Journey to a Lifetime of Helping Others

Dr. Rao attended medical school in India where she met her husband. In 1980, the couple moved to the United States, and Dr. Rao completed her residency at University of Illinois before moving to Texas. She worked at Kaiser for eight years and admitted many patients to Cook Children’s. At the time, most Medicaid patients did not have a primary care physician, so all physicians were on call. 

“When we discharged patients, we didn’t have anywhere to send them for the follow-up care they needed,” Dr. Rao said. “The neighborhood health centers that Cook Children’s started have been a meaningful addition to help us continue caring for children and families close to home.”

In 1996, Dr. Rao worked in the first Cook Children’s neighborhood health center – a 500-square-foot mobile building on a playground. 

“We have come a long way since then with nine neighborhood health centers serving the underserved,” Dr. Rao said.

A Passion for Preventive Care

Dr. Rao was determined to work at the neighborhood health center, ensuring every patient had a primary care home and referrals to specialists. She promoted immunizations, well checkups and other issues like mental health or speech therapy. 

“The neighborhood health centers serve as a patient’s home for treatment of existing conditions and preventive care,” Dr. Rao said. “The goal is to pick up on any problems early on instead of waiting until they have to visit an Emergency Department or Urgent Care.” 

One of the ways Dr. Rao focused on preventive care was taking a special interest in supporting children with obesity. At the time, nutritionists did not work with kids, so Dr. Rao stepped in to fill that gap. One of her patients who struggled with obesity visited the neighborhood health center every two weeks, and she made a personalized meal plan to help him make healthier choices. At 16 years old, it was time for him to transfer to another doctor due to his age. Dr. Rao will never forget the last conversation with his mom. 

“The patient’s mom said she appreciated my effort to personally meet with him so often, and it meant a lot to me,” Dr. Rao said. “It was heartwarming to hear that he benefited from it.”

Advances in Modern Medicine

Throughout her 29-year career at Cook Children’s, Dr. Rao has seen many advancements such as the change from paper to electronic records. Dr. Rao said EPIC is linked to specialists, Emergency Department and Urgent Care visits which allow for continuity of care as pediatricians are able to look up labs and imaging. 

She has also seen a difference in common diagnoses due to immunizations. 
“People don’t realize how much immunizations have helped,” Dr. Rao said. “When I started as a resident, meningitis was the most common reason for hospital admissions. Tetanus, measles and chickenpox were also prevalent childhood diseases. My hope for the future is that the immunization schedule will stay the same.”

Looking to the Future

Dr. Rao is thankful for the Cook Children’s vision to open the neighborhood health centers and sees it as the hospital’s ongoing legacy. She said the training and advancements at the Las Vegas Trail Neighborhood Health Center will have a far-reaching impact.

The Las Vegas Trail Neighborhood Health Center features services such as counselors, social workers, and speech therapists. The new space also allows families to take part in hands-on learning, including kitchen demonstrations where they prepare healthy meals together. 

“Having onsite specialists makes a big difference as there is no delay in treatment,” Dr. Rao said.

A Mother’s Insight

As a mother of two children, Dr. Rao understands that some challenges children face go beyond parenting and require compassionate care to help each child thrive. 

“I was able to pick up on problems with other kids that came from my own experience as a mom,” Dr. Rao said. “It is not just the home situation that makes them who they are. They come with their own personalities and there is no guidebook.” 

Dr. Rao said one of the most rewarding experiences is when former patients bring their own children to see her – a full circle moment. 

A Legacy of Serving the Underserved 

Dr. Rao retired in October. She is looking forward to continuing to serve the underserved through volunteering. 

Above all, Dr. Rao is grateful for her time at the neighborhood health centers and counts it a privilege to have cared for each of her patients. 

“I’m thankful I was able to be part of the legacy at Cook Children’s to care for the underserved.”

The Texas Department of State Health Services has not reported an outbreak.  

Cook Children’s pediatricians Devona Martin, M.D., and Jenica Rose-Stine, D.O., say they have seen a surge in cases at their primary care clinic in Willow Park, Texas.  

“Over the past few months, we have noticed a big increase in the number of cases of salmonella,” Dr. Martin said. “This usually presents as diarrhea that has blood or mucus and fever. Each case is reported to the Health Department to try to track down a cause, but a common source has not been identified.”  

Since July, the Emergency Department at Cook Children’s Medical Center – Fort Worth has also reported increased numbers of patients with salmonella.  

“In the ED, we usually see less than 20 patients per month with a diarrheal illness caused by salmonella,” said Stephanie Felton, D.O., associate medical director of the Cook Children’s Emergency Department. “In the month of July, we had 43 positive cases. We had 59 in August, 71 in September, and 74 in October.”  

Last week at Cook Children’s, 11 out of 229 patients tested for Salmonella were positive, resulting in a 5% positivity rate.  

Dr. Felton, Dr. Martin, and Dr. Rose-Stine provide answers to commonly asked questions about Salmonella.  

What is salmonella?  

Salmonella is a bacteria that can cause gastrointestinal illness and fever called salmonellosis. It is one of the most common causes of foodborne illness in the United States.  

What is the difference between salmonella and E. coli?  

Although salmonella and E. coli cause similar illnesses, they are different kinds of bacteria. E. coli more commonly produces a toxin that can lead to kidney damage, a condition called hemolytic uremic syndrome. This isn’t seen as often with salmonella.  

What are the symptoms of a salmonella infection?  

Symptoms of salmonellosis are diarrhea with blood and/or mucus, vomiting, abdominal cramps, and fever. 

How do children contract salmonellosis?  

Salmonella infection can be contracted by consuming contaminated food products, including poultry, eggs, produce, infant formula, and water. It can also be spread through contact with infected animals, like reptiles and birds, or other people who are infected if strict hand hygiene isn’t followed.  

Is salmonella contagious?  

Yes, salmonella is contagious and can be spread by person-to-person contact or by touching contaminated surfaces. The incubation period usually is between eight and 72 hours following exposure. You may be asymptomatic during this time.  

Salmonella is not as contagious as the viral stomach bugs we often see.  

How can parents and caregivers prevent infection?  

We can prevent infection with proper hand washing, especially before eating and after touching animals. Make sure that your counter spaces and sinks are clear of any bottles, sippy cups, or dishware before washing any fruits or vegetables. Cook and prepare all poultry and meat products appropriately. 

Only use FDA-approved formulas for your infants. Thoroughly clean all bottles, pacifiers, and toys before handing them to your children.  

How are salmonella infections treated?  

Treatment primarily involves rehydration and rest. Infants less than three months old or children with moderate to severe illness may receive antibiotics. These infections usually clear on their own.  

What should parents do if they think their child has a salmonella infection?  

If you are worried about your child having salmonella, please contact your primary care physician. He or she can run stool studies to confirm the diagnosis.  

Unless your child has blood, mucus, or fever with their diarrheal illness, it’s likely a stomach virus and not salmonella. Keep your child at home and make sure they hydrate!  

If your child is acutely ill or if you are concerned about dehydration or prolonged fevers (100.4 degrees Fahrenheit for five days or greater) please bring your child to the Emergency Department for an evaluation.  

Newsweek, in collaboration with Plant-A Insights Group, conducted a large-scale employer study to recognize the nation’s top workplaces. The study encompassed over 1.5 million comprehensive company reviews from more than 250,000 employees, showcasing the best places to work across all industries in the United States.

“Being named one of the best workplaces in America by Newsweek is an incredible honor and a testament to the unwavering dedication of our remarkable team at Cook Children’s,” said Rick W. Merrill, President and CEO of Cook Children’s Health Care System. “Our employees are the heart and soul of this organization, and their compassion, resilience, and commitment to our Promise inspire me every day.”

The selection process for America’s Greatest Workplaces 2024 involved a rigorous five-stage evaluation. Initially, HR professionals were interviewed to identify key drivers of employee satisfaction. Following the interviews, a main employee survey gathered reviews from U.S. employees familiar with their employers. Additionally, an elaborate desk research project was conducted, collecting 15 KPIs relevant to a great employee experience, including social media reviews and information on corporate culture, work-life balance, and career opportunities.

“Finding a great workplace is an important decision that needs to factor in pay, respect, training and advancement as well as healthy work-life balance. Newsweek and market-data research firm Plant-A Insights are proud to publish ‘America’s Greatest Workplaces 2024,’ the second annual ranking that highlights companies which are committed to offering a positive and supportive working environment,” said Nancy Cooper, Global Editor in Chief of Newsweek.

Fostering a Nurturing Workplace and Exceptional Patient Care

In recent years, Cook Children’s launched several initiatives to uphold these gold standards, ensuring a healthy and happy workforce.

Through internal surveys and listening sessions, Cook Children’s identified burnout among employees at all levels and responded by implementing programs aimed at reducing stress and supporting employee well-being both on and off the job. This approach fosters a culture where employees feel like family and are encouraged to see the world through the eyes of others, be it patients, family, or staff.

Employee feedback has been instrumental in developing initiatives such as Employee Resource Groups, which support the diverse faces and voices within the organization. Cook Children’s comprehensive employee benefits includes primary care and mental health counseling for staff and their families, tuition reimbursement for career development, and expanded parental leave.

These efforts are designed to connect the dots for employee well-being, facilitating the delivery of safe, kind, respectful, collaborative, generous, and imaginative care to patients and their families.

“We have always strived to create a supportive, family-like environment where every employee feels valued and included," said Mr. Merrill. “This recognition reflects our collective efforts to make Cook Children’s not only a place of healing and hope for children but also a nurturing workplace for those who devote their lives to this vital mission. Thank you to each and every one of our employees for making Cook Children’s such a special place.”

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By Carrie Pyle, D.O.

I had the opportunity to go on a medical mission trip to Migori, Kenya through an organization called Kenya Relief. The organization operates an orphanage, a school and a medical clinic.

Nearly every two weeks, a medical mission team travels to Migori to spend about four days working in the clinic. The teams are made up of outpatient providers, surgeons of different specialties, anesthesiologists, nurses and surgical techs. My team included a surgeon, two podiatrists, six certified registered nurse anesthetists (CRNAs), a family nurse practitioner, a radiologist, a sonographer, a social worker and myself.

I was able to go on the trip with my husband, Garrett Dupree, who is a CRNA. He provided anesthesia to surgical patients.

My whole experience was incredibly challenging and humbling. I saw kids ranging in age from a couple of months old to young adults. I saw patients with conditions I had only studied in textbooks but had never seen in real life. Because we did not have internet access to our usual online resources, I had to rely on my knowledge and advice from my team to care for these patients. We were able to work through this obstacle as a team and brainstorm ways to work together to provide better care.

Some days I saw some very heartbreaking cases. One of the first patients I saw was a young girl who has never been able to walk. Since she was an infant, she has experienced seizures intermittently and hadn’t received any treatment. We had a long conversation and answered some of the family’s long-term questions, even though the prognosis wasn't the answer they had hoped for.

I also saw another young girl who had developed a very serious bone infection called osteomyelitis, which caused swelling and drainage in her knee. She never received treatment to cure the infection. She needed to go to a children’s hospital immediately for antibiotics and possibly surgery to save her leg and prevent the potentially life-threatening infection from spreading.

Sending her to this hospital posed a significant financial burden to the family, but they were determined to get their child the care she needed. Together as a team, we helped the family cover the cost so that she could start treatment. By the time our team left, she was slowly improving.

Overall, my time in Migori was incredibly heartwarming and heartbreaking at the same time. Every patient we saw was so kind and grateful to be heard and to receive help. At the same time, I was really shocked by the degree of poverty and the significant barriers to medical care that are accepted as the norm for Kenyans. They’re faced with decisions to either have food on the table, send their children to school or receive medical care, and oftentimes, medical care is chosen last. I left Kenya feeling grateful for the high quality and comparably easier access to medical care that we have here in the States.

Before they can pump weights in the school gym or march with the band this summer, teens in Texas need to complete a form that aims to catch any underlying health concerns.

The annual UIL pre-participation physical evaluation form applies to junior high and high school student athletes and marching band members for the 2023-2024 school year. The form has two parts:

1.      Medical history – a list of yes/no questions about headaches, dizziness, chest pain, seizures, allergies and more. This portion must be filled out every year by the student and parent or guardian.

2.      Physical exam – performed by a physician to check the student’s lungs, joints, vision, weight, heart rate, blood pressure and more. UIL requires the physical exam before the 7th, 9th and 11^th grades. Some districts, including Fort Worth Independent School District (FWISD), require it annually.

Doctors at Cook Children’s say the physical exams are an important safeguard for student athletes. Sports physicals give doctors the chance to check for a variety of concerns – everything from poor eyesight and asthma to a lingering sprain or even a serious heart condition.  

“The goal of a sports participation physical is to review each child’s health history, to perform a thorough exam, and to identify health issues that could predispose the participant to a high risk of having symptoms or an injury while playing sports,” said Ann Natterer, M.D. at Cook Children’s Pediatrics Cityview in Fort Worth.

Why go to your regular pediatrician for this exam?

Dr. Natterer points out several advantages, including patient privacy and getting up-to-date with routine care, such as vaccinations.

“The pediatrician knows the child the best, has access to past medical history, and is also in a better position to facilitate any follow-up evaluations that may be necessary,” she said.

The pediatrician sees the big picture during a sports physical, said Wuroh Timbo, M.D. at Cook Children’s Pediatrics Lake Forest in McKinney. Your teen’s doctor has the files to track changes over time in weight, heart rate, medications and other parts of health history. Your teen’s doctor also knows about any previous illnesses, such as rheumatic fever, which can cause heart valve damage.

“And I think also just having an already established rapport with the families,” Dr. Timbo said. “It’s way easier to communicate with someone you already know. You’re going to get better information and give better information when there’s already a previously established relationship.”

Dr. Timbo recommends that parents make the appointment for their teen’s sports physical as early as possible. Getting the physical exam done early in the summer beats the rush that typically happens just before football workouts and band practice start. In other words … don’t put it off. It’s better to find out in May rather than in August if a student athlete needs vision correction, an inhaler or physical therapy, for instance.

What to Expect

It takes about 15 minutes, Dr. Timbo said, to go through a sports physical. Blank spaces on the UIL form allow the doctor to make note of any abnormalities with the patient’s eyes, ears, throat, lymph nodes, pulse, lungs, abdomen, back, feet and joints.

A sports exam gives patients the chance to ask questions or report any problems that impact their athletic ability. Knee pain and heel pain are the two most common complaints that Dr. Timbo hears. Sometimes the athletes tell him they’ve noticed shortness of breath or frequent headaches.

“Whether it’s something like exercise-induced asthma that we hadn’t caught before, or it’s an injury that re-aggravates every time they do a certain movement, we want to know, and we want to come up with a treatment plan to address it,” he said.

After the exam, the doctor checks one of three options on the UIL form: cleared for participation, cleared after completing additional evaluation or rehabilitation, or not cleared due to concerns. A referral might be needed for further tests with a specialist.

FWISD Director of Athletics Lisa Langston, Ph.D. said a physician’s clearance offers some assurance that the students can safely practice and compete in sports activities. Thanks to the required physical exams, she said, conditions such as cardiac issues and hernias have been detected through the years.  

“The students understand it’s all about their health and wellbeing. We’re not just doing lip service,” Dr. Langston said.

Dr. Timbo urges his patients to listen to their bodies. Speak up if something feels off. Understand that the annual sports physical is geared to pick up on any medical condition that might hinder their performance. Some underlying conditions could even be life-threatening, such as heart rhythm disorders that might lead to sudden cardiac arrest. 

“All doctors want their patients to be active,” he said. “Athletics is good for the body, good for the heart and teaches great life lessons on the ability to work in teams, resiliency and concentration. But we as physicians want to make sure that they’re safe to participate in these activities.”

By buckling their children into car seats and lifejackets, parents are taking steps to protect against tragic accidents. Safe sleep practices fit into that same mindset.

Taking precautions in an infant’s sleep space -- just like the precautions involving car seats and lifejackets – helps reduce the risk of serious or fatal injury. That’s why Cook Children’s urges families to make it a priority to create a separate, safe sleep environment for babies 1 year and under. The safest place for babies to sleep is on their backs, on a flat and firm surface, in their own bassinet or crib without pillows, blankets or soft toys.

The message of Safe Sleep gained urgency at Cook Children’s and across the community after we shared that 30 infants died over a 15-month period from cardiac arrest, respiratory failure or other trauma due to sleep incidents that happened at home.

From January through April 2023, five sleep-related deaths were recorded at Cook Children’s, all to infants under 1 year old. These deaths happened on couches, adult beds, and during co-sleeping. 

It isn’t safe for anyone to sleep in the same bed with babies at night or even for quick naps on the couch or in a recliner, due to the risk of unintentional suffocation. Babies can fall, be strangled or wedged between furniture and walls. Loose sheets, a comforter or another person’s body can cover the baby’s face and block the airway.

Co-sleeping already creates unsafe risks for babies. The U.S. Department of Health and Human Services identifies several factors that increase the risk even further, including:

• Co-sleeping with one or more people
• Co-sleeping on a waterbed, old mattress or an especially soft surface
• Napping on a couch or armchair, either alone or next to someone else  
• Co-sleeping with adults whose fatigue or use of medication, drugs or alcohol makes waking up difficult 

More than 3,500 sleep-related infant deaths occur each year in the U.S., according to the Centers for Disease Control and Prevention.

What are some reasons that bed-sharing occurs?

Some parents share reasons such as convenient breastfeeding, generational or cultural habits, busy lifestyles, the expense of cribs, limited space to put a baby bed in a crowded home, and the belief that “it won’t happen to me.”

Bianka Soria-Olmos, D.O. of Cook Children’s Pediatrics Haslet says that when her patients report that they bedshare, she shapes the conversation from an injury prevention perspective. In her experience, most families that choose to co-sleep have tried but given up on putting their infants in a separate sleep place. 

“The majority of the time moms say the baby just won’t stay in the bassinet,” Dr. Soria-Olmos said.

Some parents opt for bed sharing because they believe it will promote strong emotional bonds. Dr. Soria-Olmos wants them to know that co-sleeping isn’t required for bonding. That’s because everything that parents do to care for their baby – feeding, bathing, diaper changes, singing, play and more – creates the parent-child bonds. 

Paulette See, M.D. at Cook Children’s Pediatrics Haslet understands how tempting it can be for parents to bring their baby to bed with them, especially when they’re exhausted. 

“I get where you’re coming from,” said Dr. See, who is a mother and grandmother. “As much as we want to love and cuddle our babies all the time, for them to sleep on their backs in their own space is the safest.” 

In Dr. See’s experience, postpartum anxiety can lead some mothers to incorrectly believe that their baby is safer sleeping in the parent’s bed. It eases their minds to realize they can still see and touch the baby if the bassinet or crib is within arm’s reach, she said.

Dr. See empathizes with patient families who say their baby sleeps longer and cries less in the parents’ bed. But “just because something fits our lifestyle better doesn’t make it right,” she pointed out.

Here’s a comparison Dr. See makes: Your baby might scream in their car seat, but you buckle them in anyway. The same logic applies to the crib, where your baby might cry at first when learning to sleep separately, but you stick with it from a safety standpoint.

Cook Children’s pediatricians and health care providers want to share the information you need to keep your child safe and healthy. Cook Children’s encourages all families to understand that they can check on, feed and comfort their baby without sleeping in the same bed. Share a room, not a bed. A safe sleep space for your baby can either be a bassinet, portable crib or play yard near their parent’s bed.

RELATED:

Pediatrician's Advice: Straight Talk About Sleepless Nights (checkupnewsroom.com)

So the Rock-N-Play’s Been Recalled. Now What? (checkupnewsroom.com)

Pediatricians Offer Virtual Newborn Classes for Parents (checkupnewsroom.com)

The number of babies and toddlers who screened positive for marijuana in the Emergency Department at Cook Children’s continued trending up in 2022.

Last year’s data show 33 patients between ages 0-3 whose urine tested positive for a molecule called tetrahydrocannabinol (THC), the main psychoactive ingredient in the cannabis plant. Back in 2019, there were just eight patients from the same age group with THC-positive urine. The number climbed to 13 patients in 2020, and to 29 patients in 2021.   

Doctors at Cook Children’s say the marijuana intoxication cases they see in babies and toddlers are caused by accidental ingestion of edibles. Edibles are marijuana-infused food items such as gummies or other candy, cookies, brownies, beverages and other products. They aren’t safe for children to consume.

The U.S. Centers for Disease Control and Prevention (CDC) cites the longer-lasting and unpredictable effects of edibles, in which the strength of the ingredients might not be known. Ingestion can cause altered mental status, extreme sleepiness, high heart rate and trouble breathing in young children.

“We’re not here to judge but to provide a warning that if you’re going to have these in your home, you really need to lock them up so that kids can’t access them,” said Daniel Guzman, M.D., who works in the Cook Children’s Emergency Department (ED).

Teenagers made up the majority of the 693 patients in the ED who tested positive for THC in the urine screenings last year. Even though there were far fewer younger patients affected overall, any ingestion by babies and toddlers raises concern. To a curious child, a candy or cookie edible looks like something good to eat.

Recreational marijuana use is illegal in Texas. But a product called delta-8, derived from legally grown hemp, is legal to buy and sell as long as THC levels are less than 0.3%. Delta-8 concentrated in a lab can produce a “high” similar to marijuana. Also, low-level THC medical marijuana can be prescribed in Texas for patients with conditions such as epilepsy and multiple sclerosis. 

