhaps we have added two parent full-time jobs with ambitious goals for promotion to our list. Perhaps we have added travel, dietary limitations, or exercise ambitions to the day. Perhaps we don’t live close to other family members and have to go at it alone or with the help of nannies and baby-sitters. We have a lot on our plate—too much, if we don’t also throw in some forgiveness and self-acceptance.

Alas, we are only human, and there are only 24 hours in a day. We will not be able to do it all. We all make mistakes.We hope to recognize them. With a positive growth-perspective, we can plan to manage things differently next time, but we will be sometimes misguided and imperfect people even then. And that’s okay. We are great even in the striving. We wear the clothes well, even if not like a supermodel might.

STEP THREE: RECOGNIZE THAT WE ARE ALL SPECIAL, FLAWS AND ALL

In the words of the inimitable Mr. Rogers, “Whether we’re a preschooler or a young teen, a graduating senior or a retired person, we human beings all want to know that we’re acceptable, that our being alive somehow makes a difference in the lives of others.” Working through the steps of this blog, we hopefully have moved away from shaming ourselves and from listening to a cruel inner critic to instead accepting our own humanity. Now we should move beyond self acceptance to a point of appreciation. Let us even embrace some of our limitations and imperfections.

When I was younger, Christmases in our family were great, complete with baking cookies, singing carols, playing games together, and enjoying Christmas movies. One area in which my child-self felt we might improve, however, had to do with decorations and the spectacle of it all. I had some friends whose families really went “all out” in that area—they had amazing decorations and lights inside and outside their homes, beautifully wrapped gifts topped with bells and elaborate bows, and Christmas morning resplendence as in the opening scene of The Nutcracker Ballet.

One day I asked my mom why we didn’t do more of that. “Daphne, I have our family to tend to, a full-time job, and even night classes—the choice is between my using my scarce free time to decorate our home and fancily wrap gifts or my spending that time enjoying the season with you and our family.” She went on, “I thought it would be best to cherish the time together— don’t you agree?” I really did agree. My mom showed me that— within the limits of our situation—she chose us. This was a wonderful lesson of love that sprung directly from human limitation, and I love and thank her for it.

As for my dad, according to what some parenting books say, my dad was a little too loud, yelled a little too much, and wasn’t measured enough in his reactions to the world around him to fit the bill for their “no-scream” and always- calm parenting principles. He was emotional and ever expressive—(mostly in love and joy, but on occasion in frustration or anger )—a true “spicy Italian,” as my own husband referred to him. We always knew where he stood on any given issue.

Though yell he would, if for example the cat pooped on the white carpet or my sister and I misbehaved or talked back, the other side of his honest expression of emotion was that he was the loudest and biggest declarer of love I have ever known. His voice carried so far that— in any piano recital or dance recital or school awards program or anything— I could always hear my dad’s voice above the others, shouting proudly, “Brava, Daphne!” It wasn’t the volume of his voice, though, that made him so special— it was his passion, eloquence, and most importantly his sincerity. Not just at weddings or parties but also very often in our day to day life, he opened his heart to us. I grew up hearing him express how much he loved me, my sister and my mom, how great he thought we were even in our differences, and how lucky he felt to have us. So actually, the expresssiveness some parenting gurus might call his “imperfection” was just the other side of what made him so incredibly special as a father, the best of fathers, truly.

So no more self-shaming! We are important to our children, even with our constraints and our shortcomings. We strive to show them how special they are, but it is important to turn that support and appreciation inward as well. We are unique, and we make a positive difference.

Let us finish with a boost from Mr. Rogers, a voice truly opposite to that of our harsh self-critics. “You’ve made this day a special day, by just your being you,” he always said at the end of his shows, “There’s no person in the world like you, and I like you just the way you are.”

No, these parents didn’t go out on the town for an intimate night together. Instead, they walked downstairs to a quiet room, tucked inside Cook Children’s Medical Center.

At the end of the movie, they will return to reality and the continuous beeping of monitors in their child’s hospital room.

“We wanted to do something that would give parents a sense of normalcy,” said Kristi Rico, Family Programs Specialist at Cook Children’s. “We have a lot of families who are here for months. Often, they don’t want to leave their child, so we created ‘Parent Date Night’ as a way to help them relax and reconnect without having to leave the hospital.”

Parent Date Night isn’t just dinner and a movie. Developed in the summer of 2016, it’s an evening meticulously planned by Rico and the Nutrition and Food Services team at Cook Children’s. First, Rico comes up with a theme and then hospital chefs develop a menu around it.

