As pediatric experts, Cook Children’s Health Care System know that protecting a child's health is about preventing emergency room visits just as much as treating illness. Ahead of the major soccer tournament, the system launched "World Cup Wednesday," a weekly healthcare series providing local and international visitors with essential resources on injury prevention, heat safety, water safety and guidance on when to utilize urgent care versus the emergency department.

The hottest time of the year in Texas is here, with temperatures regularly ranging from 80-100 degrees between June and August. Medical experts from Cook Children’s Health Care System advise caregivers and parents on what to know before attending outdoor activities or fan watch parties.

“Children can't cool off the body as well as adults,” said Monica Herrera, M.D., a pediatrician at Cook Children’s Pediatrics Windhaven, “it's important that we keep them hydrated.”

Dr. Herrera emphasizes that hydration is key during these months, as well as protecting children's skin from the sun and mosquitoes.

Learn the signs of heat-related illnesses

Spending too much time in the heat without proper hydration can lead to heat exhaustion and heatstroke. Dr. Herrera said learning the signs for heat-related illness is important, so caregivers know when to seek medical attention.

Symptoms include:

• Feeling faint or confused: A child may begin acting disoriented.
• Walking unsteadily and losing coordination.
• Headache
• Abnormally warm skin: Feels hot to the touch.
• Lack of urination: No wet diapers or bathroom use in eight hours.
• Nauseous and vomiting
• Shallow breathes: The body uses shallow breathing to try to shed excess heat.
• Muscle cramps: A child may complain that their legs hurt.
• Numbness

If a child exhibits these symptoms, seek immediate medical attention.

Preparedness is the number one way to avoid heat-related illness and Dr. Herrera says it starts with hydration.

Hydration Tips

Babies under 6 months old should generally be kept indoors. However, if an infant is outside, Dr. Herrera recommends they stay hydrated with formula or breastmilk. Babies under 6 months should not be given water.

“The breast milk has everything that the baby needs as does formula,” said Dr. Herrera. “If you're outside for a prolonged period they really need to be drinking every 20 minutes.”

As children get older water becomes the priority for hydration, but there are other tricks if your little one isn’t fond of H20. While water is best, other caffeine-free fluids and water-rich foods can help count toward hydration.

“Fluids don’t always come in the form of liquid,” said Dr. Herrera.

Alternative hydration sources:

• Ice cream
• Popsicles
• Snow cones
• Crushed Ice
• Fruits (Watermelon, grapes and cantaloupe) are an excellent source of hydration
• Soft liquids (such as yogurt, applesauce)

How do you know if your child is hydrated?

Check their urine. Urine is the best indicator of hydration status for both children and adults. A well-hydrated child's or adult’s urine should be clear to a light yellow, similar to a light lemonade color. If the urine is dark yellow or tea-colored, dark orange, more fluids are needed.

Sun protection

While hydration is critical, protecting a child’s skin is a close second. Dr. Herrera explained that children’s skin is sensitive and can burn when exposed to the sun for a prolonged period. While sunblock Sun Protection Factor (SPF) ratings range in coverage from SPF 10 to 80, Dr. Herrera recommends choosing products with two active ingredients: zinc oxide or titanium dioxide and use a sunblock of SPF 30.

Babies under 6 months of age should not have sunblock applied. Instead, keep them in the shade and dress them in a wide-brimmed hat.

Sunblock recommendations for 6 months and older:

• Choose a mineral-based sunscreen.
• Use SPF 30
• Apply 15 to 30 minutes prior to going outside.
• Reapply every two hours.
• Avoid sunscreens containing oxybenzone.
• Choose lotions over aerosol sprays to ensure total skin coverage.

Staying Cool in the Sun

• Dress children in light-colored, loose-fitting clothing.
• Choose breathable, absorbent materials.
• Avoid sitting directly in the sun. Seek shade when possible.
• Use cool mist sprays for quick relief.

Mosquitos

Summer heat in Texas also brings mosquitoes, which thrive around stagnant water and in hot, humid climates.

“Mosquitoes, as we know, can carry viruses which can cause severe infections and serious complications,” said Dr. Herrera. “We want to avoid mosquito bites if at all possible.”

The most effective line of defense is insect repellent.