Medical experts point out that any amount of drug will have a much greater impact on a child’s small body than on an adult. They urge precautions by all caregivers – parents, older siblings, grandparents and babysitters - to prevent the youngest and most vulnerable from swallowing any edibles they happen to find on a nightstand, in a purse, in a vehicle or in other locations. A preschool in Prosper made national headlines last Halloween after four children became ill following alleged exposure to THC.

What are the signs of marijuana intoxication? How is it treated?

Emergency Department

Abnormal behavior, extreme sleepiness and unresponsiveness are red flags for marijuana ingestion. When children come to the ED with those symptoms, doctors try to rule out other possible causes such as infection or traumatic brain injury.

“Unfortunately, we’ve seen an uptick in the number of kids who have had marijuana ingestion or use over the last couple of years,” Dr. Guzman said. If doctors suspect the child might have eaten a marijuana edible, they will ask the parents or caregivers about any drugs in the home.

“It’s a fair question to ask given the breadth of kids coming in with accidental ingestions. It’s not to judge anybody – we just want to know what we’re dealing with so that we can treat it quickly and know what to expect.”

It takes about three hours to get results from THC tests in the urine samples. Meanwhile, supportive care is provided while the intoxicating effects wear off, usually within about 12 hours. Dr. Guzman said the medical team will monitor the patient’s vital signs and fluids, protect the airway, and watch for worsening symptoms. If the patient’s breathing rate becomes short and shallow, he said, extra oxygen or a breathing tube could be needed.   

Children diagnosed with marijuana ingestion can typically be discharged to go home from the ED after they become alert, act playful, and resume eating and drinking, Dr. Guzman said. More serious cases require further care in the Medical Center.   

Admitted to the Hospital

Kyle Brady, D.O., a pediatric hospitalist at Cook Children’s, said sometimes it takes longer for young patients’ bodies to eliminate the drug. They remain extremely sleepy. The medical team waits and observes. An electrocardiogram (EKG) may be needed to measure the patient’s heart rhythm during recovery. 

“The big thing is doing neuro checks and making sure they’re arousable,” Dr. Brady said. “With the ingestive THC, your liver has to process that chemical, and it just takes time. The smaller you are with how strong some of these compounds are, it can be a few days that we see them in the hospital.” 

Severe cases of marijuana ingestion are linked to high concentrations of THC, he said. “It can be very scary and worrisome to both the parent and the provider,” Dr. Brady said.

Before he will discharge a patient from the hospital following marijuana ingestion, Dr. Brady wants to see that they’re completely awake, playing, eating and able to crawl or walk appropriately for their age. 

What safety tips do the experts at Cook Children’s recommend? Keep marijuana edibles locked up and stored out of reach. And make sure babysitters and grandparents understand those products are harmful to children, even though they look attractive.

“A little kid should not be ingesting THC, and if you as a parent are using it recreationally, you need to use it responsibly and you need to treat it as you would any kind of alcohol product or any kind of household chemical,” Dr. Brady said.

Dr. Guzman pointed out that parents and caregivers must take steps to keep their children safe around firearms and swimming pools. Safety measures apply to marijuana edibles too.

“It’s all about access,” he said. “If we can be responsible adults when it comes to any of these injury prevention areas, then we can keep our kids from getting hurt.”

If you think your child has ingested marijuana, get medical help or call the Texas Poison Control Center at 1-800-222-1222. For more information: Marijuana Edibles - Texas Poison Center Network (poisoncontrol.org)

Osaretin Aimuyo, M.D., Cook Children's Pediatrics Arlington
“My mother has always told me, 'If you aim for the treetop, you'll never leave the ground. But if you aim for the sky, you will always reach the tree.' It was her way of telling me to always aim high and have strong aspirations.”

Diane Arnaout, M.D., Cook Children's Pediatrics Forest Park
“Even though I’m a pediatrician with 13 years of experience, I still go to my mom for advice about my kids. From burping my grumpy infant to helping my school-aged kid with school troubles, mom has always had reassuring words to help me realize that it’s all going to be okay.  Also she taught me that if my kid smells a lemon in the car, she won’t puke from motion sickness. Mind-blowing. Mom is the MVP.”

Sireesha Mutyala, M.D., Cook Children's Pediatrics Plano Legacy
"Always volunteer in your neighborhood, school and church or temple. Being involved gives you a voice and builds a better community!"

Alice Phillips, M.D., Cook Children's Pediatrics Cityview
“My mom always told me being a grandmother was the best but she still had good advice for me.  She pushed me to take care of myself.  ‘Take care of Ben and Annie’s Mom. She will be a better mom if you do.' Even though she is not with me anymore, I still feel her presence in the many lessons she shared with me. Once a mom. Always a mom.”

Rekha Sivadasan, M.D., Cook Children's Pediatrics Frisco
“One of the best pieces of advice my mother ever gave me was ‘Listen to your inner voice, do the best you can and leave the rest in God’s hands.' I have made this my mantra for life!”

Karen Evans, M.D., Cook Children's Pediatrics Parkwood
“Advice from mother: ‘Know that you are loved.  Strive to be and do better than the generation before you.  For this, live your life in honor to God and your path will be made clear.’”

Bianka Soria-Olmos, D.O., Cook Children's Pediatrics Haslet
“The most important advice from the two most important women in my life came in the form of day-to-day lifelong lessons. I was fortunate to have my abuelita (grandmother) live with my family when I was growing up. She was the matriarch of our family until her death a few years ago. She reminded me ‘Ser fuerte y trabajadora. Es mas que suficiente para lograr todo lo que tu quieras’ ('Be strong and hardworking. It is more than enough to achieve everything you want.') From my mom I have learned a lot about balancing motherhood and a career. I've always looked up to her and now enjoy seeing her love for my boys.”

Brothers Isaac Martinez, 7, and Jaden Alvarado, 13, are recovering at Cook Children's Medical Center after they were playing outside their home Wednesday afternoon when the tree above them was struck by lightning.

The lightning ricocheted and struck Jaden and Isaac, causing them to lose consciousness and collapse.

“It looked like fireworks were coming down the tree,” their mother Jessica Martinez Alvarado said. “I saw the boys lying on the ground when the fireworks stopped. ... I thought I had lost my boys. It's the worst feeling ever. I would never wish that on anyone.”

Isaac and Jaden were immediately rushed to Cook Children’s Medical Center Emergency Department. Doctors say that Jaden was primarily impacted by the lightning and likely suffered a cardiac arrest. The lighting ricocheted from Jaden to Isaac.

By Thursday morning, the boys were transferred to the Pediatric Intensive Care Unit, with their mother and family at their side as they rested and played video games.

Jessica said they were still processing what happened to them. The boys said they don't remember what had happened and they were feeling OK.

It wasn't raining when the boys were struck, Jessica said. She noticed the lightning was getting more intense and was about to tell the boys to go inside when the lightning struck the boys moments later.

“They're always outside playing. They love to play football or any kind of sports," she said. “Their favorite thing to do is play with their dog.”

Her advice to other parents: “Don't let their kids outside when it's thundering. I know it's a one-in-a-million chance, but you never know, you might be that one. It was two for me. Be very, very careful with your babies. Make sure you hug them and kiss them and hold them tight."

Taylor Louden, M.D., Medical Director, Pediatric Emergency Medicine at Cook Children’s Medical Center, said that parents should be cautious and keep their children indoors when there is a severe weather threat or thunder and lightning.

“The boys came in altered and confused," Louden said. "These boys are very lucky. We're glad everyone came out OK in this instance."

If someone is fatally struck by lightning, cardiac arrest is the immediate cause of death. Dr. Louden said it is crucial for a lightning strike victim to receive CPR as soon as possible or use an Automatic External Defibrillator (AED). Witnesses should call 911 immediately.

“Fortunately, lightning strikes are very rare, but we do have to be aware [of storms], especially in Texas where storms can come out of nowhere quickly," Dr. Louden said. "Even if storms are in the distance, you're still at risk.”

According to the Centers for Disease Control and Prevention, the odds of being struck by lightning in a given year are less than one in a million and almost 90% of all lightning strike victims survive.

We celebrated all of our world-class doctors. From diagnosing a stomach bug to operating on a broken leg to making treatment plans, the work they do every day is making a difference in the lives of children.

8th Annual Slime-A-Doc

On Thursday, Cook Children's employees, patients and patient families also participated in our 8th annual Slime-A-Doc! You can rewatch the Facebook Live here.

This year, we had four categories of participants: physicians, nurses, child life specialists and members of the Cook Children’s Health Care System’s leadership team.

Thank you to everyone who participated! A big shout-out to Martin Aguado and the Facility Appearances team for making this event possible!

When your child is struggling with their mental health, it can be difficult to know where to turn. Nationwide, waitlists for appointments with child psychologists and psychiatrists can be months long. As a result, pediatricians have become the first line of defense for families who need support.

Alice Phillips, M.D., wears many hats at Cook Children’s. She’s the Board Chair of Cook Children’s Physician Network and Medical Director of Ambulatory Quality. Dr. Phillips is also a pediatrician at Cook Children’s Pediatrics Cityview, and has seen mental health concerns in her practice increase dramatically over the past 26 years. On this episode of Raising Joy, Dr. Phillips talks to us about the role of pediatricians in the mental health crisis and the growing number of tools in their toolbox to help children.

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

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

March is Women’s History Month. While the country commemorates the role of women in American History, at Cook Children’s Health Care System, we celebrate the role of women in building one of the largest free-standing pediatric health centers in the country. 

After all, it was the vision and generosity of two women that started it all. 

One was a former postmistress with few financial resources, Mrs. Ida L. Turner, who dreamed of a place where fragile babies would be cared for regardless of their family’s ability to pay. Her vision and hard work led to the opening of the Fort Worth Free Baby Hospital in 1918. 

The other was a wealthy heiress who wanted to honor her late husband by helping sick children. In 1929, Mrs. Missouri Matilda Nail Cook dedicated the oil royalties from the Cook Ranch to build the W.I. Cook Memorial Hospital. 

Eventually, the two children’s hospitals became one and grew to be one of the finest pediatric medical institutions in the country with more than 1.5 million patient encounters every year.

Throughout our 105-year history, the women of Cook Children’s have championed children; nurtured the sick and hurting; led innovation in science, medicine and technology; and steered health care with imagination, safety, generosity, kindness, respect and collaboration.

While these women number in the thousands over the history of Cook Children’s, this year, we’re highlighting a few who have made their mark in medicine. Each woman comes from a different background, different specialty and different decade, but they all share two things — a passion for their work and the Promise to improve the well-being of every child in our care and our communities.

Elizabeth Leeper, MSN, RN, CNOR

Manager of Surgical Clinical Excellence

Years at Cook Children’s: 27

Elizabeth Leeper has been a staple in Cook Children’s surgery department since she began as an operating room nurse in 1996. Today, she is the manager of surgical clinical excellence, a role she pioneered in 2017 and built from the ground up. So far, she is the first and only one to hold the position.

Leeper and her team of three reviews every single surgical case at Cook Children’s Medical Center to monitor for quality and safety. It’s no small feat for her small department. Under Leeper’s leadership, their hard work earned Cook Children’s a Level I designation as a Children’s Surgery Verified program from the American College of Surgeons. 

To achieve this designation, hospitals must meet a rigorous set of safety standards and demonstrate they have the resources needed to provide children with high-quality surgical care. There are only five pediatric hospitals in Texas with this designation, and Cook Children’s was the first in North Texas to be named a Children’s Surgery Verified program in 2019. 

“By the time I finished our application, it was over 100 pages,” Leeper said. “They look at any part of the hospital system that might potentially touch a patient and want to know information about that. I had to gather information from the lab, pharmacy, radiology, transport, all our surgeons, administration … you name it. I'm in the middle of our renewal application right now, so I'm working on pulling that information together.”

Leeper doesn’t mind the endless information collection and review. She follows in the footsteps of her childhood inspiration and founder of modern professional nursing, Florence Nightingale, who also used statistics and data to improve health care as far back as the mid-1800s.

“I discovered how much of a data nerd I really am,” she said. 

Today, Leeper draws inspiration for life and work from her daughter. 

“We have an adult daughter with a really rare neuromuscular disease,” she explained. “She lives with us and is wheelchair-bound. Knowing that she gets up every day and watching her deal with what she has to deal with, I know that if she can do it, I can do whatever is before me.”

When the load gets heavy, Leeper leans on her faith and prayer to carry her through.   

“Just being able to know that there is a God, and he does love us and that he takes care of us is an important part of my life,” she said. “I know that he's there even though, sometimes, it's hard to see.”

Lisa Elliott, Ph.D., Psychologist

Manager of Cook Children’s Behavioral Health Clinic in Denton

Years at Cook Children’s: 29

Psychology is a second career for Lisa Elliott. Initially, a human resources director with a degree in business, Dr. Elliott began taking psychology classes to better understand how to help the employees she represented. 

“I would have to call in employees for failure to show up to work, wage garnishments or disciplinary actions, and there were always reasons for that, like family, emotional or mental struggles,” she said. “So I decided to enroll in a couple of psychology courses where we were living at the time to understand how I could better help our employees.”

Dr. Elliott found the courses fascinating and impressed her professors, who encouraged her to continue her path in the field. She eventually applied and was accepted to the doctoral program at the University of North Texas where she specialized in neuropsychology. 

Dr. Elliott calls herself a non-traditional neuropsychologist because she uses both the therapy side of psychology and the testing and research side of neuropsychology. 

“I always thought I wanted to do therapy, but that's when I felt like you could nurture anyone into health,” Dr. Elliott said. “Then I discovered that nature and what a child is exposed to in utero is a huge piece of this, too. That's when I changed and recognized the value of testing and started a huge focus also in neuropsych.”

In 1994, she developed and opened Cook Children’s first outpatient behavioral health therapy clinic in a 500-square-foot office in Denton. Within months, demand for the service forced the clinic into a bigger space.

Dr. Elliott mentors and trains the next generation of neuropsychologists, too. For 22 years, she has led a neuropsychology fellowship program that provides training for people completing graduate degrees and requirements for full licensure. 

While impactful, neither of these accomplishments makes her proudest moments list. For that, she thinks only of her patients. 

“This isn’t about me,” she said of her work. “What gets me in my little happy zone is actually when I see my patients’ success and see them excel, thrive and take pride in the coping skills they've learned and their increased self-confidence and self-esteem, that brings me to tears.”

When adversity comes, Dr. Elliott turns to prayer and leans on her source of hope — her faith in God. Then, she looks for ways to serve others.

“I've always decided that not only do I want to look for the helpers when there is trouble, but I want to be the helper,” she said. “I want to model that hope, kindness and compassion. When we are doing for others, that also helps us through our own personal adversity.”

Carla Smith, D.O., FACOP, FAAP

Pediatrician at Cook Children’s Pediatrics Burleson

Years at Cook Children’s: 14

Carla Smith, D.O., was a member of one of the first graduating classes at the University of North Texas Health Sciences Center in 1979 — one of only three females out of 70 students. Even so, she doesn’t consider herself a trailblazer for women in medicine.

“You become a family with the people that you spend that much time with,” Dr. Smith said. “As students, we all just wanted each of us to succeed, not caring if we were male or female.”

Dr. Smith can’t remember a time when she didn’t want to be a doctor. She knew, even as a child, that she would pursue a career in medicine. The desire to be a pediatrician came during her pediatric rotations in medical school. 

“I realized how much I enjoyed working with children and their zest for life and wellness,” she said. “And possibly a little bit of selfishness as I realized that children love to be well, and they could make me laugh and help me keep a young and healthy attitude.”

Dr. Smith was one of the first locums doctors for the system. A locums doctor works temporarily for another physician. She initially worked part-time for a Cook Children’s physician in Granbury who needed a day off each week to be with her young children. Dr. Smith went on to work temporarily at many local physician offices when they needed someone to fill in. 

Then, in 2010, Cook Children’s built a clinic in Burleson, where Dr. Smith has lived since 1995. She jumped at the chance to work full-time in her own community.

“I was hired, as was Dr. Lanna McClain, and I can honestly say that we both cried when we arrived at our beautiful office for the first time,” she said. “That is my proudest moment, the opening of the Burleson office, and being able to work in my hometown! It has now been open for 13 years. A fantastic office with three physicians, two nurse practitioners, a great office manager and a great staff.”

The journey to becoming a pediatrician wasn’t always easy, she said, but Dr. Smith wants other women considering a career in medicine to know the hours of study, training and sacrifice were worth it. And when they get overwhelmed, to do what one of her professors once told her: “Take it one step at a time.”

Candace Gamble, M.D.

Medical Director, Genetics

Years at Cook Children’s: 7

As a geneticist, Candace Gamble, M.D., puts together the pieces of a patient’s genetic puzzle, including medical and family histories and genetic testing results, to identify an underlying disorder. Once a diagnosis is made, she and her team help patients and their families navigate their health care needs through counseling and advocacy. 

In college, Dr. Gamble thought she wanted to be a lawyer, but after a little more than a year following that path, she realized her heart wasn’t connecting with the legal profession. So she pivoted and found her calling in the biological sciences. 

“I look at my work as a calling when the days and weeks become difficult, so my faith is what does it for me,” Dr. Gamble said of what gets her through adversity. “I’m not sure I could have made it through this long journey to medicine without my faith foundation. It’s not about me and my accomplishments, but about my divine purpose.”

Watching her team work together to find creative solutions to overcome recent staffing challenges is one of her proudest moments at Cook Children’s. Dr. Gamble said each person in her department, from administration to clinical staff to the nurse practitioners and fellow doctors, has been incredible team players and instrumental in developing creative solutions to continue to meet their patient’s health and well-being needs. 

“I love caring for our patients but my work family in genetics makes it so much easier,” she said.

During her residency, and thanks to the influence of one of her mentors, Dr. Gamble became interested in the study of skeletal dysplasias, a category of rare genetic disorders that affect a baby’s bones, joints and growth. She has been an investigator in several skeletal dysplasia research studies and a contributor to many publications.

“Much of the research I have done was all natural history studies, learning more about the disease process and how they affect patients,” she said. “But now we are entering an exciting time where treatment options are available for specific conditions and patients and families that desire treatment. One example of this is vosoritide, a daily injection that can be used for those with achondroplasia, which is the most common skeletal dysplasia, to increase final adult height.”

Having a mentor, she said, kept her moving forward in the pursuit of her passion. Dr. Gamble encourages other women working towards a career in health care to find someone, in medicine or another profession, that will hold them accountable to their dreams and goals. 

“Those dreams were put upon your heart for a reason, and I truly believe they are part of your destiny and purpose,” she said. “Having a mentor is especially important for women of color who may lack access to tangible representation in a certain field.”

Story by Jean Yaeger. Video by Tom Riehm.

When she was an elementary school student, LaQuatre Rhodes, D.O. had a passion for science projects and a big goal: to become a doctor.

“Your experience at the pediatrician's office is one that either excites you as a kid or makes you nervous,” said Dr. Rhodes, pediatric gastroenterologist. “I would be excited because I knew I was probably going to get a little treat, and I liked all the things that were happening there.”

That same enthusiasm carries over these days in her practice at Cook Children’s Specialty Clinics in Prosper. As she treats children and teens who have GI issues - diseases and disorders of the digestive system – Dr. Rhodes provides medical expertise and an example for aspiring physicians. She often notices a special look of recognition and wonders on the faces of her Black patients when they meet her in the exam room. Feeling at ease, those patients will approach her in very close contact.

“It’s just the exposure. It’s a joy and humbling to know that seeing someone who looks like you makes you feel more comfortable,” she said. “Some of them will let me know that they want to be a doctor. Seeing me definitely helps to put that in reality for them.”

According to the Association of American Medical Colleges (AAMC), about 5% of physicians in the United States identify as Black or African American, like Dr. Rhodes. That proportion could increase as medical school demographics shift. The AAMC reports that 11.3% of students entering med school in 2021-2022 cited Black or African American race or ethnicity, up from 9.5% the previous year.

As we celebrate Black History Month in February, Cook Children’s wants to salute Dr. Rhodes and everyone who brings diverse representation and voices of advocacy to health care.

“You can be the face of change you want to see by going into a field where you’re a minority,” said Dr. Rhodes, who never encountered a Black pediatrician growing up in Shreveport, La. “Having a seat at the table and more diversity is what changes the field and allows people to see things from a different lens.”

Path to her Goal

Science was Dr. Rhodes’ favorite subject, stemming early on from her participation in science fair competitions. One of her projects measured the effects of antacids (Rolaids, Tums etc.) on indigestion; as a fourth-grader, she already showed a preference for GI topics. Dr. Rhodes took Advanced Placement courses in high school. But academics wasn’t her only love … ballet, student council and sports also kept her busy.

Dr. Rhodes gives credit to her mother for modeling the core values of perseverance and hard work. Even though her mother was 18 when Dr. Rhodes was born, she was determined to achieve higher education. She was the first in the family to graduate from college and obtain a master’s degree.

“I was raised by a single mother who always instilled in me to reach for the stars, to be bold, be brave, and dare to be different,” Dr. Rhodes said. “Everything I learned, everything that has driven me to be very independent and focused, has come from her.”

She also volunteered at a free health care clinic where she saw the need for greater access to care. Her aspiration grew even stronger when she saw several slightly older Black acquaintances from her hometown enter medical school.