“We’ve made steak and eggs to pair with Breakfast at Tiffany’s and chicken piccata with angel hair for Roman Holiday,” said JoAnn Williams, Executive Chef/Senior Manager of Food and Nutrition Services at Cook Children’s.

Each meal begins with a salad and ends with a dessert, like tiramisu or cheesecake. To the surprise of many, all of the food is made in-house with parents in mind.

“We try to make it really elegant because these parents have missed so many meals and so much time together,” said Williams. “We want it to be something they will remember.”

Some of the first Parent Date Night events were attended by Stephanie and Reggie Campbell. The couple spent four months in the Neonatal Intensive Care Unit (NICU) last year with their newly adopted son, Owens. He was just 4 days old when they arrived after traveling all the way from their home in Lancaster, South Carolina.

“Being in the NICU is really stressful, so knowing that you could get out of the hospital room and escape the beeps and noises for a little bit helped,” said Stephanie. “It also helped to be able to meet other parents going through similar things and know that if you were needed, you were just downstairs.”

“It’s important for parents to be able to meet and talk to one another,” said Rico. “They’re all here because they have a child who is not well. We want them to be able to share their experiences, if they choose.”

For the Campbell family, having the opportunity to connect with other parents has had a long lasting impact. While they are now back home in South Carolina with their happy 10-month-old son, they still keep up with the friends they made at Cook Children’s.

“Some families don’t want to break away from their children, but that’s unfortunate because you really need to,” said Stephanie. “Being in the hospital will wear you down if you don’t step away every now and then.”

Planning and gear is necessary when setting off for a day of water fun, but for kids with diabetes it can sometimes feel like an Everest expedition. Their checklist can include any or all of the items below:

●Blood glucose meter

●Supplies to check blood sugar

●A cooler or ice packs to keep insulin cool

●Insulin

●Insulin injection supplies

●Insulin pump supplies

●Snacks for low blood sugars

Children and their families with Type 1 diabetes deal with additional risks on top of the typical worries that all families deal with. Some diabetes specific risks include:

●Low blood sugar

●Dehydration

●High blood sugars

●Ketones

The wisdom and experience of a parent of a child with Type 1 diabetes adds more practical value. I discovered this article on swimming with Type 1 diabetes.

I reached out via Twitter to the mom and author of the article. As the mother of two girls with Type 1 diabetes, she had a lot of good, practical advice, which I endorse and would give to my own patients.

I know it helps to here from other moms. Here are some of the thoughts and tips that she shared about her now older girls.

Importance of swim lessons

My girls passed all of their swim lessons and have reached the level that will safely take them into adulthood ... I still tend to hold the book and scan the water until both are safely drying off on my blanket. Once a mom, well, always a mom.

“Managing” blood sugars

Despite this natural maturity and necessary growth, our family is still cautious with Type 1 diabetes and swimming. We know that blood sugar management during exercise can be tricky on a good day, let alone, on a day of intense swimming, where every single muscle is engaged and active.

Here is a list of strategies that we use to help keep teenager independence while staying healthy with Type 1 diabetes.

1.Check blood sugar before you go into the water.

2.Blood sugar MUST be above 100 mg/dl.

3.If not, BEFORE swimming, eat a small protein and carb snack and do not bolus. Our girls like re-sealable chocolate milk jugs, cheese and crackers or small peanut butter and jelly sandwiches.

4.Swim with a buddy and never alone.

5.Every hour, get out of the water and check blood glucose.

6.If blood sugar is rising, which often happens due to adrenaline during exercise, reconnect the pump and take ½ of the recommended bolus amount. This also helps to avoid ketones from lack of insulin.

7.Stay hydrated. Even if you feel like you are not thirsty, drink 8 ounces of water each time you are checking your blood sugar.

8.Always bring money. If you find yourself eating through snacks, be prepared to purchase carb-laden food from the snack machine or beach shack. This happens more often than not, so I stress this often!

9.Be prepared for lows that might happen an hour or two after leaving the water. With T1d, it’s not just the first event (swimming), but the second, third and fourth events that need proper planning. For that reason, always tuck in more glucose, more meter strips and extra supplies than you think you might need. Chances are, you will need it!

I hope this article was helpful and makes for a better water safety experience.

My gratitude to naturallysweetsisters.com for sharing.

According to a lawsuit filed by the American Civil Liberties Union (ACLU) on Monday, the deputy violated the rights of two children when he shackled the kids around their biceps in the fall of 2014. The boy and a 9-year-old girl had both been diagnosed with attention deficit hyperactivity disorder (ADHD). The lawsuit alleges that both children were being punished for behavior related to their disabilities.

