As she’ll admit, pickleball has developed into big part of her life, becoming most of what she spends her time doing outside of medicine. After playing professional tennis for most of her life, Pitts picked up pickleball when one of her best friends started playing it professionally. She decided to try it one day, and while she struggled at first, she slowly started to love the sport. She found that it gave her a chance to be social and athletic at the same time. Soon, it became her favorite activity.

Pickleball is a great sport for people of all ages. There are many mental health benefits as it gives players an outlet and a fun form of physical activity. This sport also has a very social element to it, even Pitts shares she has made new friends through playing pickleball on various teams.

“I’m committed to helping young athletes have well-balanced, healthy and active lifestyles, but I’m also extremely passionate about helping young athletes prevent injuries and recover from them,” explains Pitts. “Having been a professional athlete myself and still playing in professional pickleball tournaments currently, I understand how difficult and frustrating injuries can be” she continues. "I want to be a mentor for them by supporting my patients through injury recovery and getting them back to playing the sport they love.”

That passion and commitment is why Pitts created the Pickleball Medicine program, the first pediatric program of its kind in the state. Pickleball is the fastest-growing sport in America, easy to learn, fast-paced, fun and social. Since it’s a new sport for some young athletes, Pitts wants to introduce players to pickleball while providing them with the knowledge of playing safely. She understands the mental and physical benefits of the sport and the importance of protecting young players’ bodies. She believes pickleball is following the same path as tennis, where it will become more competitive and lead to more injuries among young players trying a new sport. This program combines her background in medicine and pickleball, drawing on her expertise both inside and outside the clinic.

If you are interested in playing pickleball or possibly wanting to try it out, Dr. Pitts has some advice for young athletes:

• Wear the appropriate attire, such as court shoes. The correct footwear will help prevent ankle injuries
• Warm up and stretch before!
• Understand the basics
• Don’t be afraid, just try it! There are so many levels to it
• Have fun!

Cook Children's Pediatric Specialties Abilene

Cook Children's Pediatric Specialties in Abilene is staffed by three nurses who feel blessed and honored to be part of the Cook Children's family.

One such nurse, Sophia Garza, has been at the clinic for more than 17 years, witnessing its growth from a small location into a thriving, expanded facility that now supports multiple specialties. Her favorite part of the job is being able to see the children of former patients.

"I've been here long enough that I'm seeing the children of some of our previous patients," Garza said.

One special example is a father who was treated for Type 1 diabetes as a child, who now brings his son to this clinic for care.

This Abilene clinic has made a huge impact on the community by allowing patients to receive specialized care locally instead of making the three-hour drive to Fort Worth or Prosper. This is especially beneficial for oncology patients, who can now get treatment at the Abilene location rather than making the long round trip for each visit.

Garza said there is truly something special about this clinic.

"We are like family, and I cannot imagine working with a different group of people," she said. "We all come together with the same goal: to have fun and make sure families are getting the care they need."

Garza is proud of the clinic and looks forward to its continued growth, remaining eager to serve more families in the West Texas area. Here's to 40 more years for the Cook Children's Pediatric Specialties in Abilene!

Cook Children's Pediatric Specialties Midland

For many families in Midland, having a Cook Children's Pediatric Specialties clinic located in their city is a critical lifeline. It ensures that children in this West Texas region can access premier care and medical expertise without the burden of travel. With over four decades of service, this clinic’s impact is deeply rooted and has become a cornerstone in the Midland community.

Julie Jolly, a nurse at this clinic for nearly 27 years, says she has loved every minute of her career at Cook Children’s. She has many unique patient family stories, including one recent discovery: she was caring for a young patient with leukemia only to find out later that the patient’s father had also received treatment for his childhood cancer through the Cook Children’s network. This generational connection shows the enduring legacy of care the health care system provides.

Jolly’s years of service have illuminated a profound truth about her young patients. While she has learned much from them all, she is continuously inspired by their unyielding resilience.

She describes her patients as "grabbing life with everything they have," embodying strength that not only helps them heal but also gives immense meaning back to the caregivers.

The Midland clinic operates with powerful team unity, expressing deep pride in their role as a vital component of Cook Children’s Health Care System. This shared commitment and focused dedication are what truly set them apart, ensuring that compassionate, specialized care is fully delivered to every family they serve. Here's to 45 amazing years of the Cook Children's Pediatric Specialties in Midland!

Cook Children’s Pediatrics Granbury

Cook Children's Granbury is celebrating an amazing anniversary: 30 years of serving children in the area.

The clinic has been part of significant growth in both the surrounding community and its practice.