She earned a bachelor’s degree in biology from Baylor University and a master’s in biology from Louisiana Tech University. A summer program allowed her to shadow physicians, go to an anatomy lab, and preview other facets of medical careers.

But the MCAT tripped her up. Dr. Rhodes took the medical college admission test three times before scoring high enough to submit an application. She cites the MCAT as her biggest hurdle. “Once I got in, I was able to soar” at Ohio University Heritage College of Osteopathic Medicine, where she earned her medical degree.

While on a clinical rotation at the Cleveland Clinic, Dr. Rhodes crossed paths with a pediatric resident named Anthony Anani, M.D. Fast forward several years, and Dr. Anani was medical director for Clinical Services at Cook Children’s Medical Center reaching out to Dr. Rhodes about job openings in Prosper. Dr. Rhodes joined Cook Children’s in August 2022 as Dr. Anani’s colleague in pediatric gastroenterology.

Helping Sick Kids Get Better

Dr. Rhodes enjoys working with adults as well as children. But she decided to focus on pediatrics because of the resilience of children.

“Children are just pure joy,” she said, “and when they're sick, you want to make them well. And when they're doing well, it's a rewarding, humbling feeling.”

Her love for the human digestive system developed in part from research on the livers of rats that were fed various diets. The structure and function of the GI tract key parts – including the esophagus, stomach, intestines, liver and pancreas – fascinate Dr. Rhodes.  As she puts it: “All roads end up leading to GI.”

Reflux and constipation are common concerns for the patients she sees. More complicated cases include inflammatory bowel disease, chronic liver disease, and unexplained vomiting/nausea and bleeding. Dr. Rhodes provides biopsies, endoscopies, colonoscopies and other services.

Finding Inspiration

Dr. Rhodes points to Dr. Rebecca Crumpler as a health care pioneer for her achievement in 1864 as the first Black female physician in the United States. Dr. Rhodes predicts the physician workforce will continue to become more diverse. Cognizant of the opportunity to influence future doctors, she makes herself available to young people seeking reassurance about medical school.

One of Dr. Rhodes’ favorite quotes embodies her philosophy of pursuing your goal even in the midst of challenges: "Every dream begins with a dreamer. Always remember, you have within you the strength, patience, and the passion to reach for the stars to change the world." – Harriet Tubman

“That quote just really inspires and motivates you to want to be great and to dream big. It gives you the inspiration that it's possible, and to embrace things that come along the way.”

As the Surgeon-in-Chief for Cook Children’s Healthcare System, Eric Hubli, M.D. knows that every surgery needs a backup plan. In many cases, one backup plan is not enough.

“The key to a really good surgeon is the ability to adapt. When operations move in a unique or unexpected direction, you have to be able to create plans b, c, d and e,” Dr. Hubli said.

During the separation procedure for 16-week-old conjoined twins AmieLynn and JamieLynn Finley, multiple layers of plans were considered and vetted in order to give the girls a chance at life on their own. Dr. Hubli has been a colleague and champion for surgeons at Cook Children’s for the past 15 years. Now he is part of a multispecialty team that came together in an effort to understand and manage every nuance of the separation surgery.

Dr. Hubli’s primary role before the surgery was to assist the other surgeons with the organizational process to remove any barriers so their vision could be realized.

“We put our minds together, reviewed all the clinical data and thought about where the challenges would be," Dr. Hubli said. "We then worked to solve them. One person cannot figure it all out, so it was truly a blessing that we had surgeons, anesthesiologists and multiple doctors from different backgrounds. The various viewpoints allowed us to see things from many angles and these collegial interactions were critical to our future success. There were no egos for we were all focused on one goal – a safe and successful surgery.”

Journey to Plastic Surgery

When Dr. Hubli started medical school at Tufts University School of Medicine, he planned to become a pediatrician, but one surgery changed everything.

“During my first clinical rotation, I saw an operation for the first time in my life," Dr. Hubli said. "It was the coolest thing that I had ever seen. The patient went to sleep and woke up ‘fixed.’ I thought the procedure was nothing short of miraculous so right then and there, I decided that I was going to be a surgeon. There are many surgical fields, but I decided on pediatric craniofacial/cleft and plastic surgery because I love working with kids and I enjoy the challenge associated with the uniqueness of every surgery. No two cases are alike, so every operation requires its own unique solution.”

As medical director of Craniofacial and Cleft Services at Cook Children’s, Dr. Hubli brings more than 29 years of craniofacial, cleft and pediatric plastic surgery experience. His focus is exclusively on children with reconstructive craniofacial and cleft issues.

“One of the things I love about pediatric craniofacial surgery is that I get to be with my patients throughout their childhood and teenage years," Dr. Hubli said. "I meet them as a baby and then travel along with them as they grow and develop. Facial structures change as we grow so I monitor my patients and make surgical adjustments when needed. I have two kids of my own, but I consider all these patients to be mine as well.”

Giving the Twins a New Lease on Life

Early on January 23, Dr. Hubli felt more than ready. Gathered outside the Operating Room doors, he joined the twins’ team of 25 medical staff as the group took a moment to pray for the long day ahead. All the hours of planning and replaying different scenarios in their minds would play out in real life.

Once they walked through the Operating Room doors, Dr. Hubli was confident that each team member knew their role and that the group was up to the challenge ahead. He wore green scrubs along with AmieLynn’s team and worked with the pediatric surgeons to perform her closure after the separation. Dr. Hubli said mental nimbleness is an essential part of the surgery – something his team is very familiar with and practices every day. 

“In surgery, you have to expect the unexpected," Dr. Hubli said. "Even the most straightforward case may have a surprise.  On top of that, surgeons who practice in the pediatric realm face the unique challenge of changing patient size. One day you may be operating on a premature baby who weighs less than three pounds and the next day a 300-pound, 16-year-old offensive lineman from the local high school’s football team may be on your OR table. You have to be able to adjust.”

This ability to adjust is demonstrated by all those who participated in this unique surgery. Surgeons, anesthesiologists, scrub techs, nurses, CRNAs, administrators; every member of the Cook Children’s team understands these challenges and each one is uniquely prepared to rise to the occasion.

Milestones Lead to Historic Moment

Many milestones brought Cook Children’s to this historic moment of separating conjoined twins.

“When I think of the milestones of our surgery program, I think more about our milestones as a medical center because we are all connected to accomplish the same goal," Dr. Hubli said. "In my mind, that is what makes Cook Children’s unique. Across the board, from the police officers to the food services and environmental services employees to the Radiology department, from the lab technicians to the CEO and CFO – everyone is all in. The Cook Children’s family has a vocational dedication to caring for these kids and their families. Every person pulls in the same direction – we are here for the kids and their families. This laser focus is why the hospital and our surgery department are top-notch. I have worked in other facilities but Cook Children’s is special – going that extra step is our standard. The caring and kindness you feel at this hospital is genuine. Every patient and family really matters to our staff.”

With every year that passes, Cook Children’s attracts new highly talented people. Dr. Hubli said over the span of 15 years since he began at the hospital, the main campus has expanded from one building to a destination hospital system that covers eight city blocks. New Operating Rooms, new patient rooms, a new NICU and advanced medical devices were brought to Cook Children’s. A new medical center in Prosper opened this month.

“I’ve seen nothing but incredible growth. Every year we enhance our facilities and our staff. In turn, this means that our patients have access to more service lines and care options. The surgery department is a great example of this growth. In the past few years, every surgical service line has added new surgeons. These surgeons have different specialty training which broadens our ability to meet the needs of our community. If your child has a neurosurgical, orthopedic, urological, craniofacial/cleft, ENT, ophthalmologic, pediatric or cardiac surgery issue, we have the staff to assist. In fact, the breadth of the surgery program at Cook Children’s has been recognized by the American College of Surgeons and the medical center has been recognized as a Level One Children’s Surgery Center. This means the hospital rates as a high-end, full-service pediatric facility.” 

By the Numbers

• Surgeries performed at Cook Children’s every year – 20,000
• Sets of conjoined twins born viable in the world each year – 5 to 8
• Percentage of conjoined twins that are female – 70
• Hours spent planning separation surgery – hundreds
• Medical staff in OR for separation surgery – 25
• Total hours in Operating Room for separation surgery – 11
   

‘Every surgeon is potentiated by our wonderful staff'

Dr. Hubli said surgery involves much more than the surgeon. He firmly believes that surgery is a team sport. 

“It’s great to have the best surgeon in the world on your staff, but that surgeon is useless unless the rest of your hospital can meet the challenges presented by complex surgical care. I am happy to say that Cook Children’s has the required talent. From Central Supply to the PICU, from Environmental Services to the C suite, our team is ready, willing and able. This support allows every surgeon to maximize his/her talent as they are all potentiated by this wonderful staff.”

Looking beyond the clinical realm, Dr. Hubli points to the commitment and dedication of the Cook Children’s administration and the surrounding community as key factors in bringing the hospital to this point.

“We can do this case because of the talent we have in the building, the administrators we work with and the community that we serve who supports us unequivocally. I really feel the community is behind us in all we do. The care that we give to children and families when they come in is returned tenfold from the community we serve. Whether it’s time or treasure, the people of our community are 100% behind us. It’s this give and take that makes Cook Children’s great. And that’s why I think we continue to be very successful.”

“I am proud that we have grown to a point where we can meet the challenges presented by the most complex cases.  I am also proud that we have the team right here in Fort Worth. But it’s not personal pride – it’s pride in our team. I am humbled to work with a group of caring, dedicated and giving people. Our Promise speaks to caring for the children and families of our community. I am honored to be able to work with a group of people that bring Our Promise to life.”

It's Personal

Dr. Hubli knows what it feels like to hand over his child to a surgery team. Seven years ago, his son underwent surgery at Cook Children’s – an experience that changed his perspective. 

“I walked into the building that day as a parent, not a surgeon,” Dr. Hubli said. “Before my son’s surgery, I always used to see the clowns walking through the hall and didn’t think much of it. But then the clowns came to my son’s room, and it was the first time I saw him smile in two weeks. That event reminded me that every member of the Cook Children’s team contributes in their own special way. I love those guys.”

Story by Heather Duge. Video by Tom Riehm.

When Shelbie Collins signed up for a camp just for kids with cancer in 2008, she had no idea the countless ways it would change her life.

As she battled cancer, little did she know that her future husband, Kaleb, was in his own fight with cancer and that their paths would intersect at Camp Sanguinity.

A Shocking Diagnosis

On the last day of second grade, Shelbie Collins woke up lethargic and not feeling well. Her mom thought it could be a virus but took her to Sandra Peak, M.D. of Cook Children's Pediatrics Lewisville - Castle Hills, just to be sure. At the office in Carrollton, Dr. Peak noticed a contusion on Shelbie’s arm and bruising on her chest. She suspected leukemia and immediately ordered blood tests.

“In that kind of situation, you’re working five steps ahead of what is happening in the room,” Dr. Peak said. “I ordered blood tests stat.”

That same day, Dr. Peak had to make the phone call every pediatrician dreads. She was not able to reach Shelbie’s mom, so she called her dad.

“That is a conversation that will forever be etched in my mind,” Dr. Peak said. “Her dad was instantaneously devastated and ready to attack the cancer. The security Shelbie’s parents had in their child’s health was pulled out from them instantly. That one phone call changed everything.”

Journey to Healing

Shelbie remembers her dad setting her on his lap and saying the words “you’re sick and we’re going to take you to Cook Children’s and will be by your side the whole time.” But Shelbie says it didn’t really sink in until she was at the hospital and heard the words “acute lymphoblastic leukemia” and “chemotherapy.” 

W Paul Bowman, M.D., Shelbie’s oncologist at Cook Children’s, would lead the team providing Shelbie’s comprehensive care. 

Treatment began immediately and a couple of weeks in, she underwent surgery to receive a port. Dr. Bowman talked to her parents about a therapy program he coordinated – Total XV protocol which is a research partnership between Cook Children’s and St. Jude Children’s Research Hospital that includes three phases and lasts 2 and a half years. 

Shelbie’s parents agreed to the protocol, and the first phase, induction, involved 46 intense days of chemotherapy. During the second phase, consolidation, Shelbie received high dosages of chemotherapy for three to four days biweekly. After two months of phase two, Shelbie moved to the final phase, continuation, with chemotherapy once a week.

“Through the inevitable ups and downs of chemotherapy, Shelbie remained a positive and happy child,” Dr. Bowman said. “She was always inquisitive and wanted to participate actively in her treatment with an understanding of the purpose behind each procedure and medication.”

Taking a Turn for the Worse

Sixteen months into her treatment, Shelbie’s doctors discovered she had gallstones. Later that evening, she spiked a fever and developed sepsis, a severe illness caused by an overwhelming infection of the bloodstream by toxin-inducing bacteria. Her kidneys shut down, and within 24 hours, she was in septic shock. Dr. Peak rushed to the hospital.

“When I walked into her ICU room, she was surrounded by so many doctors and nurses and on a ventilator. I could see the devastation in her parents’ faces. In that moment, it was the most fear I have ever felt as a physician.”

Dr. Peak and Shelbie’s other doctors discussed options as she only had a less than 1% chance of making it through the night. Britt Nelson, M.D., and the other doctors decided dialysis was the only option for her to have a chance at survival. Dr. Nelson's idea to do dialysis saved Shelbie’s life, Dr. Peak said.

“She was very sick,” Dr. Peak said. “Angels were flying so low around her that night.”

‘Miracles do Happen’

Shelbie was in an induced coma and fought through the infection for nearly three months in the hospital, not able to receive any chemotherapy. As the infection proved relentless, Shelbie proved resilient. She overcame sepsis and had to relearn how to walk and eat again.

What was planned for six months in rehabilitation ended up only being six weeks. After only three weeks, Shelbie’s determined spirit was on display as she started walking on her own.

“It was amazing to see Shelbie after that, walking into my office with all her energy and positivity. She is a reminder that miracles do happen.”

Shelbie’s cancer ultimately was put into remission, and she remains cancer-free.

Another Journey with Cancer Begins

In 2007, as Shelbie was nearing the end of her treatment, Kaleb Collins was just beginning his journey with cancer at Cook Children’s. He was 10 years old at the time and played baseball almost every day in his hometown of Wichita Falls. So, when Kaleb’s right knee began to swell, his parents thought it was a baseball injury.

After the first set of scans, doctors initially thought it was a growth plate fracture, but full body scans later revealed a different diagnosis – osteosarcoma (bone cancer) in his knee. 

Dr. Bowman also served as Kaleb’s primary pediatric oncologist as Kaleb underwent chemotherapy and a total knee replacement while taking part in a childhood cancer research study which involved 70 weeks of injections. In early 2010, Kaleb finished his treatment.

“Both Shelbie and Kaleb were fortunate to have the support of loving parents and family who contributed to a sense of security and emotional stability during their prolonged course of treatment and follow-up,” Dr. Bowman said. “They faced childhood cancer with courage and determination.”

“Looking back, I feel blessed,” Kaleb said. “I had a great mentor who was treated at Cook Children’s years ago and helped me through. I remember the people who cared for me always looking for ways to distract from the reason I was there, like Dr. Donald Beam and Dr. Kenneth Heym who would play games with me and amazing nurses who still keep in touch.”

Once-in-a-Lifetime Meeting

During the summer of 2008, Shelbie and Kaleb arrived at Camp Sanguinity – it would be her last year and his first time as a camper at a place they both found to be their safe haven. After meeting and sharing each other’s stories, they realized a common bond: they both viewed cancer as a part of who they were but something that did not define them.

“Having gone through cancer, we have more empathy for each other and a different lens for us to look at others,” Shelbie said. “We took our experiences and turned them into that strength.”

Kaleb describes his time at camp as an incredible week where kids with cancer just get to be kids.
In the summer of 2014, Shelbie and Kaleb went back to the camp for a leadership retreat for childhood cancer survivors. This time they reconnected and stayed in touch.

Shelbie remembers the day their relationship shifted to being more than friends when she visited him after surgery in December 2014.

“Sparks flew almost instantly,” Shelbie said. “I remember Kaleb texted me on my way home.”  

A New Chapter Together

Five years later, Kaleb proposed to Shelbie and the next chapter of their lives began in Oklahoma. Knowing the couple may have difficulty getting pregnant after undergoing chemotherapy, they were referred to a fertility specialist. While waiting for the appointment, Shelbie found out she was pregnant with their miracle baby. One of her first thoughts was moving back to be close to family and another very important person to them – Dr. Peak.

After their son, Graham, was born in 2021, the couple decided it was time to move closer to home.

“I made an appointment with Dr. Peak,” Shelbie said. “She started bawling. Graham was three months old when he first met her. Dr. Peak being Graham’s doctor has been the cherry on top. Watching her take care of our miracle baby is the biggest blessing to us.”

Dr. Peak feels the same way and loves her “grandpatients.”

“I have always wanted to be a doctor since I was a kid and played clinic for fun,” Dr. Peak said. “It is moments like taking care of Graham that remind me how blessed I am to be there for the whole family.”

Gaining Strength from her Patients

When Dr. Peak was faced with her own health challenge a couple of years ago, it was her experience with Shelbie that helped her get through the tough times.

“When someone tells you it’s cancer, your whole world crashes,” Dr. Peak said. “It had been years of me giving that news and I never dreamed I would be on the other end.”

In moments of despair, as she fought through treatment to fight breast cancer, Dr. Peak thought of Shelbie and other kids who handled cancer with such grace and strength.

“How could I not be strong?” 

Giving Back to Others

Shelbie and Kaleb visit Cook Children’s for annual checkups together and provide research on the protocols as part of the Cancer Survivor Program. They have a passion for giving back in ways they were given – such as being counselors at camp. They served in that role for four years and have plans to go back.

Kaleb said he shares hope with the campers at Camp Sanguinity by showing them they have a lot to look forward to as survivors, counselors and even having a family one day.

“Camp is everything,” Shelbie said. “It is so impactful, and we have every intention of going back as counselors this year.”

Shelbie also regularly gives back in another way – her job. She says that watching nurses interact with families while she was a patient and shadowing in the Hematology-Oncology Clinic at Cook Children’s gave her a passion for helping others in the medical setting but in a different area.

“I wanted to save that part of life for camp,” Shelbie said. “It hit a little too close to home being back in the Oncology area.”

Shelbie now works as a nurse in the postpartum unit at a local hospital.

Part of the Family

Dr. Peak beams as she talks proudly about Shelbie and all she has overcome. She truly feels as if Shelbie and her family are part of hers now.

“I carry my families and kids with me, and they will always be a part of me,” Dr. Peak said. “Shelbie is with her miracle baby now, but she is my miracle baby.”

Go here to view Camps for Kids at Cook Children's.

Written by Ashley Antle. 

All babies are special, but 16-week-old twin sisters JamieLynn Rae and AmieLynn Rose Finley are making history in one of the most unique ways possible. On Monday, they became the first conjoined twins ever to be separated at Cook Children’s Medical Center in an 11-hour procedure months in the making.

Conjoined twins are estimated to occur in only 1-in-200,000 live births. JamieLynn and AmieLynn are omphalopagus twins, meaning they are joined at the abdomen and share one or more internal organs. In their case, it’s a liver.

“As far as conjoined twins that reach and stay viable after birth, at least for the first few days, there's really only about five to eight of those per year on the entire planet, so it is very rare,” said Jose Iglesias, M.D., Cook Children’s medical director of pediatric surgery.

Even so, the girls’ story begins like many others.

James Finley and Amanda Arciniega of Saginaw, Texas, wanted to add one more baby to their family of five. The youngest of their three children at the time, 7-year-old James, was elated at the prospect. He’s always wanted a younger sibling and playmate.

Little did any of them know — or expect —their hope for one more would become a gift of two.

“She said that's the baby's head,” Finley said, describing how their obstetrician shared the unexpected news of twins at their 10-week ultrasound. “I was like, ‘What is that?’ and she said, ‘That's the other baby's head.’ And I was like, ‘What?’”

Double Blessing

The revelation of the twins' connection came early in the pregnancy. The 10-week ultrasound showed the babies had little to no separation between them. Images taken at the following appointment confirmed the babies were conjoined. Suddenly, the family’s excitement for welcoming two new additions was covered by a cloud of questions, uncertainty and fear. 

“I would not have thought in a million years that I would have twins,” Arciniega said. “And then conjoined twins on top of that.”

In the months that followed Arciniega enjoyed an easy and uncomplicated pregnancy, save for the many appointments with specialists across the state to determine who best to deliver the twins and what hospital was most capable to care for them after birth.

The couple settled on maternal-fetal specialist Bannie Tabor, M.D., whose practice is located at Texas Health Harris Methodist Hospital Fort Worth in Fort Worth, Texas. He is also the medical director for Cook Children’s Fetal Center. In his 32-year career of caring for high-risk pregnancies, Dr. Tabor has delivered more than 5,000 babies.

Soon after taking Arciniega and her unborn babies as patients, Dr. Tabor reached out to Dr. Iglesias, a longtime colleague, to review the case and discuss the possibility of separation.

“It was a big surprise when I got the first phone call from Dr. Tabor saying he had conjoined twins that he was starting to follow,” Dr. Iglesias said. “At that time they really didn't know the babies’ anatomy specifically. So I said there is a big range of possibilities and we need to see what happened with the initial MRI to make some plans from there.”

Many conjoined twins die in utero or do not survive long after birth because of the nature of their joining and the organs they share. But scans showed JamieLynn and AmieLynn each had their own heart and heart sac, increasing their chance of survival and making them candidates for future separation.

