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

“I don’t see how that could be possible. You see, William doesn’t know the difference. You think it would be easier because you are comparing him to a typically developing child. But to William, life is good. As he becomes older, sure he will see some differences, but that doesn’t mean it will be easier for him, you can’t predict the future and you are not him. I think what you mean is that it would be easier for you, me – anyone in his life. It would make things normal or typical for everyone else – And besides, have you seen normal lately – how scary can that be?”

William has changed people’s lives. He has made a difference in the 10 short years that he has been here. I’ve watched him soften people’s hearts, who before knowing him would have never embraced a mentally challenged child. I’ve watched him change people’s perceptions of children with disabilities. I had a helper for one semester, picking up William from school at Kinderfrogs, taking him to child care, and then staying with him. In one short semester, Susan changed her entire college plan. She was no longer going to go to University of Texas for journalism, but now she attends UT and changed her major to special education with a minor in deaf education. She had learned sign language with William and wanted to pursue working with special needs children and sign language.

I’ve watched William teach his brother and sister’s compassion, patience, and various life lessons that most parents only dream of ever helping their children experience or learn. He has made his siblings better teenagers, and given them the forethought to be better adults. They in turn impact those around them and change other’s perceptions. I challenge you to find a day that William didn’t positively impact someone, somewhere. He changes the world, one day at time, one person at a time. If William didn’t have DS, then he wouldn’t be William and I want my William; the good, the defiant, the hard-headed, jovial, the loving twerp that I have embraced since day one. To change him, would require undoing ALL the good he has done. To change that single chromosome would alter his identity. Who am I to decide to undo all the incredible things he has done and will do? I’ll take the hard work, I’ll take the nay-sayers, and I’ll take the medical risks (even leukemia). It’s all worth it to me. I was blessed to be given the opportunity to be William’s mom and my personal thought – God doesn’t make mistakes – even when we do.

I believe in these children, in our children. I believe that they are very much needed in our society and in our lives. Their spirit is contagious. Their presence is needed to put life into perspective more than we care to admit. Simply taking a moment to look past the disability allows us to see all the value and worth they hold inside and what each one of them brings to life. These children are incredible. (Sometimes I really wonder who truly has the “disability.”)

So, to answer the question asked by my oldest son and by others, would I take away that one extra chromosome? Absolutely, positively not! William is perfect the way he is. He is William and I love him.

My name is Barbi Beard-Wolfe and I am incredibly proud to be William’s mom! and I love his extra chromosome!

About the author

Barbi Beard-Wolfe is the Parents as Partners coordinator for Family Services at Cook Children's. Parents as Partners program is a family-centered care initiative, designed to work with families who are being cared for at Cook Children's. This program provides support to patients and families and strives to improve the safety and quality of the care provided. Learn more about the program here.