According to staff members and physicians, the clinic thrives because of the community's trust, which is evident in seeing multiple generations of these patient families.

“Because of this accomplishment, we are blessed to have patients return with their own children, gifting us with 'grand-patients,'" said Elisha Soto, a medical assistant at this primary care office. “Everyone at the clinic is ecstatic to serve the next generation—the best possible celebration for this milestone.”

As the clinic looks toward the future, staff are excited for continued growth. Here’s to the next 30 years of Cook Children’s Pediatrics Granbury!

Celebration and Gratitude

The exceptional care provided inside of each of these clinics is all because of the amazing staff, nurses and physicians who have dedicated their lives to this work. The milestones and celebrations would not have been possible without their hard work. We best serve our patients and their families because of each of them. We celebrate you and thank you for everything you have done this holiday season!

Christine Hernandez, Workforce Development Specialist, Cook Children’s Health Care System

A connector and collaborator—those are the words often used to describe Christine Hernandez, a workforce development specialist at Cook Children’s. She is on the frontlines of shaping and nurturing the talent that forms the core of the Cook Children’s Health Care System. Hernandez’s passion for people and purpose is evident.

“I want to contribute to a healthier, more capable workforce and to help individuals unlock opportunities they may have only dreamed of before,” said Hernandez.

She cultivates support and collaboration, thriving in an environment where actions align with values and words. Cook Children’s mission resonated with her from day one.

"I spent the first two decades of my career in public and private sectors, navigating a wide range of human resource work," Hernandez said. "I learned how organizations breathe when talent is aligned with mission, how strategic partnerships unlock opportunities, and how thoughtful collaboration and workforce development can transform teams and communities."

She loves building pipelines that connect people to meaningful careers, collaborating with educators, employers, and community organizations to make career pathways more accessible. When a workforce development specialist position opened up at Cook Children’s, Hernandez knew it was her calling.

“I felt an immediate spark,” said Hernandez. “I knew I could bring my experience here, not only because it is the type of work I love to do, but also because the work aligned with my values and the difference, I want to help an organization make.”

 Beyond her professional life, Hernandez is deeply rooted in her family. She is a devoted daughter, sister, a mother to two daughters and a son; an abuela to a grandson, an aunt to three nieces, a great aunt, and a proud dog mom to her German shepherd and four grand-pups.

A lifelong Texan, she was born and raised in Fort Worth and loves to walk and shop down the streets that raised her. Her inspiration extends to a small, daily reminder on her desk: a G.O.A.T. trophy, which stands for "Greatest Of All Time," given to her by one of her daughters.

It reminds me greatness is not measured by titles or accolades, but by the impact we have on others, especially the next generation,” said Hernandez

The culture at Cook Children’s makes it easy for Hernandez to call the organization home. It is not just the meaningful mission, but the way everyone works together to fulfill it -from teams to the community. “By bringing together our teams, educators, community organizations, and participants, we turn our efforts into a real and lasting impact,” said Hernandez.

The authenticity, collaboration, and shared purpose at Cook Children’s perfectly align with her own values of service, connection, and selflessness. This alignment is what fuels her every day to make a difference for the healthcare system and for every life she touches along the way.

Veronica Riddell, LCSW, CCM, Manager of Service Coordination/STAR Kids Case Management, Cook Children’s Health Plan

When life gets hard, Veronica Riddell hears the voice of her beloved mother echoing in her heart. Struggling to feed three small children and determined to carve out a better future for them, Riddell’s mother left behind the small Mexican border town of Valle Hermoso, Tamaulipas, and courageously uprooted her family to Texas, all for the hope of brighter tomorrows.

“My mom put her heart and soul into making sure we had everything we needed, and in the process, she instilled in me the importance of hard work,” Riddell said. “My mom always told me, ‘Echale ganas,’ which means ‘do your best,’ and when things get tough, you try harder. She would say, ‘Si, se puede,’ which means, ‘You can do it!’ These phrases have stuck with me throughout my life, and when things are tough, I can hear my mom cheering for me to keep going and not give up.”

Riddell was 10 when her family moved to Texas. The opportunities available to her in America were a far cry from the traditional upbringing she was accustomed to in Mexico, where the men worked in the fields, the women were homemakers and there was no opportunity or resources for an education beyond 6th grade.

“For the first time, I could dream and explore what it would be like to further my education beyond the 6th-grade level, and I realized that the American dream that people talked about was a real possibility for me,” she said.

Not only did Riddell become the first in her family to graduate college, but she is the only one to hold a master’s degree. She began her career in health care as a social worker, thanks in part to guidance she received from an ESL teacher who recognized in Riddell a passion for helping others.