“I think the key thing when we first met the family was they had a lot of anxiety about the situation, what the options were and what they could do,” Dr. Tabor said. “I think I gave them the confidence that, while I could not promise everything would work out, we would do everything that we could and, with everybody involved — from me to the neonatologists to the surgeons — they were in the right place.”

Family Ties

Texas Health Harris Methodist Hospital Fort Worth and Cook Children’s Medical Center have a long history of physical and professional collaboration. Both facilities are located in the heart of Fort Worth’s Medical District along a historical stretch of Pennsylvania Avenue that cattle barons once called home. The two facilities are joined by a skywalk and, in Cook Children’s early days, even shared some utilities. Local neonatologists practice at both hospitals’ neonatal intensive care units (NICUs) and many Texas Health Fort Worth obstetricians, including Dr. Tabor, regularly consult with Cook Children’s pediatric specialists.

“The working relationship between the whole team, that's made possible by the close relationship of the hospitals, allows us to be the center that can provide this type of highly advanced service to North Texas so families don’t have to go halfway across the state or halfway across the country or even to Dallas for care,” Dr. Tabor said.

Early in the pregnancy, Finley and Arciniega also consulted Ben Gbulie, M.D., F.A.C.S, of Posh Plastic and Reconstructive Surgery in Mansfield, Texas, and a member of the plastic surgery faculty at Cook Children’s. They learned of Dr. Gbulie through Finley's mother, whose friend told her of a local plastic surgeon with experience in multiple conjoined twin separation surgeries.

After long discussions with the couple, he pointed them toward Cook Children’s Medical Center.

“I explained to them that traveling for surgery is not a problem, and a lot of people do that,” Dr. Gbulie said. “But if you can get the same quality of care where you live, it's always better because you want to be able to have long-term follow-up. While this is a major, complex operation, it is not something that is beyond what I felt Cook Children’s could do.”

Finley and Arciniega were relieved to hear Dr. Gbulie’s recommendation. The family lives less than 30 minutes from Cook Children’s. To know that they could stay close to home, close to their other children and close to their support system was comforting.

Cook Children’s was also familiar. Two of the couple’s older children have received care at the medical center. Their daughter, Aaliyah, 13, spent weeks in Cook Children’s pediatric intensive care unit (PICU) when she was 7 for a nearly deadly bacterial infection called Bartonella henselae. It’s commonly known as cat scratch fever and can be acquired when scratched by a cat. Big brother, James, is a frequent visitor to Cook Children’s as he manages sickle cell disease. 

“Sometimes we come in here and I’m like, ‘Hey, I’ve seen you before,’ to a doctor that has been around our son or Aaliyah, and they’re like, ‘Hey, I’ve noticed you, too,’” Arciniega said. “So it’s kind of like we’re family here.”

“Everybody’s always treated us nice,” Finley added. “It takes a lot of pressure and anxiety off when you know your kid is going to be taken care of.”

Delivery Day

As the babies grew in utero, Dr. Tabor closely monitored their progress and, together with a team of doctors from both hospitals, prepared a delivery and post-natal game plan. During Arciniega’s third trimester, Dr. Tabor became concerned with the slow growth rate of the babies and determined it was best to deliver them early.

On Oct. 3, 2022, at 34 weeks gestation, JamieLynn and AmieLynn were delivered via C-section at 10:40 a.m. at Texas Health Fort Worth. Arciniega required a vertical incision over the traditional horizontal approach to delivering the babies safely. Both weighed 4 pounds, 7.8 ounces. JamieLynn was the longer of the two, measuring 16.9 inches to AmieLynn’s 16.5 inches.

“It wasn’t an easy delivery, but we made it look easy,” Dr. Tabor said reflecting on that day.

Upon delivery, neonatologists Chad Barber, M.D. and Mary Frances Lynch, M.D., took over the babies’ care in Texas Health Fort Worth’s NICU. Like with any set of identical twins, telling them apart can be tricky and, if mistaken, dangerous in the hospital setting. To help keep their identities straight, Dr. Barber and Dr. Lynch chose a favored color for each girl, purple for JamieLynn and green for AmieLynn, and used Sharpies to mark each baby’s color on one of their nails.

After a month, the girls were transferred to the NICU at Cook Children’s Medical Center where they remain today, still under the care of Dr. Barber and Dr. Lynch who practice at both Texas Health Fort Worth and Cook Children’s. The girls’ color codes followed them there, too, and are used as an additional layer of safety when identifying the babies for medication administration, feedings and individual care needs. They even inspired the purple and green crayon costumes the girls sported for Halloween.

Home Away From Home

In the NICU room, which has been their babies’ home since November 2022, Finley and Arciniega attend to their infants like many other parents of twins — together. It takes two to pick them up, especially considering how they must navigate the tubes and wires that monitor the babies’ vitals and deliver nutritional support. Scripted signs handmade by the NICU nurses hang on the wall, making their private NICU room look a little more like a sweetly appointed home nursery.

The girls lay face-to-face on their sides, carefully and frequently repositioned from one end of their shared crib to the other in order to give equal time on each side. Although currently the smaller of the two, JamieLynn is wide-eyed and alert. Her gaze fixes on and follows those that enter the room. She’s feisty and makes sure everyone knows when she is unhappy. Sister, AmieLynn, is more reserved. She’s often the calmer and more chill of the two.

Together, the beloved girls evoke the attention of their parents who make sure there are enough cuddles and kisses to go around, especially from their protective dad. He’s already planning ahead for the days when young men come calling for any one of his three daughters.

“Every window will have a rose bush underneath,” Finley said with a laugh, but only half kidding.

Their days in the NICU are filled with feedings, naps, diaper changes, baths and a number of therapies to help with mobility, strength and eating. The girls respond especially well to music therapy and love it when Grandma sings to them during her visits. Their siblings, brother Isaiah, 15, Aaliyah and James, visit regularly, too. James loves to entertain them, and the girls respond with delight.

Their face-to-face positioning makes feedings and diaper changes a challenge, but nurses have developed creative workarounds to accomplish both. Most of the time they can be bottle-fed one at a time by a single caregiver, with AmieLynn often waiting patiently until sister is satisfied. When patience runs out, feeding is a two-person job.

The older they get, the more they move their limbs. It’s not uncommon for one to unintentionally punch and sometimes anger the other. The girls wear mittens to protect each other from scratches.

All the while doctors monitor their progress, study their anatomy and plan for the enormous task of separation. 

Journey to Separation

The timing of conjoined twin division varies from case to case and primarily depends on how complicated the anatomy is. In the girls’ case, their anatomy and growth support a surgery date sooner rather than later.

While the girls are thriving in the NICU, they are not growing at the same rate, partly because they share some blood supply.

“One is stealing groceries from the other, basically,” Dr. Barber said.

AmieLynn is beginning to develop scoliosis. Feedings are becoming more and more challenging with their size, mobility and face-to-face proximity. While separate, their hearts are exceedingly close together and grow ever closer as the girls age.

“They're pretty much at their maximal, I like to say, baby stretchability,” Dr. Iglesias said. “So their skin is pretty stretchy. Their abdominal walls are stretchy. We've got the benefits of using that. By separating early, they're not going to be as used to the loss of having essentially part of you that is different, so hopefully, that transition will be better. There are not very many more benefits to waiting longer versus doing it now.” 

At nearly 4-months-old, the time is right.

It’s taken months of planning and collaboration. Countless hours have been spent building a comprehensive medical team, studying scans of the girls, building models of their anatomy, mapping out potential surgical solutions, identifying the what-ifs, troubleshooting potential problems, inventorying equipment needed to accomplish the surgery, preparing the operating room (OR) and rehearsing the carefully choreographed surgical production. Dr. Barber estimates there have been at least 100 medical professionals, from physicians to nurses to therapists and other clinical specialists, intimately involved in the girls’ care and surgical planning.

“I think the teamwork is a great point to bring up because it's everything,” Dr. Iglesias said. “It takes a huge team to get all of this working as smoothly as you can make it, given the unknowns that we'll have. Having everybody open and honest talking to each other regardless of their position, that's the definition of teamwork.”

The surgery comes with great risk and a number of unknowns. Because they must dissect the liver, an extremely vascular organ, bleeding is a concern. A significant risk of infection also exists, for which the twins will be monitored weeks into recovery. Doctors are unsure of how the babies’ hearts will respond to their new anatomic position as the girls lay on their backs for the first time in their lives. Then there are questions about how to best close the abdominal wall, many of which can not be fully answered until separation is accomplished. The girls may require additional surgeries to complete closure and reconstruction.

“In order to prepare for this, it's a lot of practice, practice, practice and more practice, trying to really think of every possible scenario so that we're not surprised by anything,” Dr. Barber said. “There's always going to be unexpected things, but if you're prepared for the worst possibilities and the most unlikely outcomes, then you can hopefully not get too caught off guard.”

For their part, mom and dad pray, leaning on the same faith in God that carried them through when their older children faced medical crises.

Separation Day

Monday, Jan. 23, 2023. JamieLynn and AmieLynn are ready for their big day. Thanks to their NICU nurse, they’re sporting fresh mani-pedis in their signature purple and green to help identify them in the OR.

Before the sun rises, family and members of the medical team gather in the girls’ NICU room. It’s calm and quiet as mom and dad steal a few final pre-surgery kisses from their babies. Grandma sings softly. Others pray. The girls are awake, content and comfortable. Just before 7:30 a.m., they begin their journey to the OR.

Inside the OR is a sea of medical professionals: three anesthesiologists, four pediatric surgeons, two plastic surgeons and about a dozen other clinical professionals. They are separated into two teams, one for each girl. Those in purple scrub hats belong to JamieLynn’s squad, while Team AmieLynn dons the green. Everyone will work together until the babies are separated, then each team will focus solely on their assigned baby.

“The reason that's important is because you need focus,” Dr. Gbulie said. “You want to minimize room for errors and the risk of confusion. So little things like color-coding everyone and everything minimizes the risk of giving the wrong medication on either side. It's truly a community effort that involves a multi-specialty team.”

The first few hours involve inserting central lines for delivering anesthesia and placing breathing tubes. Then, sedation begins. The process is slow and methodical.

“When we're talking about taking care of conjoined twins compared to taking care of just a single baby, one of the biggest questions is what is shared, and there does seem to be some shared circulation between the girls,” said Chandra Reynolds, M.D., the lead Cook Children’s anesthesiologist on the surgical team. “What is the response going to be for baby B when we give baby A certain medication? It’s a very slow and stepwise approach until we better understand what happens to one when the other receives medication. The key thing is to give one baby a certain amount of medication, watch and wait for a while to see how things are going and, based on that response, we can give her sister a certain amount as well.”

Once the girls are safely asleep, the surgeons begin marking incision lines. At 12:28 p.m., the separation officially begins. Guided by plastic surgeons, they are careful to make cuts that give the girls’ abdomens the best chance of closure.

First, surgeons open the abdominal wall and dissect the lower part of the sternum and the liver. A little under two hours in, the family receives word that the girls’ shared liver is separated. The private waiting area where the family anxiously awaits news of progress erupts with cheers. Finley and Arciniega embrace.

Surgeons painstakingly work layer-by-intricate-layer until they reach the backside of the abdominal wall where they complete the dissection.

The update everyone’s been waiting for comes at 3 p.m. JamieLynn and AmieLynn are officially separated and on their backs. Tears and shouts of praise flow from family and friends in the room. Their relief is palpable.

“I want to tell you that all of the people in there taking care of them cheered even louder than this,” said the nurse delivering the news, followed by laughter from the family.

There is still a long way to go.

“Once the babies are finally physically separated, then we have to initially look for other additional anomalies and see if there is anything else going on,” Dr. Iglesias said. “We transfer one baby to the other bed where one surgeon will follow and an additional surgeon will pick up with the other and continue to do the evaluation.”

Once each baby is ready for closure, their assigned pediatric surgeons, Dr. Iglesias for JamieLynn and Marty Knott, D.O, for AmieLynn, begin closing the chest and abdomen. Plastic surgeons Dr. Gbulie and Eric Hubli, M.D., Cook Children’s Surgeon in Chief and medical director of craniofacial and cleft surgery, assist with skin closure.

By 6 p.m., the surgery is complete. This time Dr. Iglesias, Dr. Gbulie and Dr. Knott deliver the news to the family.

“We did it,” Finley said in response. “I don’t know what I did, but we did it.”

To this Dr. Iglesias replies, “You trusted us. That’s what you did.”

All the while, neonatologists Dr. Barber and Dr. Lynch stand by for the girls’ post-surgery return to the NICU.

One by one, the sisters exit the OR on their way back to their familiar home away from home in the NICU. For the first time in their lives, they lay on their backs, each in their own crib. The family gets a momentary glimpse from afar as the girls are wheeled past the waiting room, and cheer them on as they pass. About an hour later, mom and dad are able to join the girls in the NICU.

The first look at their twins in separate beds brings a wave of emotion. For the first time, they must divide their attention between the two. They start with JamieLynn. Arciniega places her pinky finger in her baby’s hand.

“It’s OK, Mommy’s here,” she whispers.

Then to AmieLynn. Finley gushes about her strength and how proud he is of his quiet fighter.

It’s a monumental moment, but none of the physicians are ready to say “mission accomplished.”

“The challenges the girls may face after surgery are very difficult to fully prepare for,” Dr. Lynch explained. “We do still have some unknowns as far as how their shared vasculature and their shared anatomy and positioning over these last three months will affect them. As Dr. Barber alluded to earlier, we have to prepare for many different scenarios. The things that will worry us and that we’ll be the most focused on in the first few days are going to be breathing support and pain control. As you can imagine, this is an incredibly big surgery and pain control will be at the top of our list.” 

They’ll be watching for signs of infection, too.

“The soft tissue usually swells over the first two to three days,” Dr. Gbulie said. “If you get through those two to three days, you're usually OK. That being said, we are going to be going through potentially some bowel and definitely the liver, so there is a relatively higher risk of wound infection and that usually shows up at about five to 10 days.”

Road to Recovery

Recovery is best described as slow.

“I'm sure mom and dad are going to think we're moving in slow motion,” Dr. Iglesias said. “The first steps are going to be healing of the very large incision that is required to separate them. We have to wait for their gut to start to work before we start allowing nutrition to move through their intestines. Some of these things may require staged procedures so the family's ready that the abdominal closure may take more than one operation. We're hopeful it won’t, but that's a possibility.”

They’ll need extensive rehabilitation, too, which will include nutritionists, physical therapists, occupational therapists, speech therapists and more.

Doctors say they’re optimistic but will continue to hold their collective breath until they are waving goodbye to the girls as they leave Cook Children’s for their first ride home.

“I'm very hopeful that they're going to have a good recovery and lead healthy lives in the future,” Dr. Iglesias said. “They're going to have a bit of a ramp up from the recovery, but I think they're going to be able to get there eventually, and very close to normal if not completely normal.”

Until that chapter of this story begins, JamieLynn’s sassy spirit and AmieLynn’s sweet smile remain on full display as their NICU team continues to care for their daily medical, physical and emotional needs. This time, together, but separate.

Cook Children’s is a not-for-profit organization. Donations to Cook Children’s Health Foundation allow us to care for our families when and how they need us. Give today to support patient families like Jamie and Amie. Go here. To donate items at the Medical Center for Jamie and Amie, email AandJ@cookchildrens.org.

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

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

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

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

What to Expect

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

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

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

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

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

Alleviating Embarrassment

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

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

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

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

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

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

Larger than life-size digital displays, storybook murals, walking paths that invite exploration and play, and spaces bathed in every color of the rainbow — it’s what childhood daydreams and imaginations are made of. These are also a few of the moments of magic kids and their families will feel, see and experience when they walk through the doors of the new Cook Children’s Medical Center – Prosper.

The medical center opens to the community on Monday, Jan. 9, at 8 a.m., and is ready to serve those from Prosper and beyond seeking care under Cook Children’s signature blue peaks.

The 23-acre Cook Children’s campus in Prosper is the culmination of a multi-year expansion project into the rapidly growing northern region of the state. Cook Children’s began developing the health care landscape in the area in 2019 with the opening of an urgent care center and several area primary care offices, followed by a medical office building and outpatient surgery center in 2020. The medical center will support these existing services with an emergency department; a surgical and procedural floor; an infusion center; an outpatient imaging center; a retail pharmacy; an inpatient unit with medical-surgical and pediatric intensive care beds; and two floors of shell space that allow for growth to meet the future needs of the community.

“Cook Children’s Medical Center – Prosper is the next step in supporting those services and serving families in Prosper and the surrounding communities,” said Rick W. Merrill, president and CEO of Cook Children’s Health Care System. “It brings world-class medical care from Fort Worth closer to the homes of children living in the northern sector of the Metroplex. We’re very excited to be able to offer families the care they’ve come to expect and trust from Cook Children’s but in a location closer to their neighborhoods where they have the support structure of family, friends and community resources.”

A Leading Legacy

Those who know the heritage of Cook Children’s say that while construction of the Prosper campus took several years, it’s actually been generations in the making.

“Multiple generations have built Cook Children’s,” said Kevin Greene, vice president and administrator, Cook Children’s Medical Center – Prosper. “We have a nearly 105-year history of dedicated doctors, nurses and support staff caring for children. We are stewards of that history, and I believe that is one of the key components that differentiates Cook Children’s from other pediatric health care systems. Being able to provide top-tier pediatric care with a world-class experience is a product of our century old legacy and the generations that came before us.”

The patient and visitor experience was paramount when it came to creating the building’s blueprint. Each space of the facility is designed with everything for the child in mind.

In the main entrance, guests are welcomed by a Sistine Chapel-like painting of cartoonish flying cows — a nod to Cook Children’s Cowtown roots — a giant digital wall, and a tile motif of a tree whose color-coded falling leaves create a kid-friendly and interactive wayfinding trail to the emergency department in one direction and outpatient services in the other. At each stop in their journey through the facility, kids and their families are greeted with spaces that invite imagination, discovery, play and rest in a way that connects the dots between their ideal experience at Cook Children’s and the health care they receive along the way.

“If I had to pick one of my favorite aspects of the medical center, it's the initial presentation our families experience when they walk in our front doors,” Greene said. “It’s so focused on that child’s experience, and everything has been designed with the child in mind. You feel like you're in a special place. We were very intentional with that. I can't wait for the community to experience and understand who we are in that first moment when they walk in.”

Critical Additions

The medical center's 10-bed emergency department adds much-needed emergency care beds to the area in a time when many pediatric emergency departments are overflowing from an unprecedented season of viral illnesses. Over the next several months, Cook Children’s anticipates opening an additional 10 emergency department beds to support the emergency care needs of children.

Anticipating future growth, a total of four operating rooms have been built and equipped to keep kids close to home when they need surgery. Two will open with the medical center on Jan. 9. The remaining two will open in the future as the community and its needs grow. Each operating room is equipped with technology that allows for real-time remote viewing and physician collaboration with colleagues at Cook Children’s Medical Center in Fort Worth if needed. This gives Cook Children’s Medical Center – Prosper patients and families the advantage of the health system’s full network of world-class physicians and surgeons.

“I’m really excited about the technology built into this campus, and I like the fact that physicians and providers were involved in the design process from day one,” said Tony Anani, M.D., MPH, MBA, gastroenterologist and Medical Director of Clinical Specialties at Cook Children’s Medical Center – Prosper. “There are some features that we’re really going to enjoy while practicing medicine. One of them is the ability for doctors to beam into our surgery and our endoscopy suites. So all our partners in Fort Worth have the ability to help us with their brain trust for difficult patients up here without us having to move the child downtown, and that would not have been possible without the technology and without it being designed into the building.”

Patients awaiting surgery are prepped in one of 12 private pre-operative exam rooms. A surgery waiting area provides private space for families to wait while a child undergoes a procedure.

Until now, children in Prosper and throughout the northern region needing intravenous infusion therapy would have to travel to Cook Children’s Medical Center in Fort Worth or to Dallas. A dedicated infusion center at Cook Children’s Medical Center – Prosper will now bring this critical service close to home for our families. In addition, a specialty procedure area, also referred to as the SPA, has three procedure rooms for gastroenterologists, pulmonologists and ear, nose and throat specialists. The SPA is designed so that physicians can easily work together on difficult cases.

Supporting each of these services is an imaging center equipped with all of the imaging and diagnostic technology needed to provide advanced care for pediatric patients.

Each inpatient room includes a 65-inch television that can integrate with the patient and family’s personal devices. The television serves as an interactive hub for anything the patient may need, from ordering food to entertainment to connecting and consulting with Cook Children’s specialty physicians at the medical center in Fort Worth if needed.

“We're not just Cook Children's – Prosper. We're part of the integrated health care system,” Greene said. “When a family is cared for on our campus or in one of our clinics, they will have the full weight of the entire Cook Children’s Health Care System behind them. From our home health division, to our health plan and physician network made up of more than 800 physicians and providers, our families can rest easy knowing they now have access to one of the nation’s largest integrated pediatric health care systems focused entirely on their child's care.”

Welcoming New Talent

In addition to its technology, infrastructure and patient experience, Cook Children’s Medical Center – Prosper is attracting trailblazing medical talent and bringing more than 500 jobs to the community. Trailblazers like Kanika Bowen-Jallow, M.D., a pediatric surgeon at Cook Children’s Medical Center – Prosper, and only the ninth Black female pediatric surgeon in the United States. Also, Dr. Anani, who was the first physician hired at Cook Children’s Medical Center – Prosper when all administrators had to show him was an empty parcel of land and a vision. Both Dr. Bowen-Jallow and Dr. Anani shared Cook Children’s vision and have been instrumental in the development of the Prosper campus and its services.