Finding the best repellent:

• DEET is the most effective option.
• For infants up to 2 years of age, use a maximum of 10% DEET.
• For children older than 2, a maximum of 30% DEET.
• Apply repellent only to exposed skin or on top of clothing. Do not apply it underneath clothing.
• If concerned about applying directly on the skin, apply repellent on clothing instead.

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Texas surpassed its number of hot car deaths from 2024 on July 14, according to the Texas Department of Health Services (DSHS). A sixth and seventh fatality was reported in August in North Texas.

The increase contributes to the more than 20 hot car deaths reported nationwide this year as of August 26. Vehicular heatstroke is the second-leading cause of vehicle-related deaths in children under 15, trailing only car crashes.

Experts from Cook Children's Health Care System, Viviana Esparza, program coordinator at the Center for Community Health, and Sharon Evans, trauma injury prevention manager, emphasize the preventable nature of these tragedies.

“It can happen to anyone but it is 100% preventable,” Esparza said.

She notes that 52% of hot car child deaths occur when a child is forgotten. According to kidsandcars.org, parents can suffer from exhaustion due to lack of sleep, stress, and changes in their normal routine. Any one of these can cause a parent or caregiver's memory to fail at a time when you least expect it.

“Parents need to realize this can happen to anyone,” Evans said. “They aren’t bad parents but they get distracted or there’s a change in their routine. Make it a habit to put something you need in the back seat with the child.”

Twenty-five percent of hot car child deaths are due to a child gaining access to an unlocked vehicle or a child getting the keys. Evans recommends teaching toddlers and preschool-aged children to honk the horn if they become trapped, enabling them to draw attention to the vehicle.

Esparza says the third most common is knowingly leaving a child in a vehicle for a quick errand. DSHS emphasizes that a cracked window does not protect a child or pet from heatstroke.

“A car heats up about 20 degrees in 10 minutes and the temperature just keeps growing after that, often reaching 130-140 degrees in 30 minutes to an hour,” Evans said.

Esparza encourages families to remember the acronym A.C.T. to prevent heatstroke:

• A: AVOID heatstroke and other heat-related injuries by never leaving your child alone in a car, not even for a minute. When the vehicle is at home, keep the doors locked and keys or key fobs out of a child's reach.
• C: CREATE reminders. Place an item you need, such as a bag, wallet, or cellphone, in the back of your car or next to your child. This is especially important if you're not following your normal routine. If your child is with a care provider, ensure vehicle-related procedures are in place, such as vehicle searches or locking vehicles when not in use. Use technology to your advantage and use apps or other communication methods to stay connected with your childcare provider.
• T: TAKE action. If you see a child alone in a car, call 9-1-1. Emergency personnel want you to call, and they are trained to respond swiftly to these situations. One call could save a life.

Summer has begun, which means more outdoor activities and finding ways to cool down. Cook Children's Health Care System experts share tips for parents on how to keep children safe and prepared for the heat, from cooling down at the pool to summer travel safety.

As the 4^th of July approaches, we are sharing the latest drowning data from Cook Children’s Health Care System. As of January 1 to June 18, there were 20 drownings treated at Cook Children’s, two of which were fatal. Most of these patients have been in the 5-year-old and under age group.

So far in 2025, there has been a decrease with 18 drownings and two fatalities. Most drownings in 2025 have occurred in a swimming pool or spa, second highest were bathtub-related.

While most drowning encounters were not fatal, drowning injuries can result in severe effects, especially on a child’s brain development. Drownings can happen silently and quickly. A submerged person might not attract attention or appear to be in danger.

Cool Down: Water safety and drowning prevention

Drowning is the leading cause of unintentional injury and death for children ages 1 to 4 and the second leading cause for kids 5-14 in Texas.  Eighty-eight percent of drownings occur with at least one adult present. 

• Wear swimsuits with bright colors that are easily detectable in water.
• Designate an adult Water Watcher to ensure constant visual supervision of children in and around water.
• Implement 15-minute shifts for Water Watchers.
• No Distractions: The Water Watcher must have no distractions, including conversations, phones, reading, or consuming alcohol.
• Communication is key: Talk with all caregivers (family and friends) about your child’s swim ability or water competency skills.
• Never assume that adults will be watching, but rather verbally confirm it before leaving your child in their care.
• Barriers: Locks, alarms, and pool fences can help keep unsupervised young children from entering swimming pools.

