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.

The Community Health Needs Assessment (CHNA) provides valuable insights from parents, caregivers, and community leaders across our eight-county service region: Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant, and Wise Counties.

More than a hundred leaders from North Texas community organizations tuned in on May 6 for the first session of the two-part summit, during which Cook Children’s explained the methodology of the survey and outlined key findings. It is important to share these results because community organizations and leaders can use this data to inform their strategies for continuing to improve children’s health in their communities.

The key focuses of part one were overall health and well-being, asthma, and healthy lifestyles. The full assessment can be found here, and offers more detailed information on each data collection method used. See more tools for result breakdowns at the interactive data dashboard.

Additional findings specific to caregiver support, injury prevention, mental health, and oral health will be shared on June 3.

Main concerns

The assessment included 6,877 parents/caregivers' responses over the last three years and 239 survey responses from community leaders such as representatives from health departments, nonprofits, schools, and faith-based groups.

The most pressing concerns for many families in our area are related to financial stressors.

As costs have risen over the last few years, 45% of community leaders flagged inflation and poverty as a serious problem in their community.

These struggles directly impact kids’ and families’ physical and mental health. One caregiver said in a survey that they worry about paying for medical visits in addition to other household expenses. Community leaders noted that they help many working families with food, clothes, and other needs.

Housing affordability, food insecurity, and childcare costs are increasing problems for our communities. More than half of community leaders said access to affordable, nutritious food was a serious problem.

Overall health and well-being

Insurance coverage came up repeatedly in interviews with caregivers and parents. While the majority of children (88%) had continuous health insurance in the last year, 5% (about 54,700), had a coverage gap, and 7% (about 81,400) are currently uninsured. Children experiencing homelessness were three times more likely to be uninsured.

Caregivers shared that the lack of coverage was mostly due to affordability, respondents said. Families who did not speak English or Spanish said the language barrier was another obstacle to insurance coverage, and they did not always know how to renew or update their insurance.

Vaccination rates have decreased in our eight-county area - 89% of parents and caregivers reported their child had received all up-to-date vaccines, which is about an 8% decrease since the 2021 CHNA.

Asthma

One in ten children in the service area has asthma, and it is one of the most common health conditions in kids. While asthma is manageable, 19% of those children did not have an asthma action plan. This shows a need for more education, training, and support for caregivers of children with asthma, including daycare providers, schools, and aftercare programs.

Healthy lifestyles

A healthy lifestyle for children includes a healthy weight, physical activity, nutritious food, and adequate sleep. Only 35% of children in our area eat fresh fruits and veggies at the recommended amount, and the majority of children (94%) are spending more than two hours on entertainment screen time every day.

While living a healthy lifestyle benefits overall health, many children and families face obstacles to doing so. Not everyone can access nutritious food in their neighborhood, and 1 in 7 children do not live in an area that has sidewalks, parks, playgrounds, or recreation centers.

In the eight-county service area, approximately 34% of children (about 390,100) live in households that cannot always afford to eat good, nutritious meals and 21% of children (about 236,400) live in a household that reported receiving food stamps or SNAP benefits in the past year.

SNAP gives families financial help to buy nutritious food, but cuts in this program have made it harder for families to get those benefits. The reduction of SNAP emergency allotments also places additional strain on local food banks and community organizations to bridge the gap left by the reduced benefits.

Reduced benefits may lead to increased food insecurity, limiting access to nutritious meals and negatively affecting the health of families and children, ultimately exacerbating social and economic inequalities.

Calls to action

Based on the findings, Cook Children’s Center for Community Health identified crucial next steps to improving children’s health in our communities. One of those tactics is to foster more partnerships focused on non-medical drivers of health, such as food security, economic stability, and housing.

Cook Children’s also plans to strengthen collaborations to create more community outreach for families, advocate for strategies that benefit our communities, and improve access to community resources for children.

More detailed strategy plans can be found on Cook Children's community outreach page.