“Cook Children’s is hiring,” Dr. Anani said. “That’s an infusion into the economy of Prosper and the surrounding area. We're hiring people that truly care about providing care for the children in our community. I'm really excited about this because I live in Prosper. My kids go to the schools here in Prosper, and I'm happy that we'll have the care we need nearby. What’s good for kids is good for the community, including the local economy.”

Go here to view the open positions we're excited to fill in Prosper.

The state-of-the-art facility was built with everything for the child in mind, including what they'll see and experience as they make their way through the facility. Spaces are bathed in every color of the rainbow. Storybook murals meant to capture and stoke the imaginations of children define many spaces.

In the main entrance, guests are welcomed by a Sistine Chapel-like painting of flying cows — a nod to Cook Children's Cowtown roots — a massive video wall and a tile motif of a tree whose color-coded falling leaves guide visitors to the emergency department in one direction and outpatient services in the other.

“This is an extraordinary time in our almost 105-year history in North Texas,” said Rick W. Merrill, President and CEO of Cook Children’s Health Care System. “Families in this fast-growing region can take comfort in knowing there’s no need to drive long distances to see board-certified pediatricians, specialists, intensivists, hospitalists, and emergency medical doctors. Their child’s medical needs can be met right here by our outstanding team in Prosper.”

Cook Children’s Medical Center – Prosper includes an emergency department, operating and procedure rooms, pediatric ICU, medical/surgical unit, outpatient infusion center, imaging services, retail pharmacy, laboratory services, and pharmacy services.

With thousands of families moving to this area of North Texas each month, the need for quality pediatric health care is evident. Cook Children’s has already served more than 260,000 children through its 17 primary-care clinics located in this booming region, which includes Prosper, Aubrey, Plano, McKinney, Allen, Denton, Celina, Frisco, Little Elm, Flower Mound, and Carrollton.

“Cook Children’s is more than a health care system. We strive to be an extension of your family, growing with your child from their first steps to adulthood,” said Kevin Greene, Vice President and Administrator at Cook Children’s Medical Center – Prosper. “When your child needs world-class pediatric care, we’re here – whether it’s primary, urgent or emergency care, or treatment for a chronic condition. You can trust our team to take care of you and your child’s every need.”

The ribbon-cutting ceremony for Cook Children’s Medical Center – Prosper coincides with a new look for the health care system. This month, Cook Children’s unveiled a new logo and a culture platform to reinforce its commitment to its patients and community. Patient families in the Prosper area can expect to experience the same culture of kindness, safety, and compassion they’ve come to know from Cook Children’s.

Cook Children’s has long been recognized as a leader in pediatric health. In fact, US News & World Report has ranked Cook Children’s among the best children’s hospitals in the United States every year for the past 15 years. In 2022, Cook Children’s earned recognition for cancer treatment, cardiology and heart surgery, diabetes and endocrinology, neurology and neurosurgery, orthopedics, and pulmonology.

Many of these medical specialties are currently available at Cook Children’s Prosper campus, which opened in 2019 with urgent care and primary care services. A medical office building was added in 2020 providing access to 14 specialties including:

• Cardiology
• Ear, Nose and Throat
• Endocrinology
• Gastroenterology
• Hematology and Oncology
• Nephrology
• Neurosurgery
• Psychology
• Sleep Medicine
• Urology
• Neurology
• Pediatric Surgery
• Pulmonology
• Sports Medicine

An ambulatory surgery center for outpatient procedures, outpatient lab, and retail pharmacy are also located in the medical office building. By the end of the year, 549 medical professionals and ancillary staff will work at the Prosper medical campus. 

“Cook Children’s is known nationally and internationally for its world class patient care, leading clinical research and medical advancements,” said Tony Anani, M.D., MPH, MBA, gastroenterologist and Medical Director of Clinical Specialties at Cook Children’s Medical Center – Prosper. “I’m proud to be part of this incredible organization that truly embodies the motto, “Everything for the child.”

Cook Children’s Medical Center – Prosper also showcases the best available medical technology including features directly related to patient satisfaction. For example, if a patient in the hospital needs to see a specialist at Cook Children’s Fort Worth campus, they can visit virtually through the in-room TV.

In addition, the MyCookChildrens app provides patient families access to wayfinding, information about their care team, and daily schedule, to name a few. Another perk of the Prosper campus is Peaks Tech Zone. Similar to Apple’s Genius Bar, Peaks Tech Zone provides families access to health technology advocates who can assist with setup and support for their child’s medical device and/or MyCookChildren’s account.

Cook Children’s Medical Center – Prosper marks the first hospital Cook Children’s has built outside of the flagship medical campus in Fort Worth.

Media partners: If you are interested in telling this story, please contact Public Relations Manager Kim Brown at Kim.Brown3@cookchildrens.org or at 682-885-1080, 817-266-3728

Story by Eline deBruijn Wiggins. Video by Tom Riehm.

Hispanic Heritage Month creates an additional opportunity for us to celebrate the culture and contributions of people who are Hispanic or Latino/a. At Cook Children’s, we see the world through the eyes of children and families, of all races, ethnicities and languages. Let’s hear from a few Latino/a and Hispanic pediatricians and specialists at Cook Children's.

Celina Cepeda, M.D.; Ana Rios, M.D.; Javier Gelvez, M.D.; Roberto Caballero, M.D.; Victoria Talamo, M.D. and Bianka Soria-Olmos, D.O. sat down with us to share their journeys to becoming doctors and to hear their perspectives as Hispanic and Latino/a doctors and specialists.

Did you know?

• In the U.S., Hispanics and Latinos are an underrepresented population in medical and health care professions. Only 5.8% of active physicians are Hispanic or Latino/a in the United States.
• The Hispanic and Latino population is growing and currently makes up approximately 19% of the U.S. population.
• In Tarrant County, 30.2% of the population identified as Hispanic or Latino, according to the 2021 Census.
• National Latino/a Physician Day is Oct. 1, a day to raise awareness about the need for more Latino/a doctors.

Meet 6 of our doctors and specialists

Celina Cepeda, M.D., is a pediatric nephrologist at Cook Children's Prosper. She's from Brownsville, Texas and is bilingual in Spanish and English. She enjoys teaching her patients about the kidneys and staying healthy.

“It really makes me happy when patients are Spanish-speaking only and I can help take care of them and they are appreciative of that,” Dr. Cepeda said. “Because otherwise, it's difficult for them to communicate their needs and what they're hoping to achieve for their children health-wise.”

Ana Rios, M.D., of the Cook Children's Infectious Disease team, grew up in Colombia. She says both of her parents were physicians so she always grew up listening to them talking about how passionate they were about their jobs.

“My older brother was diagnosed with leukemia and my parents were the ones who made the diagnosis,” Dr. Rios said. “That made me feel more passionate about becoming a doctor and pediatrician and helping kids like my brother. Eventually, that's what I did.”

Bianka Soria-Olmos, D.O., serves as our Medical Advisor for Digital Health and a Cook Children's pediatrician in Haslet. She has lived in Fort Worth for most of her life and as a child, she went to Cook Children's as her brother received care here.

“I always said I wanted to become a doctor and that one day I wanted to work at Cook Children's,” Dr. Soria-Olmos said. “I love that I was able to fulfill my childhood dream here. I like that we continue to strive to serve this community in the way it has been changing and do the best for the children.”

Javier Gelvez, M.D., of the Cook Children's Pediatric Intensive Care Unit, is from Colombia and was the youngest of eight children. He has been at Cook Children's for 21 years.

“We can inspire other people to be physicians and as my kids grow up I say this is an opportunity to serve,” Dr. Gelvez said. “This is the beauty of a job where you can serve other people and make a living.”

Roberto Caballero, M.D., of the Cook Children's Pediatric Intensive Care Unit, grew up in Mercedes in the Rio Grande Valley of Texas. At the time, his father was the only doctor in town. People came to their house after hours and on weekends needing help. Dr. Caballero is bilingual and said not many days go by that he doesn't have to communicate with patients in Spanish.

“That inspired me to help others and to value what it means to be available to people in need,” Dr. Caballero said.

Victoria Talamo, M.D., of the Cook Children's Pulmonology team, is from Venezuela. She says she enjoys helping people and was inspired to become a physician just like her dad.

“He was like my hero and he was everything to me,” Dr. Talamo said. “I wanted to grow up and be like him. He would come home late at night and share these amazing stories about his day.”

Getting a flu shot every year is the best way to fight off the influenza viruses that can cause serious complications, especially for children ages 5 and younger.

The flu vaccine works to prevent you from catching the flu – or, reduce the severity if you do come down with the illness. Adults and children as young as 6 months old are urged to get the flu shot by the end of October.   

Brandi Falk, M.D. at Cook Children’s Pediatrics McKinney emphasizes the importance of coming in for a flu vaccine before the flu typically starts spreading. Flu season generally extends from November through May. Shots are available now by appointment at pediatrician offices, neighborhood clinics and pharmacies.   

“The flu is a virus, and we actually pass it through tiny droplets that we make when we cough or sneeze or talk,” Dr. Falk said. “It's important that parents know that everyone is at risk.”

Flu is a contagious respiratory infection that can cause fever, chills, headache, muscle aches, dizziness, loss of appetite, tiredness, cough, sore throat, runny nose, nausea or vomiting, weakness, ear pain or diarrhea. Dr. Falk pointed out that it can last two weeks or more, and it’s worse than having a cold. Sinus problems, ear infections, dehydration and difficulty breathing also can develop, potentially requiring hospitalization.

“A question I get asked from parents a lot is, ‘Why do I need to do the flu vaccine?’ I tell them that it can lead to life-threatening symptoms like pneumonias and inflammation around your heart, around your brain and your muscles,” she said.

In the 2021-2022 flu season, the U.S. Centers for Disease Control and Prevention (CDC) recorded 31 pediatric deaths caused by flu. Most of those cases -- ranging in age from 2 months to 16 years -- involved at least one underlying medical condition that put those patients at higher risk for flu severity, such as asthma, heart disease or weakened immune system.

Last year saw a drop in the percentage of children and teens protected against the flu. The CDC reports that 55.3% of those eligible received their flu shots, down from 57.3% previously. 

Dr. Falk explained a few key points: 

• You can’t catch the flu from the flu shot. “The flu shot is an inactive vaccine. So that means that the viruses inside it are killed.”
• Potential side effects, usually mild, include soreness, redness or swelling in the arm or leg where the injection went in. The vaccine might also cause brief headaches, fever, nausea and muscle aches. 
• After the vaccine, it takes two weeks to build up the antibodies that fight off the flu. That’s why it’s important to get immunized early. “By the time the flu starts getting more prevalent, you're already protected,” Dr. Falk said.

It’s important for the whole family to receive a flu vaccine annually, she said. Patients can receive the vaccine in combination with other vaccines at their checkup or by scheduling a nurse visit. First-timers who are younger than age 9 will need two doses, a month apart.  Kids 9 and older need only one dose.

For those who want to avoid needles, the nasal spray flu vaccine might be an option.  The flu mist cannot be given to children under age 2 or to people with asthma, certain chronic illnesses or weakened immune systems.

Flu vaccines protect against two influenza A viruses, and two influenza B viruses. The vaccine’s composition is updated each year to protect against what is expected to be the most common viruses in circulation.   

In addition to vaccination, Cook Children’s recommends these hygiene practices for flu prevention:

• Wash hands with soap thoroughly and often, especially after using the bathroom, after coughing or sneezing, and before eating or preparing food.
• Never share cups and eating utensils.
• Cover your mouth and nose with a tissue when you cough or sneeze, then put the tissue in the trash.
• Cough or sneeze into your upper arm, not your hands, if a tissue isn't handy.

And … If your child is sick, stay home from daycare or school. Make sure your child drinks lots of liquids, gets plenty of sleep and takes over-the-counter meds to alleviate symptoms.

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There’s no guaranteed way to avoid the flu. But getting the vaccine every year can help. At Cook Children’s, we believe that flu vaccinations are the safest, easiest way to protect everyone age 6 months and older from serious flu symptoms. And a flu vaccination during pregnancy helps protect your newborn baby from flu for several months after birth.

Immunizations and other services are available at Cook Children’s neighborhood clinics and primary care sites across Fort Worth and beyond. Find a location near you: Primary Care Offices/Neighborhood Clinics (cookchildrens.org)

RELATED: Get Immunized for a Healthy School Year (checkupnewsroom.com)

Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

Flu Makes a Return (checkupnewsroom.com)

 highlights the region’s best physicians as chosen by their peers. Votes are tallied and sorted by the editorial staff, and the remaining votes are vetted by an anonymous panel of esteemed doctors.

Join us in congratulating the following doctors who were honored last week: 

• Lauren Akers, D.O.
• Mouhammed Alwazeer, M.D. 
• Anthony Anani, M.D.
• Kanika Bowen-Jallow, M.D.
• Amy Brenski, M.D.
• Pamela Burg, M.D. 
• Damien Campbell, D.O.
• Celina Cepeda, M.D.
• Lily Han, M.D. 
• John McClay, M.D.
• Sireesha Mutyala, M.D. 
• Sandra Peak, M.D. 
• Nicole Pitts, D.O.
• Brittney Pryor-Craig, M.D.
• John Robertson, M.D.
• Nancy Taneja, M.D.

We are so grateful for our doctors who work tirelessly every day to make a difference in the lives of patients and families.

To view the full list of 2022 Best Doctors and Pediatric Specialists.

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.

Physicians are not always the best at taking care of their own mental health care needs. Matthew Carroll, M.D., Associate Chief Quality Officer at Cook Children’s, says that needs to change.

After losing a colleague to suicide, Dr. Carroll recently penned an article about his own journey with mental health. On this episode of Raising Joy, we talk to Dr. Carroll about the stigma of mental health care among physicians and why so many suffer in silence.

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. 

August is National Breastfeeding Month.

And as much as I hate the word “journey,” allow me to tell you about my breastfeeding journey.

I figure there’s a lot of curiosity out there about a pediatrician’s breastfeeding experience. I mean I sit in my clinic rooms all day counseling about it, right? So surely it was an easy task for me? Surely I would sit in daily joyful motherhood bliss while my babe nursed happily with ease and comfort, right?

Heck. No.

In fact, I disliked a lot about breastfeeding. But I loved some of it, too.

(And guess what? GASP! This pediatrician used some formula, too! What? Did she say the F word?)

Before I gave birth to my first kid, I knew breastfeeding could be challenging for some moms. I didn’t worry or fret about it too much, though, because how hard could it be?

I mean, you just put the baby on the boob, right? I’m a pediatrician! I got this!

Ahahahahahahha.

My first kid refused to latch from day one. I worked with lactation consultants. I struggled with pain. I had his mouth anatomy evaluated (all was fine). I tried shields. I had supply issues. My kid screamed. Every. Nursing. Session. And I cried every nursing session. His reflux was constant and affected positioning, length of feeds, and general happiness.

My postpartum anxiety was vicious. And made everything probably 10 times worse than it already was.

So, I decided to pump. Exclusively.

And it was the hardest damned thing I’ve probably ever done.

It satiated my need for control in a situation where I felt I had no control. But it was hard. And mentally and physically exhausting.

I’d pump in my office many times a day, running late for patients and adding stress to an already stressful day. And while my also-pumping work partner would pull out 10 ounces at a time when she pumped during lunch with me, I’d get a measly 3 or 4.

And every day, I went into the bathroom and cried. What was wrong with me? Why was motherhood feeling so robotic and protocoled and cold? Why did I cry for 45 minutes if I spilled a bottle?

But I knew pumped milk was so beneficial to my baby. So I kept on going. For 6 months. Until my supply tanked because I couldn’t pump enough at work. So we used formula. And guess what? My baby survived. And I survived.

It took such a mental toll on me to not be able to breastfeed my child that when I was pregnant with my second, my husband and my mom both nervously asked me…”you have some cans of formula just in case…right?”

They asked me this out of the kindness of their hearts, and I responded with, “yep! In the closet!” because I too remembered the dark days. And I wanted the experience with my next baby to be different.

And it was different.

Guess who breastfed like a champ? My next kid.

And the breastfeeding experience was great. And flawless. And so easy. And tear-free.

I loved bonding with my child in this special way. I loved feeling like nutrition and protection were transferred to her from my body. I even loved the exhausting 3 am feeds.

So why tell you all this?

To let you know that every mother is different, just as every child is different.
To let you know you aren’t alone if you felt breastfeeding was a struggle you totally weren’t prepared for.
To let you know even the professionals are human, and struggle just as much as you do.
To let you know it is okay to both love and hate breastfeeding.
To let you know I (and any pediatrician) will never judge you for the choices you make in how you feed your child.

Distribution of the Pfizer-BioNTech and Moderna COVID vaccines for the youngest age group will begin this week. The CDC's Advisory Committee on Immunization Practices’ (ACIP) recommended that all children 6 months through 5 years of age should receive a COVID-19 vaccine.

This expands eligibility for vaccination to nearly 20 million additional children and means that all children ages 6 months and older are now eligible for vaccination, the CDC said.  

Parents may be wondering if they should get their children vaccinated. Vaccines are the best way to prevent serious illness in people of all ages, including children.

The COVID positivity rate has slowly increased at Cook Children's.  

The rolling seven-day average positivity rate:

• June 20: 10.6%
• June 5: 8.4%
• May 5: 3.5%

Based on available data, our health care providers and pediatricians at Cook Children’s strongly recommend that parents get children vaccinated as soon as they are eligible.

Moderna's vaccine, for children 6 months through 5 years old, is two shots spaced one month apart.

The Pfizer-BioNTech vaccine, for children 6 months through 4 years old, is three shots over the course of 11 weeks.

The vaccines are being distributed and will be available at thousands of pediatric practices, pharmacies, Federally Qualified Health Centers, local health departments, clinics and other locations, the CDC said.

Cook Children’s is currently working on its plan to distribute vaccines to pediatrician offices and will announce details regarding scheduling soon.

Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center, has two children, an almost 4-year-old daughter and a 20-month-old son.

“My son was exposed and tested positive when he was 10 months old. We were very fortunate because I had received my COVID vaccine when he was 8 weeks old so he had plenty of antibodies and protection from me and my immune system,” Dr. Romano said. “We escaped his illness with two days of congestion and one day of fussiness. I, unfortunately, know that not all families have been as lucky.”

“These are some of our most vulnerable patients, and being able to provide them protection against COVID will be a huge relief to so many parents, including me!” Dr. Romano said. Here are her answers to some frequently asked questions:

Why should my child get the COVID vaccine?

It is extremely important to get everyone who is eligible vaccinated.

Vaccinating against COVID is what will continue to allow everyone to return to a more normal life. 

People who are fully vaccinated are significantly less likely to spread COVID-19 because of their smaller viral load, which means a lower risk of transmission to others. That’s one of the main reasons why I’m so excited to get my children vaccinated against COVID. My father is a type-1 diabetic with rheumatoid arthritis who is immunocompromised due to his medications, and I always worry about accidentally spreading COVID to him.

Additionally, someone who is vaccinated against COVID, even if they are exposed and test positive for COVID, is at a significantly decreased risk for complications such as ICU admissions, the need for life support and death.

Here at Cook Children’s between Dec. 19, 2021 and Jan. 15, 2022, there were more than 14,800 children who tested positive for COVID at their pediatrician’s office, a Cook Children’s Urgent Care, or at the medical center. Out of 321 patients who required hospitalization, only 18 were vaccinated against COVID. Out of the 37 patients admitted to the PICU with COVID, only two were fully vaccinated. This data strongly suggests that the vaccine is effective at preventing hospitalizations and at preventing ICU admissions.

COVID vaccines also help prevent MIS-C, multisystem inflammatory syndrome in children. MIS-C is a potentially very serious complication that we see four to six weeks after a COVID infection or exposure. Out of a large cohort of 21 million vaccinated young adults, only 21 children developed MIS-C after COVID vaccination. This tells us that not only can a COVID vaccine prevent severe illness from an acute infection, but it can also prevent some of the more serious complications following COVID exposure.

COVID vaccinations also prevent long-haul symptoms such as daily headaches and persistent fatigue. Although not common, we do see COVID long-haul symptoms in a pediatric population. Patients who are fully vaccinated against COVID are 50% less likely to develop long-haul symptoms.

COVID vaccines do not affect a woman’s fertility. The American College of OB/GYN, the Society of Reproductive Endocrinology, and the Society for Maternal Fetal Medicine have recommended COVID vaccination for all women whether they are pregnant, or trying to become pregnant, or breastfeeding.

On a more practical aspect, a fully vaccinated person will also have different quarantine requirements after exposure or testing positive for COVID. As someone who lived through a 10-day quarantine, I would not recommend or want to repeat it. A fully vaccinated person can have shorter quarantine periods.

How do we know it’s safe for children 5 and under? 

Despite the name “Operation Warp Speed,” the process to investigate and certify the vaccine did not cut any corners. Throughout the vaccine development process, researchers had to follow the same procedures and regulations as if they were developing a new medicine for headaches or blood pressure.

In addition, both the Pfizer and Moderna studies have increased their sample sizes throughout the process to make sure that side effects or reactions are not being missed. Participants in the study were closely monitored.

Should parents get their children vaccinated, even if their child recently had COVID?