In 2009, Riddell joined Cook Children’s Health Plan as one of two social workers on the STAR Kids/CHIP case management team. Today, she manages the team, which now consists of more than 50 nurses, social workers and supervisors. Her team is integral in educating and connecting families in the STAR Kids/CHIP programs with the appropriate services and support for their child who may have a medical, intellectual, or behavioral condition.

It’s all about helping members achieve new milestones and reach their highest potential, no matter their challenge, she says.

Stacy Putman, MBA, RRT, CMTE, Director of Transport

Stacy Putman, MBA, RRT, CMTE leads the team that provides critical medical care to patients in ambulances and aircraft en route to Cook Children’s.

As the director of Transport, Stacy oversees the people and fleet that deliver the Cook Children’s standard of excellence during about 4,100 transports each year from sites across Texas, the United States and even abroad.

“Getting to provide patient care thousands of feet above the ground is a unique and rewarding part of this team’s job,” she said. “I am blessed to get to lead this amazing team as they provide the top-notch care that Cook Children’s is known for in some of the most challenging situations and environments.”

Cook Children’s Teddy Bear Transport utilizes seven ambulances, a jet, a turboprop and a helicopter. The team is made of neonatal/pediatric nurses, respiratory therapists, paramedics, communications specialists and outreach educators.

They work in tight spaces -- in the air and on the road -- to care for children being transported for lifesaving care or specialty procedures at Cook Children’s facilities. They’ve also helped transport patients during evacuations, such as Hurricane Harvey.

Stacy, a native of Weatherford, Texas, found her calling in health care when she enrolled in a respiratory therapy program at Weatherford College. 

“Once I graduated from high school, I really didn’t know what I wanted to do in life,” Stacy said. “Honestly, I had no idea what an RT was at the time, but figured I would check it out. This would turn out to be the best decision of my life and has led me to where I am today.”

Twenty-five years ago, Stacy started at Cook Children’s as a respiratory therapist in the Pediatric Intensive Care Unit. She built her career with the attitude that her success depends on the work she put into it.

Cook Children’s transport service, with Stacy at the helm, will continue to grow to meet pediatric needs in North Texas and beyond. She’ll take Teddy Bear Transport to new heights – with aircraft that goes faster and farther than ever before - as Cook Children’s Health Care System expands its reach.

Stacy is mom to two sons ages 28 and 13, and two sweet dogs. Although she no longer wears a helmet and makes the transports herself, she takes pride in her colleagues who do. When every moment counts, her team members uphold Cook Children’s reputation for excellence each time they head for the Blue Peaks with the most fragile patients on board.  

The best part of working at Cook Children’s is making a difference in the life of a child, Stacy said. From babies born in high-risk deliveries, to critically injured teens, patients receive the best care possible during transport and once they arrive at a Cook Children’s location.

“Even though I am no longer the one giving direct care to these children, it is an honor to lead and support the team of nurses, respiratory therapists and paramedics who do.”

Chrystal Bryant, MSN, RN, STAR/CHIP Case Manager, Cook Children’s Health Plan

If there is one thing Chrystal Bryant knows, it’s women’s health. Not only is she a nurse, certified doula, and high-risk maternity case manager at Cook Children’s Health Plan, but also a survivor of ovarian cancer, for which she was diagnosed at 19 years old.

“Working in women’s health is fulfilling for me as it involves supporting women during important life events and helping them navigate complex medical situations at times,” Bryant said. “I believe women should feel empowered to seek the care that they need and deserve. I find purpose in educating our health plan members about their bodies, nutrition, and what to expect during their pregnancy and postpartum journeys.”

Fueled by a passion for fighting the country’s alarming rate of maternal morbidity, Bryant spends her days ensuring that the CCHP members that she works with have access to the health care and resources they need to have a successful pregnancy and healthy baby. She also works to decrease maternal morbidity as a member of the executive board for Health Equity Alliance (HEAL), an organization focused on ending health, socio-economic and racial disparities to address disproportionate death rates for mothers and infants in Tarrant County.  

“Every time a woman that I have served comes back to report that they’ve had a healthy baby and they’re both thriving, I know that I am on the right track,” she said.

Bryant comes from a long line of women who made their mark in health care. Her mother, two aunts and a cousin are all nurses. There are educators and social workers in her family as well. With her family’s legacy of service, Bryant says she always knew that she would follow a similar path, but it wasn’t until she experienced her own health issues that she decided to pursue a career in health care. In 2024, she earned a Master of Science in Nursing degree with a focus on Leadership and Management.