Fun in the Sun: Boating Safety

The risk of drowning in open water triples at age 15. Setting safety expectations with the whole family ahead of time is paramount. Most drowning fatalities in natural water are not related to boating. Texas law requires that all children 13 and under wear a life jacket while on a boat. Cook Children's Health Care System supports over 60 Loaner Life Jacket Stations in North Texas lakes, rivers, and reservoirs. The goal is to make sure no child or adult drowns at a public lake because they did not have access to a life jacket.

• Make sure life jacket usage is mandatory, along with adult supervision.
• Toe In/Vest On Policy: If a toe is in the water, a life jacket goes on.
• Life Jackets: Must be U.S. Coast Guard-approved.
• When your life jacket is on, ensure that it is buckled on your child as directed.  Always. 
• Know water conditions before getting into open water. Water conditions in lakes and oceans can vary daily.  

Heat Safety

Spending too much time in the heat can lead to heat-related illnesses, including heat exhaustion and heatstroke.

• Stay hydrated: Water is best, but other fluids count if they do not include caffeine.
• Hot car danger: Make a habit of double-checking your backseat each time you get out of the car.
• Watch out for hot buckles on car seats, as these can cause burns on your child’s skin.
• Be aware of heat illness. Know the difference between heat exhaustion and heat stroke.

Sun’s Out, Fun’s On

When it comes to sunburn, prevention is key. 

• Use a zinc oxide-based sunscreen with a minimum SPF of 30.
• Cover skin with SPF clothing.
• Apply sunscreen generously and frequently, 15 minutes prior to sun exposure.
• Reapply sunscreen every two hours and after swimming.
• For infants: Keep them out of direct sunlight, especially during peak hours of 10 a.m. and 4 p.m. Keep their skin covered with lightweight pants, a lightweight, long-sleeved shirt, and a wide-brimmed hat. 
• Wear sunglasses: Look for sunglasses that protect your child’s eyes from at least 97% of the UV rays. 
• If you are worried about any burn, even if it seems minor, consult your child’s pediatrician.

Fireworks
Fireworks can cause severe injuries that are both harmful and painful to children. Children should never handle fireworks. Even seemingly harmless sparklers can heat up to more than 1,200 degrees, making them dangerous for young children.

• The safest way to enjoy fireworks is at a professional display.
• If setting off fireworks at home, adults should only set them off in a “kid-free” zone.
• Adults should not hold fireworks in their hands or keep any part of their body over them while lighting.
• Avoid accidental burns: keep children away from bonfires and grills.

Story by Eline Wiggins. Video by Tom Riehm. Photos by Reilly Ternan.

Every year, children in Texas are prone to vehicular heatstroke. So far this year, eight children have died of vehicular heatstroke across the US, including a 4-year-old boy in Houston, according to noheatstroke.org. In 2022, three children died of vehicular heatstroke in Texas.

On Monday, Cook Children's and Prosper Fire Department teamed up to remind parents about the dangers of hot cars. First responders showed a live demonstration at Cook Children’s Medical Center – Prosper to simulate a 911 call and emergency response for a child left in a hot car. Speakers included Prosper Fire Chief Stuart Blasingame, Viviana Esparza from Cook Children’s Center for Community Health, Meena Guirguis, M.D,, emergency department physician at Cook Children's Medical Center - Prosper and  Larry Lanar Dyer of El Dorado Chevrolet.

A digital thermometer displayed the internal temperature of a second demonstration vehicle to show how high and how quickly a vehicle can heat up. The temperature inside the vehicle surged passed 135 degrees. 

Young children are particularly at risk for heatstroke, or hyperthermia, because their bodies heat up three to five times faster than an adult’s. Because cars heat up so quickly, a tragedy could happen faster than you think.

“Heatstroke in children can happen in minutes, not hours,” said Meena Guirguis, M.D., emergency department physician with Cook Children's Medical Center - Prosper. “If you see a child left in a vehicle, call 911 immediately.” 

A car can heat up 19 degrees in just 10 minutes. And cracking a window doesn’t help. It’s never OK to leave a child alone in a car, even for a few minutes and even if the car is running.

“Parents suffer from exhaustion due to lack of sleep, stress and changes in their normal routing. Any one of these can cause your memory to fail at a time when you least expect it,” according to kidsandcars.org. “Even the best of parents or caregivers can unknowingly leave a sleeping baby in a car; and the end result can be injury or even death.”

Create reminders by placing something in the back of your car next to your child, such as one of your shoes, a purse or a cell phone, is especially important on days when you're not following a normal routine.