Children should be vaccinated even if they already had COVID. Some studies have suggested a second or a third infection can be associated with more severe disease. More severe disease could mean hospitalization, ICU admission and even death.

Some infectious disease experts recommend waiting three months after COVID infection before being vaccinated so that the vaccine has the maximum effect.

Why should my child be vaccinated if they have already had COVID?

I hear a lot of parents, neighbors and friends say that they tested positive for COVID and only had mild flu-like symptoms. However, this is not always the case. While I’m happy that your first case was mild, please know that your second infection may not be the same.

What if I live in an area with a low number of cases? 

If you live in an area with a low number of cases, please still get your vaccine. With the global nature of our world, you will have plenty of opportunities to come into contact with people who come from areas with high number of cases.

COVID vaccines can also be extremely important if you want to travel. Some countries or cruises require you and your child to be fully vaccinated before travel.

Do I have to vaccinate my baby on schedule if I am breastfeeding him/her?

After a breastfeeding mother is vaccinated against COVID-19, antibodies pass through her breast milk to her baby. Various studies have found that the 87 – 95% of babies were given immunity through their mother’s breast milk against COVID-19. If it’s been more than six months since the mother received her COVID vaccine or booster, she should consider vaccinating her baby at this time.

How soon after the vaccine will my child build immunity?

Immunity will begin after the first shot! Immunity and protection have been demonstrated in Pfizer recipients within 12 – 14 days after the first dose, but this will be very short-lived. Immunity will be more permanent two weeks after the second dose.

Are the side effects of the vaccine different for children?

The main side effects are very similar to adults. There will most likely be injection site tenderness and some muscle aches. There can be redness and swelling along the injection site. Most people report fatigue and malaise that should be resolved within 48 hours.

A very concerning side effect that we saw in young men was myocarditis. However, only saw four cases in every 1 million vaccines in children 5 – 11 years old.

How do I know if my child is eligible for the vaccine?

Children over 6 months old are now eligible for the vaccine!

There are only a few very strict contraindications to receiving the COVID vaccine. The two absolute contraindications are having a severe allergic or anaphylactic reaction to a prior COVID vaccine or a known allergy to a component in the COVID vaccine.

If you have any questions about children with known clotting disorders, heart problems, or prior neurologic processes such as Guillain-Barre Syndrome, please talk to your primary care provider. The CDC recommends that these patients can receive a COVID vaccine with proper precautions.

RELATED: 

How to Help Young Children Cope with Vaccine Anxiety (checkupnewsroom.com)

7 Reasons Why This Doctor Mom’s Kids Will Be First in Line for the COVID Vaccine (checkupnewsroom.com)

The recall in February from Abbott Nutrition has placed extra pressure on the supply chain and some stores are limiting the amount a customer can purchase.

Bianka Soria-Olmos, D.O., of Cook Children's Pediatrics Haslet and Alice Phillips, M.D., of Cook Children's Pediatrics Cityview answer top questions for parents and caregivers.

RELATED: Do's and Don'ts of the Formula Shortage (checkupnewsroom.com)

PGA golfers Austin Smotherman and Stephan Jaeger were here to bring smiles to patients.

Cook Children’s staff divided up into four teams to decorate and set up the holes – each with a different theme.

All holes have a bedpan at the end – that’s why it’s called the Bed Pan Open.

The themes were “Holey Guacamole,” “Brave Pups” (our Sit Stay PLAY! facility dogs), “Board Game Mashup” and one was baseball-themed.

In episode 12 of the Raising Joy podcast, Anu Partap, M.D., M.P.H., Cook Children’s Physician Director of Health Equity, joins Wini King and Kristen Pyrc, M.D., to discuss new tools to address mental health crisis and how children are affected by social determinants of health.

Dr. Partap discusses the important role pediatricians play in addressing the youth mental health crisis. Dr. Partap recently spearheaded an effort to bring the nonprofit organization REACH Institute to train about 60 Cook Children’s pediatricians. Dr. Partap says the training program is a way to ensure equitable access to mental health care by advancing the skills of primary care pediatricians to whom families first come for help.

In this episode, she also explains what social determinants of health are, as well as how discrimination and racism impact the mental and physical health of children and teens.

Dr. Partap has been a pediatrician for more than 20 years and has extensive experience in the realms of public health, mental health, family violence, child abuse, foster care and adverse childhood experiences. 

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, Google Podcasts and YouTube.

I remember scrolling through a Facebook group for physicians a few years ago, and a popular post rolled onto my screen, written by a confused pediatrician.

“What the heck is up with all these moms wanting their baby’s tongues cut?”  It was followed by hundreds of comments of confusion and agreement from other physicians.

I chuckled a little because the tremendous pressure on parents to have their baby’s tongue evaluated is something I literally talk about every day now -- and I hardly talked about it at all when I started my career.

One study showed that from 1997 to 2012 the incidence of tongue-tie diagnosis went from 3,900 to 32,000 – a nearly 10-fold increase -- in a matter of 15 years! This might be because more moms are choosing to breastfeed compared to a few decades ago.

So what’s up with tongue ties? And when should you think about getting your baby’s tongue tie cut (frenotomy)?

Tongue ties are a hard thing to write about, as it is a topic that can be pretty controversial. Depending on whom you talk to, the advice you get will change. That’s because we’re still lacking large, sweeping studies that prove one way or another that the procedure helps more than harms. Also, a gentle reminder that some folks who perform the procedure make very significant income because of it – thus creating biased advice in some ways, I think.

Clipping a tongue tie comes with risks: infection, tongue ulceration, bleeding, tongue damage, and salivary duct damage are all possible.

What is a tongue-tie?

Tongue-tie, or Ankyloglossia, means the tongue has a tight band of tissue underneath it that restricts the tongue’s movement. The tongue typically can’t be stretched upwards very well, beyond the lower teeth or lips.

The existence of a “tongue-tie” and merely HAVING a tongue frenulum (a small fold of tissue that secures the tongue to the floor of the mouth) are not the same thing!

There are different types of tongue ties – some attach to the front of the tongue, some to the middle area, and some to the back.

All tongues have some portion of tissue tethering itself down to the floor of the mouth. Just because you see a thin band of tissue underneath your child’s tongue doesn’t mean it necessarily needs to be cut. But let’s explore when to worry.

When writing this, I decided to phone some trusted friends, because a well-rounded approach is vital. There’s a lot of information here, but I hope it gives you food for thought in making this important decision for your child.

A dentist: Drew Jamison, D.D.S., with Fort Worth Children’s Dentistry (“D”)

A Speech-Language Pathologist: Sara Adams with Cook Children’s (“SLP”)

A lactation consultant (and fellow pediatrician): Andrea Wadley, M.D., with 127 Pediatrics (“LC”)

An Ear-Nose-and-Throat (ENT) physician: Kristen Honsinger, M.D., with Cook Children’s (“ENT”)

What trends are you seeing when it comes to tongue ties?

D: There is certainly an increase in inquiries about tongue-tie in our office. I would estimate at least double the number of inquiries in the past eight to 10 years. Most of these come from new mothers looking for a solution to difficulties nursing. A majority are feeling stressed and feel like they have reached a dead end. Most have also already worked with a lactation specialist and treating the tongue-tie is a "last-ditch effort". We don’t offer this procedure in our office. I have always worked to practice evidence-based dentistry. I'm waiting for more data. I want to make certain that the procedures we provide are in the best interest of our patients. We are certainly open to including these procedures in the future, just not quite yet.

SLP: In our speech therapy and feeding evaluations, parents have questions about if the tongue-tie needs to be clipped or not. They have often received different recommendations or opinions from their different healthcare providers about “to clip or not to clip.” Parents are concerned not only about a baby’s ability to breastfeed or bottle-feed, but they also have questions about if a tongue-tie will cause speech sound differences. For speech sound concerns, the evidence we have says that tongue-tie is not directly related to articulation (speech sound) disorders in most situations.

LC: The trend that I am seeing is that the diagnosis of “tongue-tie” is the explanation for a lot of breastfeeding problems in the community. Tongue, lip and now cheek ties are "en vogue" diagnoses to the point where some will refuse Vitamin K administration, but be upset that I decline to do an elective tongue-tie clipping on their child due to the bleeding risk.

ENT: In the ENT world, we’re seeing more people referred by lactation specialists, speech therapists and other non-physician providers. Previously, most of the referrals came from pediatricians. Another trend we are seeing is referrals for speech issues/concerns related to ties. To date, there have been no good quality research studies linking tongue-tie with any kind of speech delay, speech issues such as articulation problems, or feeding issues besides breastfeeding problems. There is good quality research suggesting that tongue-tie release in babies may improve maternal pain with nursing and may improve latch and therefore breastfeeding outcomes.

Are all tongue ties “bad”?

D: No. We have a large number of patients that could be diagnosed as "tongue-tied" that we simply monitor. Most of these patients thrive. If they ever have concerns that involve speech or other issues, we try and work with speech pathology to discuss diagnosis and treatment.

SLP: Not necessarily, some children have tongue ties and can drink, eat, and talk with no difficulties. This is why it is important to have the child evaluated by a medical professional that is familiar with tongue ties and can help look at those functions.

LC: Not all tongue ties are bad. As the baby grows, often the "tie" or frenulum will stretch and grow over time. Occasionally, ties will need to be corrected later in life, but often kids get by just fine without having them repaired. If the baby has a visible tongue-tie but is transferring milk well from the breast or sucking well from the bottle, I often leave these alone and follow up over time.

ENT: It’s normal to have a frenulum or “tie” under the tongue -- most babies (and adults!) do and it’s a normal part of the anatomy. An evaluation by a qualified specialist is necessary to determine whether or not the frenulum is restricting tongue movement or causing other difficulties, however.

When do you think it’s a good idea for parents to seek out frenotomy (tongue-tie clipping)? Are there any patterns you watch for or anatomical problems you notice in an exam?

D: I can certainly expand on philosophy here, but to remain concise, we typically tell parents: If you feel like you have exhausted all other options, including consultation with lactation consultants, then we promote the procedure. Scientific literature confirming effectiveness and results are scarce. However, we find that about half of our patients report an improvement in nursing.

SLP: If the tongue-tie is impacting the child’s ability to eat or drink – then it is time to consider frenotomy. I look at the overall function of eating or drinking to help determine if the family should talk to their doctor about that procedure. Sometimes, a tongue can look severely tied, but the child still has a great range of motion and no difficulties with eating or drinking. Sometimes a “mild” looking tongue-tie can present with really significant difficulties eating or drinking. You can’t always go by how it looks. For breastfeeding babies, if the mom is experiencing pain with feedings and has tissue damage to her breasts – then I collaborate with physicians about a frenotomy.

LC: I consider clipping tongue ties for babies whose tongues have a "heart shape" when they are extended. If they are unable to lift the tip of the tongue, it is very difficult to breastfeed. If the mom is having a lot of pain with breastfeeding and has lesions/blisters/bruising along the edge of the nipple that is in a "tube of lipstick" distribution this could be due to a tongue-tied baby or if the mom's nipple is shaped like this after every feeding and does not "round out" quickly. I also consider them for breast (or bottle) feeding babies who are taking in a lot of air with feedings, clicking with feeds, or who cannot sustain a latch long enough to transfer milk from the breast. I will also evaluate "posterior" (back of the tongue) or submucosal tongue ties if the baby is not transferring milk well and all of the other factors are accounted for.

ENT: In general, the sooner the better. One of the main goals we have is to help parents who choose to breastfeed to be able to do so- and making sure that we fix a tongue-tie when necessary can be an integral part of this. If there is something that we need to fix, it’s generally best to try to do it as soon as possible so that both the baby and mom can reap the benefits as soon as possible.

Should tongue-tie clipping be done in the newborn period, or do you think there are instances where it should/could be done later in life?

D: I think I answered this in the second question, however, I emphasize limiting any procedure unless necessary.

SLP: Hopefully, if there are concerns noticed with breast or bottle feeding, the procedure is done quickly so that we can support breastfeeding or can help that baby bottle feed. I have seen a few instances where the patient was older, about 12-18 months because the difficulty became more apparent as they were not able to use their tongue appropriately as they began to chew foods.

LC: As a newborn hospitalist, I would clip tongue ties during the newborn period if they were causing very obvious problems or mothers were having significant pain with breastfeeding. Often, I would clip them if the mom was an experienced breastfeeder and had lots of pain or had a previous baby with a tongue-tie that needed to be clipped. Now as an outpatient physician, I will clip tongue ties that have been referred to me by other professionals who have evaluated the mom and baby. These are often done around 1 to 2 months of age. After the parents have exhausted other options.

ENT: It’s easiest if we’re able to do a tongue-tie release procedure before around 3 to 4 months of age because the procedure can be done in the office. When a child gets much older than that, it’s typically recommended to do the procedure in the operating room. Since the research shows that the procedure improves breastfeeding outcomes, it is best performed as soon as possible.

If parents are on the fence about the procedure, who do you think they should reach out to? Do you think they should get advice from more than one profession?

D: I think a team approach is best when diagnosing and treating a tongue-tie. Different specialists’ understanding and communication of specific concerns lead to a well-informed treatment plan. If it is related to nursing, I would follow the advice of a lactation consultant or pediatrician.

SLP: Lactation consultants can help with questions on the latch at the breast. Speech pathology can help with feeding/bottle concerns and speech sound concerns. Dentists and ENTs are also great resources because they can provide insight as well. If you have a concern or are unsure, reach out to qualified health care professionals that are willing to listen to your concerns and that have knowledge on tongue ties – have an open and honest dialogue with them and come prepared with your questions.

LC: If parents are on the fence, I would recommend getting opinions from several trusted physicians. Pediatricians, family doctors, ENT and of course physicians with extra lactation training would be ideal. I would warn families to beware of "professionals" who are pushing the procedure without having done a full evaluation (which includes a feeding assessment).

ENT: I think the child’s pediatrician should always be the first one to evaluate a child and determine if they may benefit from a tongue-tie release. As far as asking other professions what they think/recommend, I would say that it is not uncommon to receive very different advice and recommendations based on who you ask. Each provider likely gives their recommendations based on their own experiences, training and background. ENT physicians also tend to rely heavily on what research papers have shown to help us to determine who will and likely will not benefit from a tongue-tie release.

Some take-home points from me, a pediatrician:

• Tongue-ties are a complex issue that is still being studied, and many factors should be taken into account when trying to figure out whether or not a procedure is needed.
• Not all tissues under the tongue are “tongue ties.” The vast majority of tongue frenula cause absolutely no issues. And many tight tongue ties can stretch out over time.
•  Be careful about what you read on the internet. I can tell you from experience – there is a lot of garbage out there, and I’ve seen many babies fall victim to a painful and unneeded procedure because a parent was so worried about something they read online.
• I’d say that in my personal experience of 12 years as a pediatrician, tongue tie clipping leads to improvement of a feeding or nursing issue maybe 50% of the time. And 50% of the time, it does not help.
• According to our current evidence, tongue ties do not seem to affect speech. Again, this is based on what we know now.
• Some older kids do report having difficulty licking their lips or teeth or licking an ice cream cone. This is one of the rare reasons older kids may need it cut.
• If you’re wondering about getting your baby’s tongue tie cut, consider talking to more than one specialist – the more, the better, especially if you are considering getting a “posterior tie,” or back of the tongue, cut.
• I’d definitely consider getting your baby’s tongue-tie evaluated if he struggles with drawing milk out of the breast or bottle if you are a mother who continues to experience a lot of pain with nursing after more than 2 weeks, and/or if he cannot extend his tongue past his lower teeth or lips (plus struggles with one of the issues above).
• When you read the comments of this post, you’re going to see a lot of “just do it! It helped my baby!”, or “getting the tongue tie cut was the worst decision ever…” – please remember that every child is anatomically and physiologically different, and one person’s experience may not be what you experience.

I hope this post helped give you the slightest bit of clarity on a topic that is not so clear.

For as many tiny studies I found showing that cutting a tongue tie doesn’t help a baby feed, I found an equal number showing that it does in fact help. The truth is, we need more data -- more big studies involving lots of babies -- before our answers will be clearer and more confident when it comes to tongue ties.

The baby in the picture is a sweet patient of mine. He has a normal tongue frenulum that might appear worrisome when you see it, but as a newborn, he was able to transfer milk easily, and he thrived.

Now, for some extra reading!

Ankyloglossia and Lingual Frenotomy: National Trends in Inpatient Diagnosis and Management in the United States, 1997-2012. https://pubmed.ncbi.nlm.nih.gov/28168891/

Breastfeeding: What to do about Ankyloglossia. https://publications.aap.org/aapnews/article-abstract/36/6/11/25079/Breastfeeding-what-to-do-about-ankyloglossia-lip?redirectedFrom=fulltext

A systematic review: The effects of frenotomy on breastfeeding and speech in children with ankyloglossia. https://pubmed.ncbi.nlm.nih.gov/33501864/

Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. https://pubmed.ncbi.nlm.nih.gov/25941303/

Frenotomy for tongue-tie in newborn infants.  https://pubmed.ncbi.nlm.nih.gov/28284020/

Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review. https://pubmed.ncbi.nlm.nih.gov/25941312/

The effect of ankyloglossia and tongue-tie division on speech articulation: A systematic review.  https://pubmed.ncbi.nlm.nih.gov/33964037/

Spring is officially here! Along with the start of spring, allergies are starting back up again as well. However, at Cook Children’s there has been an increase in flu cases at CCHCS this past month and the cold season isn’t over just yet along with the COVID-19 pandemic.

Let’s figure out how to tell if your child has a cold, the flu, allergies or COVID-19.

Right now, your child’s sneezing, cough or fever may just scratch the surface as to which of the four it could be.

“Even though it’s spring, parents need to keep in mind some of those winter viruses are still circulating. There are a lot of respiratory viral illnesses still going around that we associate with the wintertime,” said Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Haslet Office said. “In Texas, the weather is not full on spring, it is still cold outside some days.”

Allergies

Allergies are caused by pollen and the environment.

“Allergies usually do not have any of the symptoms that viruses usually cause fever, body aches, or overall general ill feeling,” Dr. Soria-Olmos said. “Most kids with allergies are going about their normal day other than the nuance of symptoms. The overlapping makes things confusing.”

Cold, Flu or COVID?

Symptoms of the common cold, the flu and COVID are very similar. The main way to tell the difference is through testing.

Each of these is a virus that affects the body and can affect the way kids act. A fever is the most common symptom to monitor between the cold, flu and COVID-19.

Cold and flu typically come with additional symptoms such as a decrease in appetite, fatigue, chills, etc. Sometimes you can have a cold without fever. Flu typically causes an increase in temperature.

Parents of children under the age of 2, should contact their pediatrician if the fever continues for more than 48 to 72 hours. This is to help determine if the doctor should see the child and or if a parent can continue supportive care at home.

Although we have seen fewer COVID-19 cases in the community, it is still something to think about as a cause of fever, cough and nasal congestion or sore throat.  

“Testing is the main way to help us determine between different causes of similar symptoms,” Dr. Soria-Olmos said.

Dr. Soria-Olmos encourages parents to speak with their pediatrician on how to treat their child and identify the cause of their symptoms.

We invite you to join us in celebrating all of our world-class doctors. From diagnosing a stomach bug to operating on a broken leg to making treatment plans, the work they do every day is making a difference in the lives of children.

Please consider making a donation to Cook Children’s in honor of your favorite doctor. There’s a place in the donation form for you to leave a note. If you choose to share your story or extend a thank you, we will make sure they get it -- because they would love to hear just what they mean to you and your family.

Slime-A-Doc

After a two-year hiatus, Slime-A-Doc made a comeback! The event will be hosted at 3 p.m. Wednesday at the Cook Children's Medical Center on the South Tower Lawn. 

Thank you to all of the participants and congratulations to this year's winners: 

• Child Life: Laura Sonefeld, Sit…Stay…PLAY! coordinator 
• Nurses and APPs: Lauren Mecke, NP, Urology 
• COVID Command Center Leaders: Stan Davis, chief operating officer 
• Physicians: Diane Arnaout, M.D., and Daniel Guzman, M.D. 

Flu cases continue to increase at Cook Children's Health Care System. From March 13 to March 19, there were 275 positive cases of influenza A and zero cases of influenza B.

Positive flu cases have steadily increased every week since mid-January.

For the week of March 6 through March 12, lab data showed that there were 242 positive and 511 negative cases of influenza A. There were zero positive cases of influenza B.

By this time of year, typically cases decline.

“But what we have seen over the last week or two is cases are actually on the rise,” said Pediatrician Alice Phillips, M.D. of Cook Children's Pediatrics Cityview.

There has been more activity during the 2021-2022 flu season compared to 2020-2021. Typically, the flu season starts in November and the spike can be in December or January, Dr. Phillips said.

Why is there a current increase in cases? One potential contributing factor comes from people wearing their masks less frequently and returning to pre-pandemic activities. On Feb. 25, the Centers for Disease Control and Prevention issued new masking guidance for areas of low transmission of COVID-19.  These guidelines can be read here.

With students out of school for spring break, it could potentially stop the spike of cases, but pediatricians will have to wait and see the data when kids return to the classroom, Dr. Phillips said.

What are the symptoms? What should I do?

It’s a good idea to get your child tested if you believe they have the flu, Dr. Phillips said. The symptoms are similar to COVID-19 because both have symptoms of fever, cough and a sore throat. Both illnesses could potentially pose a risk to someone who is immunocompromised.