ADHD is a common challenge in classrooms across the country. So what should parents and teachers do to prevent a child from becoming too unruly to handle? Lena Zettler, director of Psychology at Cook Children’s, suggests the following:

• Have a plan
• Have a team
• Have an advocate

“What are the steps that will be taken and who are the key people involved? These things should be understood before an emergency happens,” Zettler said. She says it’s important to remember that kids with ADHD most likely aren’t acting up for attention.

“Education is the first step for treatment for ADHD. It’s is a neuro-developmental disorder. It is not a disorder of bad parenting,” says Zettler.

Students with disabilities make up 12 percent of the student population nationally. According to the U.S. Department of Education, they account for 75 percent of the students who are physically restrained by adults in their schools. To prevent such drastic measures from being taken, parents who have a child with ADHD should have a conversation with their child’s teacher about the condition before the school year begins.

Together, parents and school officials need to put a team in place to assist in the child’s education and plan out what will happen when the child acts out.

Parents and school officials also need to designate an advocate, someone the child can turn to for help. The advocate could be an assistant teacher, a counselor or even a principal. By putting a team together and a plan in place, parents can help ensure ADHD children and their classmates get the most out of the school year.

“Taking these steps will not only benefit a child with ADHD, they will help the entire class,” says Zettler.

“Inside Out,” the new hit movie, helps us to understand, however, that sadness is just as important to our world and our perceptions, as joy and anger and all of the other emotions we encounter as human beings. We cannot pretend that sadness isn’t there. We cannot ignore it and hope it will go away. There is a reason for our sadness and if we don’t experience that feeling, it gets stuck inside where it grows and festers and can then prevent our other feelings from being realized.

We’ve heard the idea that we can’t know true joy without having known sorrow. The point in the movie where things change is when Riley’s parents stop and listen to her feelings. Riley tells her parents that she misses her old home and she wants to be with her old friends. Nobody is trying to change the way Riley feels. Nobody is trying, including Riley, to cover up her sadness with something else. Riley is allowing herself to feel the sadness and her parents are there with her, allowing her to feel. They are supporting her feelings and are listening to her.

As parents, we want our children to be happy. We want to protect them from pain. Unfortunately, that isn’t always possible. Once we understand that our children must go through pain and sadness, our job is to be there for them in those times.

We must allow those feelings to be experienced and we will likely experience the same feelings with them. Sometimes children (and adults too!) can’t put words to what they feel, but luckily words aren’t always necessary. As parents, we need to realize that at times silence is better. Don’t try to solve the pain. Don’t try to “make it better.”

As hard as it may be, let it happen.

As kids experience their feelings, they will begin to heal. Ask your child what they’re feeling and let them find their own way to tell you. They may not want to talk, so just be there. Hug them. Sit quietly with them and make sure they know you are willing to be by their side no matter what they are feeling. When they do talk about it, validate them. Tell them that it is okay to be sad, or angry, or confused. They need to know that whatever they are feeling is okay; it isn't wrong.

Here are a few examples of validating language that you can use:

“That sounds like it is really hard for you.”

“I can see that ___________ made you feel __________.” (Use their words for these blanks)

“I’m guessing you might have felt ______________ when _______________happened.” (When they aren’t providing you with answers of their own.)

Try to avoid these phrases/comments which invalidate someone:

“It’s not that big of a deal.”

“Don’t worry about it, you’re going to be fine!”

“You’ve got to be a big boy/girl, we’re not going to cry.”

Previous 'Inside Out' topics:

What 'Inside Out' teaches about fear

About the author

Shea Ingram is a music therapist at Cook Children's. At Cook Children's, music provides a creative intervention for children and young adults individually or in a small group format. It allows our young patients an outlet for the physical and emotional challenges they face in their lives.Music as an outlet and/or therapy aids communication and can be helpful to those who find it difficult to express themselves in words. Research supports music effectiveness in many areas such as: overall physical rehabilitation and facilitating movement, increasing people's motivation to become engaged in their treatment, providing emotional support for patients and their families, and providing an outlet for expression of feelings.

Surprised? Lisa Elliott, Ph.D., clinic manager of Cook Children's Behavioral Health in Denton, Texas, isn't. Elliott, a licensed psychologist, says parents and teachers often have an outdated view of what a victim looks like.

"The general public has always perceived that children who are vulnerable to bullying have some sort of social deficit, physical handicap or learning disability," Elliott said. "While this is true, socially adept kids are equally vulnerable to bullying, especially when they attempt to climb the social ladder."