RELATED STORY

Survey Highlights Health Concerns in the Community

School nurse Lori Hamman provides first aid and comfort to the students at Wedgwood 6^th Grade Center who arrive at her office with assorted injuries and illnesses on any given day.

She treats nosebleeds, headaches and vomiting. She helps manage asthma flareups and the extremes of diabetic blood sugar levels.  At set times, she dispenses medication to students with chronic conditions like seizures or attention-deficit/hyperactivity disorder. Occasionally, an upset sixth-grader will need a few minutes in Hamman’s office just to calm down.

“It can vary from minor things to complex things like a broken bone,” she said of her job at Wedgwood, in the Fort Worth Independent School District (FWISD). “That’s kind of the exciting thing about being a school nurse.”

Rekha Sivadasan, M.D. at Cook Children’s Pediatrics in Frisco described school nurses as a valuable extension of the pediatrician’s office. Dr. Sivadasan hears from school nurses who may call to check on a patient’s immunization records, or to discuss a severe food allergy, or to alert her that a student has elevated blood pressure. Communication and collaboration – among pediatricians, school nurses, and parents or guardians – make the best approach, per Dr. Sivadasan.

“Ultimately, the child benefits to know that there are different people who have eyes on them to help the child feel safe, to feel cared for, to feel loved,” Dr. Sivadasan said. “If they know that there are different entities that are all working together to ensure their success and their good health, then I think that just adds to the security and confidence for the child.”  

Expert input shared by school nurses plays an important role in developing accommodations for students who have disabilities, Dr. Sivadasan said. Other critical duties may include reporting suspected child abuse to state authorities, and notifying help for a student who expresses suicidal ideation.  

 “If a child has something that is bothering him or her -- whether it’s physically, emotionally, behaviorally, mentally – the nurse is their go-to person at school,” Dr. Sivadasan said. 

School nursing is a specialized practice of the nursing profession. What difference does it make when school nurses work together with a child’s doctor and parents? The American Academy of Pediatrics explains: “Academic achievement, improved attendance and better graduation rates can be a direct result of a coordinated team effort among the medical, family, and educational homes all recognizing that good health and strong education cannot be separated.”

Tips for Parents

At Wedgwood, Hamman encourages parents to communicate directly with her at the beginning of the academic year if their child has a chronic condition. She enjoys the relationships formed when students come to her office.

“It’s a safe place,” Hamman said. “I don’t expect homework from them or written assignments or testing. They can just come in and relax and destress.”

Depending on the grade level, Hamman and her colleagues at FWISD encounter a wide array of ailments and issues, from playground bruises and wiggly teeth to drug abuse and pregnancy. Some students require specialized care for catheters or feeding tubes. Others turn to their school nurses for help with mental health. Meanwhile, the nurses are gearing up for the 2022-2023 flu season while continuing to check on students out with COVID-19. 

School nurses also implement screenings for spinal abnormalities, growth, hearing and vision. Hamman recalled one student who had trouble seeing the eye chart. 

“I made a referral and now she has glasses," Hamman said. "I rescreened her, and she can see 20/20.” 

We talked to a group of experienced local nurses about key things parents should know:

• Send any meds to school in the original packaging with a specific written request signed by a physician or licensed prescriber.
• If your phone number or address changes, or if your emergency contact’s information changes, tell the school nurse and data clerk. They might need to reach you.  
• Make sure the nurse’s office has your child’s most current shot records.
• If your child’s health history changes, tell the school nurse. This includes a new diagnosis or starting/stopping a regular medication. 
• Give signed permission for the school nurse to communicate with your family’s health care provider.

School nurses say their role involves social work, counseling, advocacy, record-keeping and disease prevention. Why do they love what they do? Here are some perspectives.

More than Band-Aids

Shannon Cooper, Director II for FWISD Health Services, said the biggest change in her 17 years of school nursing is the increase in diabetes, asthma and medications. “It has become so much more complex,” she said. Cooper said the familiar presence of nurses at school shapes in a positive way the students’ view of health care. 