If you have the flu, you should isolate. You can stop isolating once you’re fever-free for 24 hours without fever-reducing medicine.

Common flu symptoms are:

• Fever or feeling feverish/chills
• Cough
• Sore throat
• Muscle or body aches
• Headaches
• Fatigue (tiredness)
• Vomiting and diarrhea are more common in children than adults

When should we go to the doctor?

“I think anytime a parent has a concern about their child, they should call their provider because if you're worried, your instincts as a parent are very strong,” Dr. Phillips said.

She said also it could be good to bring them to the doctor if:

• They’ve had a high fever that you can’t control
• Showing signs of dehydration, such as dry mouth, no tears in their eyes
• If your kid looks sick and you want them checked

Typically, a child can recover at home. You can call and get guidance over the phone if they’re keeping fluids down, and they’re resting and can control the fever.

Remember, it is not too late to get your flu shot. This serves as your best defense against the flu when combined with good handwashing.

There’s been a ton of surprises related to the COVID pandemic and skipping flu season last year was another one I never saw coming.

Masks and social distancing definitely played a role but the absolute lack of cases was still shocking.

So, will we get lucky again this year?

I doubt it.

And here’s 3 reasons why:

1. Social distancing and masking are going away or gone. And we all want to get to that place…but it does mean we’re likely to have flu cases spread among classmates and families.
2. Skipping a flu season last year may make individuals more vulnerable to flu this year. Our bodies haven’t seen flu for almost two years. And just like our other colds went wild in kids this fall, flu could do the same this winter.
3. A mild or absent flu season last year may make people more likely to skip their flu shot this year. “Do we really need one after last year?” is a common question I have been asked.

What can you do to protect your child and their friends?

Get them their flu shot. Now’s not the time to get cute. Just do it.

Start to work with your child on hand-washing and covering their coughs. We need to protect ourselves and others.

Keep your child home if they are sick. If something seems to be brewing, give it a day to develop at home.

This pediatrician has watched your mental battles from the sidelines this year, Mama.

2020 was not an easy year to be a mom.

Personally, I can tell you it kind of sucked, right? Just a little. The pandemic brought about so many hard choices that NO mother should ever have to make. My brain’s stream-of-consciousness ran a little something like this:

“Should I let my kids play with other kids? Will they get sick if they do? Will not interacting with others harm them more than catching COVID will? Should we start in-person school? Will masking all day be hard for them? Is virtual school a better option for us? Will looking at a screen all day hurt my kid’s eyes? Will lack of interaction with peers lead to social regressions? Are my kids eating and snacking too much? Do I need to choose between my kids seeing their friends, and my kids seeing their grandparents? Is my child in his room too much? Is he exercising enough? Is he sad too often? Is social media going to influence his behavior? Is it normal for sleep to be this much of a struggle – for both me and my kid? Am I telling my kids to wash their hands too much? Will this give them a germ complex? What do I tell my kids when they see those protests on the street? What do I tell them when they see the news on TV? What do I say when they hear people angry and shouting at each other?”…and so on and so forth…over and over…and for me, usually happening at 3 a.m.

So now that you know that I worried about a lot of the same things you did, let’s talk.

This Mother’s Day I’d like to tell you about what I’ve seen and heard in the privacy of my exam rooms.

More anxiety than I’ve ever seen in my career. In both parents and kids.

More depression in children and teens.

More mental crises.

More weight gain.

More screen addiction.

More sleep problems.

More suicidal thoughts.

Momming has never been more difficult. Not only have we been burdened by our own mental struggles, but we’re trying to cope with our kids’ mental strain now more than ever.

Some advice:

1. “Put on your own oxygen mask first – and then help your children with theirs”. Take care of yourself so that you can then throw that energy into your child and his/her struggles.
2. Look for help – Cook Children’s pediatricians, psychologists, and psychiatrists and hospital staff are here for you. We know kids - especially the mental health of kids. Check out the new Cook Children’s JOY Campaign for TONS of resources.
3. Please, ask questions. If your kid is struggling, ask your pediatrician – will some socializing be okay? Should my kiddo return to school/ go to camp? Is it safe? What are the pros/cons? What is the risk by doing this activity or that one? How much screentime is healthy for my kid? Is this behavior normal, or is my teenager showing signs of a problem? What are some resources so I can learn more?
4. Look into counseling. At my office EVERY DAY I tell parents: every single human on the planet goes through a time in their life where they’d benefit from therapy. Do it. Don’t feel weird about it. Just go talk to someone – and take your kid to talk to someone. Psychologists are trained to help you through this.

From one mom to another: we are not meant, as humans, to deal with as much stress as we have in the past year and come out unscathed.

There’s a reason you keep hearing the word “unprecedented” when it comes to 2020 and 2021. The pandemic, the politics, the civil unrest - this was a year that no one anticipated, and no one was prepared for. Know that you’re not alone in what you or your child may be dealing with.

So put down your armor, you warriors. And reach out your arms and accept some help! And give yourself a little grace.

This year was a scary and painful mess. And this Mother’s Day, no matter how much you yelled at your kids, no matter how much you felt you didn’t have the answers, and no matter how much you questioned your decisions, I want you to pat yourselves on the back. Because just surviving has been the victory here. And you’re doing the best you can.

Dr. Olvera and Dr. Hanson have been piercing ears as part of their clinical practice within the Cook Children’s Network since 2016. They both use a medical ear piercing system only available to pediatricians and medical providers.

When should I get my baby’s ear pierced?

This is truly an individual decision. If you decide to pierce your baby’s ears, we only ask that they have received their first set of immunizations at age 2 months. Dr. Olvera and Dr. Hanson prefer to pierce ears from 2 to 9 months and then after age 4 years. Piercing a child’s ears between the ages of 1 to 4 is the most difficult age in terms of cooperation. It is important to understand that most children will cry when getting their ears pierced.

As far as age, some parents prefer to wait until a child can make the decision for themselves. Again, no judgment here. For some, the decision is a cultural one. In some countries, such as Spain, infants' ears are pierced right after birth. Dr. Olvera had her ears pierced at age 8, so she offered the same for her own daughters. Many families have the tradition of waiting until age 10 or 13 to have ears pierced. We respect all decisions!

Where should I get my baby’s ear pierced?

Again, this is a personal choice. More and more pediatricians do offer this service to their patients. First, ask your pediatrician if they offer the service. Some families will choose to go to a local tattoo parlor or the local mall. We recommend that you do your research on the place you choose and determine the age groups they serve. Make sure that you know families have had a good experience at the place you decide to go to.

Dr. Olvera and Dr. Hanson provide medical ear piercing to everyone in the Cook Children’s Network, even if your pediatrician does not offer the service.

What earrings should I use?

With the system that we use, the earrings are provided. You will have a choice of either medical-grade titanium or medical-grade plastic earrings. The earrings used for piercing are only designed to stay in for 6 weeks. You are asked to remove the earrings after 6 weeks and replace them with earrings of your choice. This step is important as the earrings used for piercing have thicker posts. We caution patients to stay away from costume jewelry for the first year. It can take up to a full year for the holes to be completely healed. If a patient has very sensitive skin, we recommend buying replacement hypoallergenic earrings to use for the first year. The medical-grade plastic earrings are excellent for patients with sensitive skin.

How do I take care of my ears after piercing?

The medical ear piercing system we use requires no special cleaning agents. The company recommends cleaning the piercing site (around the earring) with soap and water twice a day. Older children should be reminded to not touch their ears with dirty hands.

What sites do you pierce?

We do traditional ear piercing, usually single lobe piercing on each side. However, we are also comfortable offering second piercings on the lobes to preteens and up. We do not offer cartilage, nose, or belly button piercings.

Do you pierce boy’s ears?

Absolutely!

The last few weeks have been hard, to say the least. Although the new year brought hope that we would begin to look to a “return to normal” after one year of the COVID-19 pandemic, things haven’t felt so positive. It is only natural to yearn for what once was - allowing my kids to participate in group sports without the worries. To do in-person learning without the fear that we will receive an email indicating our child was exposed to the virus, and to go on a dinner date with my husband (to make up for the canceled date from last year as the lockdown and worries began).

In the last few weeks, losing my own grandmother to COVID-19 reminded me of all the families that have experienced a loss of a loved one in the last year. Although this happens routinely as part of the cycle of human life, I am reminded that there has been “extra” loss of life, and likely many more families impacted by loss than would have occurred otherwise.

The loss of a loved one is experienced at different stages for most. A difficult part of this process sometimes goes unnoticed but is worth highlighting. Being a parent and responsible with the difficult task of explaining death to a child in a way that is developmentally appropriate is not easy.

The best way to approach this situation is to be aware of how children understand death and this will help you pick the right thing to say. It’s important to remember that even young children who don't understand death will react to grieving parents. Older children will themselves grieve. Parents should support their children through this process in order to resume their lives without significant distress or interruption.

Children have a different understanding of the finality of death. Your approach to discussing death will depend on your child's level of understanding of four main concepts of death:

• Irreversibility (i.e., death is permanent)
• Finality (i.e., all functioning stops with death)
• Inevitability (i.e., death is universal for all living things)
• Causality (i.e., causes of death)

Babies and Toddlers

Infants and toddlers do not understand death but do sense what a caregiver may be experiencing. It is important to take care of yourself and progress through your own grief while maintaining routines that will help foster healthy progress through the life event.

Preschoolers

Preschoolers see death as temporary. They are concrete thinkers and usually see things for what they appear and hearing things literally. It is important to avoid euphemisms like, "She has gone to sleep," or "…traveled to the great beyond." Children at this age cannot understand these phrases and can sometimes even generate fears about traveling or sleeping. Be prepared for this age child to ask again and again where the deceased is and or when they will come back. Always answer with a clear message, which of course can be softened with the mention that the memories will remain. At this stage, children typically have a hard time talking about what they feel and their fears may come out at unexpected times such as during play.

School Age

School-age children begin to understand death as a final event but can have difficulties understanding it is universal. Make sure to offer clear, simple, and honest explanations about what happened and allow them to ask questions. Help them when they have difficulties finding the right words to explain their feelings. At this age, they may not understand the causality of death and they may personify death. Sometimes at this age, they may worry they will be left alone and begin to think about the death of a significant caretaker. Things that are important to do at this point include:

• Remind your child that not everyone who gets sick will die.
• Reassure them of your health.
• Let them know how many people in their life care for them.
• Support children to do things to reduce their anxiety and be sensitive that they may not want to talk or think about the deceased because it is too painful.
• Take care of yourself and make sure you have support.

Adolescents

Adolescents understand death the way adults do but can have difficulties or be resistant to expressing their feelings. They begin to think abstractly and this can cause some difficulties which can lead to risky behavior or even guilt about being alive. Supporting teenagers in finding healthy ways to express their feelings is very important.

Being aware of normal responses to death, as well as signs that they may need professional help, is an important part of supporting the grieving child. Younger children can revert to immature behaviors or angry outbursts. These typically are a result of unexpressed emotions such as frustrations or confusion. In school-age children, difficulties concentrating, sleeping, or physical complaints including stomachaches and headaches can occur. Teens often experience a wide range of emotions including sadness, anger, guilt, and helplessness. Teens may either withdraw or do the opposite, and engage in risky behavior.

This time is difficult for the entire family and it is important to take the time for yourself to deal with the grief. Kids of any age can sense the emotions of a caretaker and respond accordingly. If you ever have a concern that the child is experiencing extreme symptoms and/or the symptoms of grief are not resolving, ask your child’s pediatrician for help.

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

"What’s this new movement?"

"Is this behavior normal?"

"What should I be doing about this rash?"

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

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

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

As of Dec. 5, hundreds of children have been tested for flu and RSV at Cook Children’s Medical Center, and none have come back positive. Ramon Kinloch, M.D., a pediatrician at Cook Children’s, believes this has to do with social distancing and masking due to COVID-19.

“A lot of it does have to do with the precautions we have been taking for COVID-19. When we are wearing a mask, we are less likely to spread those respiratory droplets that transmit RSV and flu viruses,” Kinloch said.

Dr. Kinloch says another reason he believes there haven’t been cases is that people aren’t around each other as much right now. With limited contact with those outside of our family units, the physical spread of the virus’ droplets is less likely to happen.

Though there haven’t been any cases yet, Dr. Kinloch believes infections will begin to rise, especially with families gathering for the holidays.

“We are beginning to see people get a little more relaxed, especially with there being a COVID-19 vaccine on the horizon. With that, we will probably begin to see a rise in the flu and RSV numbers,” Dr. Kinloch said.

Dr. Kinloch explained that in years past, Cook Children’s typically sees a slow start and then a huge spike of infections, and he doesn’t expect this year to be any different.

If you believe your child has the flu or RSV, you should look for symptoms such as a fever for more than two or three days, body aches, running or stuffy nose, and coughing. For infants specifically, one sign that could indicate RSV is fast breathing and retractions.

Dr. Kinloch says differentiating between the flu, RSV and COVID-19 can be tricky. While the symptoms are very similar, one distinguishing factor is the loss of taste and smell, which primarily accompany the COVID-19 virus.

“If a child says, “I can’t smell anything,” we have to distinguish if that’s a stuffy nose or if they literally can’t smell or taste anything. If that is the case, we would more likely be dealing with a COVID-19 situation,” Dr. Kinloch said.

The only way to know for sure if you or your child has either illness is by getting tested. Dr. Kinloch says even testing has its limitations and it all comes down to when you get tested, what symptoms you have, and your exposure. He warns that each case is different and parents should always reach out to their physician if symptoms are worsening and fever will not break.

“They are with them and they know them better than we do. If a parent is uncomfortable with how their child looks or they have a gut feeling, it’s always important to call their doctor and have them evaluated. I believe that parents are equipped to know when something is wrong with their child,” Dr. Kinloch said.

So how do I know if my child needs to be seen? Call your pediatrician if your child:

• Has more than three or four days of fever (temperature over 100.4 degrees)

• Has any type of sustained and fast breathing

• Is lethargic or limp

Dr. Kinloch says his best advice is to ensure you’re following all CDC guidelines and to remember, it’s about keeping each other safe. He advises all families to get the flu vaccine, wash your hands, and be sure to remember the guidelines amid the pandemic.

1. Books!

For infants and toddlers, there are chew-proof, waterproof, rip-proof brands of books available. Just do a quick Goolgle search. Classics like Dr. Seuss, Little Critter, and Curious George still are favorites too.

For elementary age and teens, start them on a series based on their interests. American Girl, Magic Treehouse, The Land of Stories, Eerie Elementary, The Babysitters Club, Survivors, Warriors, Dork Diaries, Diary of a Wimpy Kid, The Boxcar Children, Nancy Drew, Goosebumps, Humphrey, Keeper of the Lost Cities, Captain Underpants, Dog Man, Wings of Fire, and The Hardy Boys are all excellent options.

2. An Activity Center

Great for keeping infants busy while you’re able to get other things done. Do NOT use a walker, this puts the baby’s hips in the wrong position and delays walking.

3. Blocks

All sorts of blocks are available online and in stores these days. Just make sure they are appropriate to prevent choking risk.

4. Board Games

Games are a great option to create family time away from screens. If you played a board or card game as a kid, chances are your child will enjoy it.

5. Bike

Tricycle, Bicycle, Scooter. Make sure it is age and size appropriate for your child, and they MUST WEAR A HELMET!

6. Arts & Crafts

Paints, sand art, beads, diamond painting, suncatchers, rainbow scratch paper, molding clay, candle making, origami, felt sewing craft kit. Low-cost dollar stores often sell wooden figures to paint, so that’s a great place to stock up on cheap and easy crafting projects.

7. Fort Building Kit

Buy one or several kits for the kiddos to make an awesome fort, tear it down, and then make again in a different way!

8. Sports equipment

Basketball goal, soccer ball and goal, baseball tee, ballet barre. Let your children pursue their current sport of interest and invest in increasing their skills and confidence.

Notice the above listed toys do not suggest any electronics. The only game system game I would recommend is one where they are up and active the entire time. Remember, aside from school work, your child should have less than two hours per day on any screen including: phone, TV, gaming system, and computer. Your child would rather spend the time with you, playing a board game or being active outside, than sitting by themselves playing on a game system.

Have a very Happy Hanukkah, Merry Christmas, Happy Kwanzaa, and enjoy any and all other celebrations your family takes part in!

Physician names in order of appearance: 

1. Dr. Diane Arnaout
2. Dr. Alice Phillips
3. Dr. Suzanne Whitworth
4. Dr. Laurie Gray
5. Dr. Bradley Mercer
6. Dr. Daphne Shaw
7. Dr. Kim Mangham
8. Dr. Eriel Hayes
9. Dr. Angela Hippeli
10. Dr. Diane Arnaout
11. Dr. Bianka Soria-Olmos
12. Dr. Samson Cantu
13. Dr. Ramon Kinloch
14. Dr. Kim Mangham
15. Dr. Alice Phillips
16. Dr. Suzanne Whitworth
17. Dr. Michelle Bailey
18. Dr. Laurie Gray
19. Dr. Ramon Kinloch
20. Dr. Angela Hippeli
21. Dr. Bianka Soria-Olmos
22. Dr. Daphne Shaw
23. Dr. Jason Terk
24. Dr. Bradley Mercer
25. Dr. Kim Mangham

Most people develop some redness and itching after a mosquito bite. Unfortunately, some children will have what’s known as a large local reaction, or “Skeeter syndrome.” This happens due to an allergy to mosquito saliva. These patients develop redness and swelling within hours of a mosquito bite. The swelling can be very large (like an entire arm or leg) and typically worsens over 1-2 days. In the worse reactions there can be bruising and even blistering!

It’s not always easy even for your doctor to tell the difference between “Skeeter syndrome” and a skin infection. One of the big differences is the timeline. Skin infections usually happen several days after a bite or an injury, but “Skeeter syndrome” usually starts within a few hours of a bite. Most often children with a large local reaction will complain about intense itching. Only in the more severe cases are pain and fever seen with allergy. It’s not common, but some even develop severe allergic reactions to mosquito bites that lead to difficulty breathing.

Large local reactions are best treated with oral antihistamines (Benadryl or Zyrtec) and topical over-the-counter steroid cream (hydrocortisone 1 percent). Fingernails need to be trimmed very short, because scratching causes local skin damage that can become infected. Cold compresses several times a day help alleviate some of the discomfort. In patients who have a history of this type of reaction, I recommend daily antihistamines such as Zyrtec during the time of the year when bites are difficult to avoid. This doesn’t totally prevent the reaction, but can help keep the swelling from being as extreme. I don’t recommend topical antihistamines (Benadryl cream) because some people develop a contact allergy that actually worsens the problem

So, when should you come to the doctor? 

Any child with significant eyelid swelling or swelling that is limiting activity or skin blistering deserves an office visit because they require further evaluation and sometimes even need oral steroids or more potent prescription topical steroids. Red/swollen/hot areas of skin that are associated with pain or fever should also be examined to rule out a bacterial infection.

Tick bites don’t usually cause itching like mosquitos, but are more of a concern due to infections they can transmit. Ticks are predicted to be more prevalent this summer due to the winter being relatively warm. Ticks can transmit several infections with Lyme being one that is often discussed.

If you find a tick on your child it should be removed with tweezers by grasping the tick as close to the skin as possible and pulling straight up. Different types of ticks spread different infections. For example, infected deer ticks can spread Lyme after being attached for 36 hours or longer. Certain areas of the country have a much higher rate of local tick infection than others. Texas is not a part of that area, but cases of Lyme do occur every year.

It is best if children bathe after coming in from playing outside to wash off ticks prior to attachment. It’s a good idea to look in hidden areas such as behind the ears and on the scalp. Remove ticks if you find them and watch for a rash. Certainly, a rash that looks like a bull’s eye or a target (erythema migrans) is concerning for Lyme infection and needs to be seen for further testing.

Insect bite avoidance is important (and hard)! The large local reactions are definitely very uncomfortable, but infections transmitted by mosquitos such as West Nile or Lyme from ticks are potentially very dangerous. Using DEET containing insect repellant and wearing long sleeves during peak mosquito times are helpful.

As always, see your pediatrician if you are worried about a bite or rash and we are happy to help.

Related:

• The deets on DEET from a pediatrician
• Protecting Your Child From Ticks

Doing their best to minimize in-person visits, Cook Children’s Primary Care Physicians and Cook Children’s Urgent Care Physicians are partnering to provide telemedicine visits to help provide the quality pediatric care you expect from Cook Children’s.

A Video Visit allows a patient to have a remote visit with a Cook Children's primary care provider for non-urgent reasons. A patient must have a MyChart account to request a video visit.

• Desktop web browsers
• Mobile devices

Click here for tips on how to prepare for a video vist.  

“Many parents have simple questions that can be answered by a quick conversation with a pediatrician and do not require an in-person visit,” said Justin Smith, M.D., a pediatrician and medical director of Virtual Health for Cook Children’s. “This technology allows our pediatricians to help prevent the spread of COVID-19 while still providing high-level care to our patients.”

Patients can access telemedicine at Cook Children’s via two major pathways.

Both require two steps in preparation for a visit:

1. Patients must have active Cook Children’s MyChart accounts.
2. Patients must have the videoconferencing program Zoom downloaded to their device.