Last year, the American Sociological Review published the "Casualties of Social Combat" study, which examined more than 4,200 middle- and high-school students and found that the more popular students became, the more vulnerable they were to bullying.

Snakes and (Social) Ladders

For several years, Elliott has given presentations on bullying to the local community. She says parents are surprised when they hear a popular student can be both a bully and a victim at the same time. According to Elliott, the danger comes when a child tries to gain more status in a social clique that is emotionally aggressive or manipulative. Signs of this nonphysical bullying can be subtle and easily mislabeled as "drama."

Jockeying for position

According to the study, bullying is more likely to occur within a social group, between two "friends" who are on the same level in social heirarchy. On the outside, this may simply look like typical relationship drama. What's actually happening may be subtle but serious bullying.

How to Stop the Cycle 

No child is bully-proof. According to Elliott, the key is to to make sure your child can spot an unhealthy friendship before it goes too far.

"We should communicate to our children what true friendship is, and what it isn't," Elliott said. "This will help them discern which peers they can trust and which ones are trying to manipulate them."

Elliott offers parents the following talking points when speaking to their child about bullying:

• Even people who say they're your friends, can bully you.
• You should confront your friends when they're being hurtful to you or others.
• Retaliating may feel good temporarily, but refusing to stoop to the bully's level will win you more popularity in the long run.
• When you hear a false rumor, just ignore it and be yourself.
• You're most likeable when you respect yourself and others.
• Bullies usually have their own insecurities. Returning meanness with kindess is the best way to break down their defense.

Warning signs

If you worry your child is being bullied, look for the following signs:

• Sudden change in friendships.
• Unexpected drop in grades.
• Irritability or moodiness.
• Reluctance to go to school.
• Avoidance of social situations.
• Faked illnesses or complaints of feeling sick.

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.

These days many of the kids’ sporting associations, coaches, and sometimes even parents seem to be treating kids as little adults. However, kids are not just small grownups. Children are still growing, which makes them more prone to injury. They are also developing their strength, coordination and endurance as they grow. Kids participating in sports together, even though they may be the same age, vary in size as well as physical and psychosocial maturity.

Recently, there has been an increasing trend in younger children specializing in one sport. Specialization prior to adolescence can cause increased injury rates, early burn out on the sport and unwanted psychological stress for the athlete.

Counter to current trends, studies have shown that athletes at the elite level were more likely to start competing at a later age and compete in other sports until late adolescence. Research also supports that children who participate in a variety of activities and don’t specialize until reaching puberty are more likely to be more consistent in their performance.

Participating in a variety of sports helps with coordination, skill development, and gives the child a chance to rotate use of specific muscles to decrease the risk of overuse injuries.

It’s important for athletes, parents and coaches to be aware of the signs and symptoms of an overuse injury. These can include:

• Pain
• Swelling
• Changes in form
• Decline in performance
• Weight loss
• Anorexia
• Sleep disturbances.

Children also have the added risk of injuring their growth plates. What may cause a sprained ankle in an adult has the potential to fracture a growth plate in a child. These injuries have the possibility to disturb growth of the injured bone and cause deformity. A young athlete should never attempt to “push through” an injury. Too much stress on the bones or muscles can lead to tissue breakdown and further injury.

To prevent these injuries, the American Academy of Pediatrics (AAP) and American Academy of Orthopeadic Surgeons (AAOS) recommend: 

1. The athlete should be coached by properly trained people who are knowledgeable about proper form and technique.
2. Athletes should only participate at a level consistent with their abilities and interest levels.
3. It is important that the athlete is participating in activities they enjoy. The athlete’s desires should control their intensity of participation.
4. Athletes should not play one sport or type of sport (i.e. throwing) year round.

Young athletes should be followed by a health care team who can monitor the athlete’s body composition, cardiovascular system, sexual maturation and evidence of emotional stress. It’s recommended that children participating in high levels of activities have an ongoing nutritional assessment to look at total calories, balanced diet and intake of calcium and iron to ensure adequate intake for growth.

If at any time your young athlete is having pain or any of the symptoms above, please seek appropriate medical attention.

More resources from the Cook Children's Sports Performance Orthopedic Rehab Team Specialists (SPORTS):

• The basics of sports injury prevention for kids
• Rise of overuse injuries in school-age athletes 
• Top 10 questions parents have about sport injuries
• Young athlete’s injury prevention guide

About the author

Amanda Stukey, PT, DPT, is a physical therapist for the SPORTS program at Cook Children's. Our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete's bones, muscles, body and mind.