Originally from the Chicago area, Bryant relocated to Dallas/Fort Worth in 2008.

“I do not miss the very cold winters in Illinois,” she said. “Since moving here, I’ve met so many wonderful people through work, church and various community organizations.”

In 2017, she joined Cook Children’s Health Plan where she finds great fulfillment in helping women navigate the sometimes complicated and intimidating health care system.

“It means a lot to me that I am able to help our members access what they need while they are active on our plan,” she said. “Our members could choose other health plans so it means a lot to us that they trust us with providing them with the health care coverage that they deserve.”

When she isn’t working, you’ll find Bryant in full “Gam-Gam” mode as a new grandmother to her son’s baby. She also has a daughter pursuing a career as a licensed medical social worker, continuing that long line of service-minded women in her family.

Myisha Washington, Executive Assistant, Communications and Employee Connections

Myisha Washington will be the first to tell you she has yet to reach the pinnacle of her career, but she is well on her way.

Last year, Washington completed her bachelor’s degree in Healthcare Administration with honors — a long-held personal milestone of more than 20 years. It was a triumphant moment made even more remarkable as she juggled the responsibilities of motherhood and working full-time as the executive assistant to Wini King, senior vice president and chief of Communications and Employee Connections, formerly known as Inclusion, Diversity and Equity.

“I don’t believe I’ve reached my biggest career accomplishment yet,” Washington said. “I’m still learning and growing. However, one significant milestone I’ve achieved is becoming an executive assistant. Transitioning into this role has significantly impacted my career trajectory. It has allowed me to develop a wide range of skills and has presented me the opportunity to work closely with senior leadership, which has broadened my understanding of strategic thinking and organizational dynamics.”

When the pressures of balancing work, school and motherhood weighed heavily, Washington found inspiration in a small but powerful gift from King — a notebook inscribed with the words, “I can and I will. Watch me.” It was just the encouragement she needed to stay motivated and push through any obstacle.

“My biggest challenge that I’ve faced in my career was not feeling that I’m good enough or I wasn’t smart enough because I didn’t have my degree,” Washington said. “Not only am I a woman, I’m a Black woman in a competitive industry. I’ve faced situations where I felt overlooked or undervalued. However, I’ve learned to channel these challenges into motivation.”

Although Washington is a new graduate, she’s a 25-year veteran of the health care industry. At 18, she earned her first job in the field, stepping into an administrative assistant role at a clinic after her aunt, the previous holder of the position, was promoted. It made her the youngest assistant in the clinic at the time.

In 2020, Washington and her husband, Alex, relocated from Berkley, California, to Texas with their three sons. By 2021, she had landed a job at Cook Children’s, quickly establishing herself as a key member of the Public Relations and Communications team. Her contributions have been integral to the department’s award-winning success. In 2024, Washington and her colleague, Jessamy Brown, Corporate Communications manager, received a Worthy Award from the Greater Fort Worth Chapter of the Public Relations Society of America for their strategic plan titled Multicultural Public Relations and Welcoming Diversity and Inclusion at Cook Children’s. The Worthy Award is the chapter’s highest honor for excellence in public relations strategy and communications campaigns and tactics.

Washington’s colleagues know her as someone who approaches every challenge with a smile and a readiness to lend a helping hand — qualities that align perfectly with Cook Children’s culture of kindness and respect.

“What I like most about Cook Children’s is the welcoming and positive culture,” she said. “From the moment I started at Cook Children’s, I was impressed by how friendly and supportive everyone is. A simple ‘hello’ can make a big difference, and I’m glad this organization values such warm interactions.”

Jennifer Fuester-Reynolds, Marketing Manager

Jennifer Fuester-Reynolds ("JFR") is known for going the distance. Whether it’s building marketing campaigns that champion Cook Children’s, cultivating a community garden, running an ultra-marathon or trekking the Grand Canyon, she digs deep and goes the extra mile to overcome every challenge.

“I think the biggest challenge I face every day is fitting everything in,” Fuester-Reynolds said. “There are so many projects to work on, people to talk to, ideas and possibilities bouncing around in my head. Sometimes finding a balance is a challenge. I have to keep reminding myself that it’s an ultra-marathon, not a sprint.”

As manager of Marketing, Fuester-Reynolds spends her workdays collaborating with partners and members of her team to craft creative ad campaigns, produce engaging videos and podcasts, and write and edit print and digital content – all to strengthen and uphold Cook Children’s brand. Her career began in marketing and advertising, but the passion for caring she saw in her mom, a nurse, and her grandmother, a nursing assistant, led her to a career in health care.

Her professional philosophy is inspired by the wisdom of her grandfather who would say, “Work like you own the place.”