After that, parents can choose to either:

• Request a visit with their regular pediatrician by selecting the “Appointments” tab in MyChart or by calling their pediatrician’s office to set up an appointment. These appointments will be available during regular office times. When the time comes for a visit, patients go back to the appointments tab to complete e-check in and start the video visit. Click here to learn more.
• If your child’s regular pediatrician is not available, then you have the option to request a visit with the next available pediatrician by selecting the “Video Visit Now” tab in MyChart. Urgent Care doctors are available to see these visits from 11 a.m. to 9 p.m. every day. Once selecting the "Video Visit Now" button, patients are put in line for the next available provider.

In addition to telemedicine visits, Cook Children’s pediatricians are actively working to help keep patients safe by direct messaging with patient families and providing phone visits when video is not an option. Messages can include a picture or video and can be sent through the MyChart “Messages” tab.

For more on this, view the following:

• Primary Care Video Visits
• Urgent Care Virtual Visits
• Zoom: https://cookchildrens.org/mychart/Pages/video-visits.aspx
• My Chart: https://cookchildrens.org/mychart

Since we have access to medical-grade equipment, are trained in sterilization techniques, and are equipped to handle any potential side effects, we can offer piercings as an option. As with any procedure, there are some risks involved, but we have found that when having this done in a medical setting, and more importantly, with proper technique, the risks are rather minimal. For that reason, parents are often relieved to hear that we offer this service in our office because they feel more comfortable having us perform it.

Now there is no medical reason to pierce a child’s ears, and as such, there is no official “best” time to have it done. Ultimately, the timing and age at which you have this done are up to you and your family. My mother made that decision for me and had my ears pierced at infancy, and I'm not mad. Sometimes families want to have their baby’s ears pierced during infancy so that babies won’t remember how it felt. Some wait until the child can decide. I am happy to offer this once they are 6 months of age after they have received their necessary immunizations.

There are risks involved – mainly infection at the site or scarring. We reduce these risks by using sterile equipment and having you clean the site every day with alcohol or peroxide. This is also why we require vaccinating beforehand. If you do develop an infection, it will usually appear very red, swollen, and may have some associated discharge. Infected piercing sites will also often be quite tender. If you do develop an infection, you should contact your pediatrician right away.

Another risk is the development of allergies to metals, especially to nickel. Because of this, we always use nickel-free posts for all of our earrings. Typically we like to use medical-grade titanium posts since this tends to prevent reactions the best. Stainless surgical steel is another standard and safe option for your child. Other good options are medical plastic or gold.

Whether or not you have your child’s ears pierced at your doctor’s office, it is very important to seek out a trained professional for this. Make sure that the individual performing the procedure washes their hands beforehand, wears gloves, and uses sterile products. The part of the product that touches your skin should come directly out of the packaging before coming in contact with your skin and before touching anything else. It is never a good idea to do this yourself or at a friend’s house.

I always get asked if it will hurt, and of course, the answer is yes, but it truly is a brief pinch, and the pain resolves rather quickly. You may even experience a warm sensation for a few moments afterward as well, which is healthy and lasts only momentarily. To minimize discomfort, I recommend icing the site beforehand or taking Tylenol or Motrin. I do offer numbing cream on the earlobes for 20 minutes before the procedure, and due to this, the ear-piercing is separate from other appointments.

Some clinics might have people trained to do them simultaneously, but in my clinic, I do lobe piercings one at a time to assure the earrings have been placed in the correct position in regards to the other.

What can you expect later on? Generally, we have you keep the first earrings in for six weeks. It is important to turn the earrings and clean them with either alcohol or peroxide every day. Don’t remove the earrings too early, because the holes will actually close up right away. Avoid swimming, especially in a lake or ocean, because of the risk of infection. Be careful when removing clothing or when playing sports, etc. that the earrings do not get caught and/or pulled. If this is happening, it would be best to cover them with bandages over the earlobes to prevent this. Also, when applying make-up, hair sprays, hair dye, etc. it would be best to cover your earlobes to protect them.

It can take a whole year for the holes to completely heal, so consider wearing earrings for the entire year to keep the hole from shrinking. Keep the area around the earrings clean and dry, wash your hands before changing earrings and make sure to wash the earrings or sanitize them with alcohol before using them as well. Take care when changing earrings. Because the skin within the hole is still delicate for almost a year after piercing, there is always the risk of infection if that skin should tear.

Again, there is no medical reason to have your ears pierced. But – if you’re going to have it done, get it done right. If you decide to have it done by a physician, I am all for it; however, if you choose to go outside of the medical community, that’s OK, too – just be sure to seek out a professional who will perform it correctly for you or your child. Remember, there are some risks involved. Make sure you and your child are ready to care for the site properly.

So if you are ready for your child's piercing? Don't worry, I'm ear for you!

In the wake a baby is dead and her mom has been charged with her murder. In addition, the baby’s dad has been charged with aggravated battery and cruelty to a child for diluting their baby’s breast milk with water, then refusing to take the child for medical care.

By the time they did take her to the hospital, she was already dead.

Unfortunately, this is not uncommon. I remember a similar case from years ago in which a child’s family was desperate for money and thought they could use extra water to make their formula last longer. In a study from Clinical Pediatrics, up to 25 percent of families considered “food-insecure” admitted to using various methods to make their formula last longer.

The problem is that extra water is not safe for babies. It causes the sodium level in their blood to drop. Low sodium will lead to brain swelling which can cause poor feeding, lethargy, seizure and eventually death.

Giving free water to babies is not just an issue of formula stretching. Families commonly ask during the summer months if their babies need extra water due to the heat. The answer is NO!

Some reasons babies don’t need water:

• Breast milk and formula is mostly water (80-90 percent). Babies don’t get thirsty. Their diet is primarily liquid.
• Water does not have nutrition or electrolytes babies need. If a baby is going to be drinking something, why not make it be something that can help them grow?

Babies can safely start to drink some water after six months but they still don’t need a lot. They can get one to three ounces during their meals if parents want to introduce and practice with a sippy cup.

I've been interested in essential oils for a while now, beginning with a Facebook post where I sought out questions that might come up regarding essential oils and their use in children. Well, after much consideration, study and investigation, I think it’s time to release some of those results.

Whether you agree with my conclusions or not, I think you’ll find the information helpful and interesting…so here goes!

The slippery assumptions of oil supporters

We all have pre-conceived ideas about things. We can’t help ourselves. We were brought up in a particular culture or educated in a certain way or have friends that believe certain things. One of my primary goals as a person is to constantly challenge what to believe to see if there are holes in my thinking or understanding of things that are not logical.

I’m going to go ahead and put some of my pre-conceived notions and assumptions out there so that we can all be on the same page:

1.I have a strong trust in science, the scientific method and organized medicine. I can’t blindly follow any of those things, but I’m going to rely on them most of the time to make decisions for myself, my children and my patients. If the science proves that something works, I’m willing to use it or at least allow it to be used by my families.

2.I am very skeptical of anecdotal stories and advice. I often have to say, “I can’t contradict what you are saying, but it goes against what I know about this condition.”

3.I am generally very nervous about new treatments or new uses for old treatments. I often say, “I don’t want to be the first to try something nor the last. Somewhere in between is where I feel comfortable.” I want to weight risk vs benefit for everything.

4.I believe that the overwhelming percentage of parents (99.9999 percent) want the best for their child and would never intentionally harm their children in any way.

Because of these assumptions, I may evaluate oils in a different way than most people who use them do. I get that. But my patients who use them will tell you that when we talk about them, I am not judgmental (at least, I try not to be) and I am willing to listen to how they are using them as long as they will listen in return when I provide suggestions or push-back. (Most of them pretend to listen, at least, ha!)

I thought as we move through all the evidence about oils I have discovered, it would be helpful to challenge some statements made by my oily friends that imply false assumptions about me:

1.“I just don’t want to give them medicine for every little thing.”

That’s awesome, me neither. When patients leave my practice, it’s most commonly because I don’t give them a medicine or test that they want. The four most common examples are medicine for colds (cough and congestion), reflux, colic or antibiotics. If medications are not indicated for those conditions, I’m not going to be writing for them. If the decision is on the fence or unclear, I’ll engage the parents to help make a decision. The three little kids running around my house rarely get any medicine, especially for those symptoms for which I see oils being used. They rarely get medicine for fever or runny nose, never for cough and certainly never because their behavior is bad that day. Most of you probably don’t use oils for this-but some of you do…I’ve seen it. I’m not trying to single out a child with special needs or developmental problems, I’m more referencing a kid/parent who just aren’t quite getting along that day. In many of these cases, the use of oils is not in place of a medication, it is often additional to what I would do.

2.“You are a medical doctor so I’m sure you don’t like alternative medicine.”

Not exactly but this one is closer to true. Traditional medicine, to me, means tried, tested and proven. Alternative medicine might be old, might be tried but in my mind the definition means that it is unproven. In fact, through my studies the last few weeks, I have come across a couple of ideas that I am considering incorporating into my practice. But, at that point, if I begin to recommend it based on review of the scientific literature, is it alternative? Or, if the oils work like some claim they do, then eventually won’t we all be using them? Are they still alternative? This assumption is partially true but only because I want to be clear with my patients on what we absolutely know about oils, not what some have claimed.

3.Patients don’t tell me about their oils because they are scared of my reaction or assume I don’t want to know.

Incredibly wrong. I have to know what medication your child is on, period. If there is information about drug interactions or negative outcomes as a result of any medication use, I need to know who’s taking it so I can get in touch with people who are using them. We do the same thing for vaccines and everything else we use in the office so that if there is a recall or another issues, we can get the word out to our patients and tell them what to be on the lookout for.

Now we can move on to some research…

The Research on Essential Oils in Kids

These are the oils for which I found some research. I’m sure I left some off but I thought these were a representative list from a Facebook question I saw come across my timeline and would give us enough information to start the discussion.

Lavender

Tea tree

Chamomile

Peppermint

Eucalyptus

Where did I look?

I started by looking myself and then had our staff librarian follow up with a PubMed search. Because I knew that would not be enough for some, I also reviewed the following websites at the suggestion of the followers of my Facebook page (The Doc Smitty): aromaticscience.com, Dr. Robert Pappas Essential Oil University and airase.com (cost me $75). I also used the NIH Center for Complimentery and Integrative Health, the MedLine Encyclopedia & Natural Medicines Comprehensive Database and the Sloan Kettering Integrative Medicine Database.

First, I’ll summarize what we found from the more traditional medical research on each oil (PubMed, NIH Complimentary and Integrative Health, MedLine and Sloan Kettering):

Lavender

• One study shows use of lavender associated with decreased use of acetaminophen after children had their tonsils out but did not show decrease in pain intensity or nighttime awakenings. (48 patients)
• Several adult studies showing calming effect of lavender.
• Another very small study showed that lavender use in babies had a calming effect.
• These and other published research involve small sample sizes (less then 50 subjects) and often the study design is lacking or flawed in other ways.

Tea tree oil

• Some fair quality studies that included children showed some possible benefit for lice, acne and warts.
• A small study in adults showed possible improvement in toenail fungus.
• Many reports of side effects from accidental overdose are pretty common with tea tree oil (confusion, drowsiness and possibly coma). Just a reminder (just like other medicines, I’m not singling out oils) that we should keep these oils out of the reach of children. I have seen people make comments like, “These are natural so you can’t possible overdose on them.” This is simply not true.

Chamomile

• A review of the use of alternative methods for treating colic (including chamomile) was published in Pediatrics in 2011. The conclusion of the reviewers was that a further look into the issue was warranted.
• Colic studies are difficult because defining what is colic is difficult, if we can agree, deciding what constitutes improvement is even harder as most “cases” resolve on their own without treatment.

Peppermint Oil

• Some studies (some including children) have shown benefit for use in irritable bowel syndrome and recurrent abdominal pain.
• Other possible uses have been studied in adults (including headache), which has shown some promise but no definitive answers have been found at this point.

Eucalyptus

• Studies have shown that use of eucalyptus and lemon can work as an insect repellant although there have been case reports of toxicity from widespread application on the skin.
• There are multiple reports of severe toxicity after excess ingestion in children.
• Some studies have shown benefit for treating head lice.

We tried to research some other oils (thieves and frankincense) but found any evidence for their use in children to be lacking or unavailable.

Of note, you’ll see that there is no evidence for the use of these oils for some of the common uses I see them touted as being beneficial for: fever, cough, congestion, allergies, teething symptoms and (the one that makes me the most frustrated-see above) behavior problems.

Other Sources

At the suggestion of readers I also reviewed the literature from aromaticscience.com and discovered one article for which I had not previously found and only discovered 11 studies when searching for children.

I also reviewed Dr. Robert Pappas’ website but could not find further information about studies in children.

The gist of most of these websites is to list tons of articles of test tube and animal models with adult studies mixed in but they have very little to no information on children.

An example of this is the Facebook page of Scott Johnson who is “one of the world’s leading experts on evidence-based, therapeutic use of essential oils and natural products.” I looked back over 6 months of his postings on Facebook. There are roughly 2-3 posts per day. I found four posts related to children: one about probiotic use for colic, one about mother/baby skin-to-skin contact, one promoting increased physical activity in kids, and one about exercise during pregnancy promoting brain growth in children. None that truly show evidence of the efficacy or safety of the use of essential oils in kids.

Finally, I signed up for a website so that I could review a study that got a lot of buzz last year in the essential oil community. It was looking at the use of oils in autism spectrum disorder (ASD). You can read more about ASD in my post here. There are many issues with the study that limit its ability to be used as proof of effectiveness: the sample size is small (12) and there is no control group (even a group that used a different concoction of oils would be helpful). It’s not that this type of study should not prompt further thinking into the issue, it’s just that the number of children and parents who started using oils for autism based on it is inappropriate. For more traditional investigations into the use of medications for autism, this would be one of the most preliminary studies and would need to be followed up by significant further studies to test for effectiveness and safety of the regimen that was recommended. Why do I care so much? Because my parents of children with developmental concerns are desperate for something that might help. I’m desperate to have something more to offer them, but I am very protective of them when it comes to those who might take advantage of them.

Summary of Research

There’s just not much out there. What is out there is small studies or case reports and other poor study designs. This effectively turns their current use by consumers into the study of essential oils. The problems is that, with no oversight, no one is systematically watching for effectiveness or safety so we may not know until much later.

Effectiveness/General Use

Do they really work or is it a mind over matter thing?

I think that there are probably some uses for oils that will be studied and proven to work. I think these will be pretty rare and only a small fraction of the claims that are currently made.

So, is it mind of matter (placebo)? Here are some of the most common uses I see for oils in kids:

Teething - It’s not even clear what symptoms teething causes …fussiness, fever, runny nose, etc have all come into question. But, if you give an oil and a symptom goes away, does that mean the oil fixed it? Not likely.

Fever - Fevers come and go during the day with illness, even without medication.

Cough/congestion - The regimens I see where children have oils placed frequently basically make it impossible to know if they do anything for these symptoms. Cough/congestion will be worse at certain times of day and better at others treatment or no.

How close are we to having actual research on the use of oils?

I still think we are quite some time away. Those that are currently doing research are often biased, are not doing high-quality studies and are using small sample sizes.

Marketing

Why are they sold through multi-level marketing (MLM)?

It’s a fast way to get a product out there and make a lot of money. Since I’ve been on social media, I’ve seen several of these types of MLM ideas crop up. The difference with these is I have some specific knowledge about the conditions they are being used for and specific concerns about how their use could harm a population of people that I care very much about. I know very little about bags and good smelling wax that can be melted with a light-bulb so I haven’t gotten involved until now.

In many ways, it protects the big company because they are not the ones out there making claims about the oils and what they can do. That falls to their independent distributors. If someone were to have a bad outcome because of their use of essential oils, who is responsible? If I prescribe a medicine that someone is allergic to, that responsibility falls squarely on my shoulders, not the makers of amoxicillin. If I prescribe the wrong medicine for a kids asthma and something bad happens, that responsibility falls to me.

Are they an increasingly popular trend or just something I was not aware of?

I’m not sure but it certainly does feel like they are gaining in popularity. Social media makes it seem that way at least.

Do you believe the claim that certain brands of oils are superior to others?

I’m sure there are differences but since we don’t even know what they do for the most part, it’s hard to answer this question.

Philosophy/Opinion

Regarding writing about essential oils: Are you mad, man?

Yes, in fact, I think I must be.

What’s the number one reason you see parents using oils instead of medicine?

In general, people are becoming less trusting of experts and organized institutions. Medicine and doctors are no different. The gap between what a doctor knows and what patients know shrinks every day. People can find out information about their conditions and know basically the treatment options that exist. People are looking to live more natural lives and most who use them feel that oils fit within that idea. When you combine these two issues, right or wrong, essential oils seem to step in the gap.

What is a good way to communicate with your doctor about your use of essential oils (for specific conditions and generally)?

I think it’s important to be honest with you doctor about your use of essential oils. As new information is uncovered it would be important for your doctor to be able to show you new research etc, especially if something shows a particular oil to be unsafe. They can only do this if they know about your use of them. Also, as doctors are prescribing medications, we need to know anything you might be on that could cause a drug interaction.

What is your take on the potential political barriers to the study of essential oils given that they are not backed by super profitable pharmaceutical companies?

Young Living is a very profitable company. They are big and profitable and will only continue to be more profitable. There is no reason that they could not start testing their own products or set up independent testing.

After your research as a pediatrician, would you use them on your children?

People will read all of this information or even do further research and come to different conclusions from me but here are two reasons I won’t:

1. I do not treat my kids with unnecessary medications. Since they are recommended for symptoms and given with the hopes of reliving those symptoms, I consider these oils to be medication.

2. I believe that, due to the lack of good studies, the use of them in children should be considered experimental at this point.

Summary

• The use of essential oils seems to be growing.
• The evidence for their use in children is slim.
• Talk with your doctor about the products you are using so that they can be aware of potential safety issues and medication interactions. 

Previous articles on this topic:

• New York Times Report: Are Essential Oils Safe For Kids?
• Essential oils and their use on children
• How safe are essential oils for children?

My interest began with a report from the Tennesee poison center that said reports of toxic exposures to oils doubled from 2011 to 2015. Of those reported cases, four out of every five were in children.

As I began my research on essential oils, I asked what you guys wanted to know. I asked on Facebook what you all wanted to know and you guys had some great questions.

Most indicated that they “really wanted to hear my opinion.”

I will take the questions and try to divide them up by category as best as I can.

I feel like I owe it to you, and your children, to give my candid answers on the subject.

Safety

Q: What harm have you seen from patients choosing oils over modern medicine?

A: I’ve seen two examples of this. The first were parents using oils for their child’s eczema. They came to me after one month of attempts (including multiple different regimens) to treat with oils and the child ended up having a secondary staph infection of their eczema because the skin was open. In fairness, severe eczema happens and secondary skin infections happen, but most of my patients with eczema do not get that severe with the medications I typically recommend. The second patient was one who had an upper respiratory infection that led to croup (noisy, barky cough). The parents were trying oils at home for three days (again multiple different attempts to get the “right” oil) before they ended up in the emergency room and admitted for two days for difficulty breathing. The theme here has three components:

1.The oil itself did not hurt the child.

2.The ambiguity as to which oil should be used led to multiple different regimens and oils being tried.

3.The biggest problem with these two is the delay in receiving appropriate care.

Q: What is the best way to explain proper dilution to others?

A: Ummmm…I don’t know. Based on what I have seen regarding research this has not truly been studied, at least in children.

Q: Are there any that are harmful for use topically?

A: There are case reports of severe toxicity with topica application that uses eucalyptus and tea tree oil from those that I studied. These are mainly due to extensive application. Toxicity to any treatment is always related to dose. The more area you cover, the more likely it is to be toxic. There are also some reports of reactions with very small applications. The other concern I have (for which we don’t know the answer yet) is how does the toxicity change when these oils are being applied hourly (as I’ve seen recommended) or when multiple oils are being used at once.

Q: Can I use them in my child with asthma?

There are no studies that show effectiveness for asthma. Any inhaled substance with a small particle size that can get into the lungs could theoretically lead the airways to constrict which would actually cause more problem in children with asthma.

Q: What happens when oil are ingested (purposefully or accidental)?

Even most pro-oil websites don’t recommend ingestion of oils in children and to use extreme caution in adults. Because we do not have studies that evaluate the safety and appropriate dosing for ingestion by children, this is the one hard line I take with my patients who are using them. Please do not use them in this way.

Q: Have you seen allergic reactions?

The allergic reactions I have seen are mostly related to the skin. Application of anything topically can flare a child who has eczema or cause contact irritation of the skin.

Q: Are they really good for you or are you you doing more harm than good?

I don’t think we know the answer to this question on a global scale. If they do have all the anti-bacterial, anti-viral and all other properties, and will actually work for those uses (which are not proven in humans), would we go on to see essential oil-resistant-bacteria? I believe we would. Especially with the way they are currently being used. Basically applying whatever oil for whatever infection (I am basing this on the fact that anytime I see someone requesting help with which oil to use, they routinely get 5-10 suggestions). That is exactly the way resistance to antibiotics occurs - too many antibiotics for non-specific indications and next thing you know a certain antibiotics doesn’t work for certain infection any longer.

Q: Is it safe to use oils along with modern medicines?

We know that these oils can affect the liver and cause the liver to metabolize other medications faster or slower. This could lead to medications not being as effective or potentially be more toxic. Some information is being gathered in adults to try to figure this out but kids are not “little adults” and we’ll likely need research in children before we can answer this for sure.

More from Doc Smitty on this topic:

New York Times Report: Are Essential Oils Safe For Kids?

Essential oils and their use on children

Essential oils and children - more questions answered