Verby Nash, Health Services nurse specialist, recalled a few unusual situations in her experience, including a student with a bead stuck up the nose, and a teacher hit by a car during morning drop-off. As they gain the trust of families, school nurses might be asked to examine a baby’s rash or a grandparent’s blood pressure.

“We do what we can to help and assess,” Nash said. “We are not doctors. We cannot diagnose. We cannot prescribe. We are very, very careful about that.”

The nurses educate teachers and staff about various illnesses and what symptoms warrant a trip to the nurse’s office. 

“It’s not just Band-Aids and tummy aches, which unfortunately is still what some people think,” Nash said. “We are there to advocate for those students because if they’re not feeling good, they cannot be successful in class.”

Cassandra Miles, Health Services nurse specialist, said school nurses are a source of “safe, sound and appropriate” information when students come to their offices to talk. She considers it a privilege to serve children and teens from pre-kindergarten through high school graduation.

“For many students, we may be the only person who they see medically,” Miles said. “Or we may be the gateway to those resources in the community or to get to the pediatrician or the mental health provider.”   

Seventy-one FWISD campuses participate in free Goodside Health telehealth services. Morningside Elementary School nurse Sasha Dawkins said pointed out the benefits of telehealth appointments in reducing student absenteeism and allowing parents to stay at work.

One frequent challenge Dawkins encounters on the job is collecting the required vaccination paperwork. 

“It may take a few more phone calls or a few more letters to get parents to understand the importance of being up-to-date on their shot records,” she said. “Sometimes at the beginning of the year it can be a little bit of a struggle to get the documents you need.”

She welcomes questions and hopes to provide support and resources. And Dawkins feels motivated every day by the opportunity to help students. “I love making a difference in someone’s life. That’s the biggest joy for me. That is the reason I became a nurse.”

You’re holding your child’s hand on your way to the first day of school. The squeeze on your hand is tighter than usual. Then suddenly your little one sees a friend, smiles, releases your grip and you watch them run to school together without a care in the world.

Everything is great.

But then you notice a tear in your eye. Suddenly, you realize your child isn’t the one nervous about going back to school. It’s you.

The back-to-school transition can be stressful for many parents, and the reasons are valid.

For example, knowing that your child struggles with change can increase your own feelings of tension.

You may worry that your child will struggle to fit in with peers and make friends.

Maybe your child had a bad experience at day care or a previous school year, leaving you both with lingering anxiety.

Some parents are concerned that schoolwork or a tight schedule may be too difficult for their child or that a teacher will not understand their child's unique needs. 

Maybe, you’ve waited until the last minute and just aren’t ready. The need to buy new clothes and school supplies may cause concerns about finances, and a steady stream of demands on your time can leave you feeling pressured and stressed.

Plus, there’s just the feeling that your young child is growing up too darn fast.

If you are stressed about your child's return to school, you may wonder if you should share your concerns. Sam McCage, clinic manager of Behavioral Health Services in Fort Worth and a licensed psychologist,  says that could be a mistake. Your child looks to you for signs that school is fun, exciting and safe and not something to fear, so it's important to discuss school in an upbeat and encouraging way.

"Recognize that children will sense your anxiety and their own will increase if you express your anxiety too much," McCage said. "If they ask about your concerns, tell them that you are excited for them and confident they will do well."

McCage reminds parents that "it's normal to feel anxiety about your child going back to school, but he says there are strategies to help you effectively manage your stress.

Here's how you can calm your concerns and enjoy this annual adventure with your child.:

• Visit the school and connect with your child's teacher and other school staff.
• Make arrangements for car pools, play dates and after-school care well in advance.
• Be patient and give the teachers time to develop a relationship with your child.
• Make sure you have realistic expectations about how your child should perform in school and extracurricular activities.
• Talk with other parents about how they handle their anxiety.
• Use humor to diffuse the stress.
• Schedule fun family activities with your children.