To reduce the number of child vehicular heatstroke deaths, parents should remember to ACT:

• Avoid heatstroke-related injury by never leaving a child alone in a car, not even for a minute. Always lock your doors and trunks— including in your driveway or garage. If a child goes missing, check the pool first, and then check the vehicles, including trunks.
• Create reminders. Routinely place something you'll need at your next stop—like a purse, briefcase or cellphone—in the backseat.
• Take Action. If you see a child alone in a car, take action. Call 911.

What to do if you see a child or pet alone in a vehicle from kidsandcars.org:

• Don’t wait for the driver to return. Call 911 right away. The 911 operator can help give you instructions on how to care for the child or pet.
• If the child or pet is not responsive or is in distress, immediately:
  • Get them out of the car by any means necessary
  • Move the them to a cooler environment (somewhere with AC or shade if AC is not available)
  • Remove child’s clothing to let the heat dissipate from their skin
  • Dampen them with cool water or wet rags, immerse in cool water (not in an ice bath) 
• If the child or pet is responsive and not in distress:
  • Stay with them until help arrives
  • Ask someone else if they can locate the driver. You might suggest they ask security of a store manager to page them

Warning Signs of Heatstroke:

• Hot, flush or red
• Slow, weak pulse or strong, rapid pulse
• Lethargy, confusion or strange behavior
• Nausea
• No sweating

The first death occurred in Providence Village on Thursday, June 24, 2019. CBS11 reports the 4-year-old boy was found outside a home just before 5 p.m. when temperatures were in the mid-90s.

The second tragedy occurred on Sunday, June 23, when an 18-month-old was left inside a car for five hours outside of a restaurant in Galveston. 

The deaths were the first two of the year in Texas and the thirteenth pediatric vehicular heatstroke deaths nationwide.

The peaking 100 degree temperatures are dangerous, especially for children, whose body temperatures rise three to five times faster than adults. There have already been 11 pediatric hyperthermia (heat stroke) deaths this year in the United States from children being left alone in cars.

Although there have not yet been any recorded in Texas, this state typically leads in hot car related deaths. Since 2010 there have been 60 juvenile deaths in Texas from children being left alone in a hot car.

Most cases of child heat stroke deaths in cars are accidental. There was a change in mom or dad’s routine, and the child was unintentionally left in the back seat. Like drowning, it is quick and it can happen to anyone.

“We do get a very small amount of people who leave the child in the car intentionally, but the majority is when you just totally forget,” Cook Children’s Injury Prevention Coordinator Sharon Evans said. “There is no socio-economic, no educational or cultural factors. It can be anyone.”

Evans and her team have partnered with Safe Kids Worldwide to develop a Texas Hyperthermia Board to educate Texans about how and why this can be preventable. The task force has changed legislation in 2016 to require birthing hospitals to educate new parents about hyperthermia and car seat checks.

“The biggest problem with injury prevention is everyone thinks it won’t happen to them,” Evans said. “We hear lots of people saying, ‘Oh, that’s just a horrible parent. How could they forget?’ Today’s world is so technologically driven, and people give more time than ever to their cellphones. If you can forget your phone somewhere, you can forget your child in the backseat.”

Outdoor temperatures don’t have to be sweltering for heat stroke to occur. The first vehicle-related heat stroke death this year occurred in April with 79 degree weather. The temperature in a car can rise nearly 19 degrees in ten minutes. Heat stroke can occur when a body temperature rises above 104 degrees and body organs begin to shut down near 107 degrees.

There have been many instances where people walk through the grocery store parking lot, see a child alone in the car and do not act for fear of prosecution if they damage the car. Texas released Texas House Bill 478 (HB 478) in 2017 to protect Good Samaritans and potentially save children from heat stroke.

HB 478 allows citizens to rescue a vulnerable child under the age of seven if there is no reasonable method for the child to exit the vehicle without assistance and if the Good Samaritan has reasonable belief that entry into the car is necessary to avoid imminent harm to the child. HB 478 also requires law enforcement must be notified and the citizen must not use more force than necessary to enter the vehicle.

Child car-related heat strokes are preventable, but can happen to anyone. It’s important to take measures in educating adults and children about the dangers of a closed car door. The effects could ultimately last a lifetime.

“It doesn’t matter how good of a parent you are. It’s just a tragic accident,” Evans said. “Being vigilant could save a life.”