“It’s a great lesson because, in fact, everyone’s workplace is theirs in a way. And when you own your work, you give your best energy, attention and passion,” she said. “I continue to work on this lesson, aspiring to learn, develop and improve all the time.”

Fuester-Reynolds has seen a lot of changes in her 15 years with the health system but says one thing remains the same.

“Though we’re constantly growing, I can say that this organization and its people consistently live out the Promise and are committed to doing everything for the child each day,” she said. “I’ve had the chance to collaborate with so many individuals across the system in my time here and feel extremely blessed to learn from so many talented and skilled individuals.”

When she’s not working to steward Cook Children’s brand, you’ll likely find her singing with her church choir, or challenging her mind and body in an ultra-marathon. Her longest distance so far is 100 kilometers, but she’s working to surpass that record this year by completing a 100-mile run, or what is known in the running world as a legendary ultra-distance. As if that wasn’t enough, Fuester-Reynolds is a gardener, too. In 2023, she joined with six of her neighbors to build a community garden in their neighborhood. There’s just something about watching things grow, she says, be it veggies, flowers, her 12 nieces and nephews, her yearly running mileage, a teammate who discovers a new talent and, of course, Cook Children’s.

“To grow a garden you have to tend, water, fertilize and appreciate the lessons learned along the way, all things you need for personal and professional growth, too,” she said.

With every personal and professional milestone, Fuester-Reynolds has the support of her husband, Bill, and their three miniature dachshunds – Carson, Kiefer and Rowan. The couple has been married for 21 years.

Diondra Williams, Talent Acquisition Navigator

With Cook Children’s Promise as her lens, Diondra Williams is always on the lookout for the best of the best. As Talent Acquisition Navigator, she spends her days processing background checks and drug screens, all to ensure that every new hire meets the high standards of care, safety and commitment that allow Cook Children’s to keep its Promise of doing everything for the child.

Williams joined Cook Children’s nearly seven years ago as part of the Senior Secretary Pool. Within just six months, her dedication and talent earned her a permanent Senior Secretary position. Not long after, she was promoted to her current role, where she makes it a point to shine like the sun.

“My days are very hectic and can be overwhelming at times,” Williams said. “It is not always easy to see the sunshine when I’m consumed with my daily tasks. Sometimes I have to be my own sunshine to make sure that I remember the impact of my job role.”

Departments rely on Williams to guide new hires through the onboarding process and ensure they are cleared to start work on time. While the core of her job is repetitive, she approaches each case with care, treating every new hire as an individual and giving their case the respect and attention each one deserves.

“My heart smiles when I see someone through to the end of the onboarding process,” she said. “I love meeting the new hires during orientation and being able to put their faces with their names.”

Working at Cook Children’s is special, Williams says. She’s particularly proud of her place in the Cook Children’s family when she’s out and about wearing a Cook Children’s shirt and someone stops her to share their experience with and gratitude for the organization.

Williams spends her free time traveling, singing, reading, and enjoying her family and friends that have become family. This includes her 12-year-old daughter.

“She’s my life, and I credit her for being the driving force in everything I do,” she said. 

Lisa Padilla, Director of Member Experience and Member Services, Cook Children’s Health Plan

Lisa Padilla has a passion for helping people. The entirety of her 25-year career has been spent in public and community health serving those living in often underserved communities. Four years ago, she brought that passion to Cook Children’s, where she works to ensure the Health Plan serves as more than just a payer, but as a true partner in the health and wellness journeys of its members. Her dedication is deeply rooted in personal experience. 

“Many in my family have been on Medicaid. My children are grown now but, when they were small, they received Medicaid services,” Padilla said. “I know how important Medicaid is for families and children and I am so honored that daily I can make decisions about the services that our Medicaid members receive.”

A lifelong Dallas resident, Padilla and her husband have 4 children and 9 grandchildren. She began her career in health care as a peer counselor in the Women, Infants and Children (WIC) Program, followed by 16 years at Parkland Health where she worked in many of the hospital’s community based programs. Along the way, she completed her bachelor’s and master’s degrees and became a Community Health Worker (CHW) and Community Health Instructor (CHI). 

In July 2021, Padilla joined Cook Children’s Health Plan as manager of Community Marketing and was promoted to director of Member Experience within six months. Of all of her jobs in health care, her current leadership role is the one she is most proud to be doing. It’s allowed her to direct and manage programs and interventions that have truly impacted lives all across Texas, she says. 

Padilla loves making a tangible difference where it matters most — on the ground in the community, where she says 80% of health care happens. It takes a keen understanding of the social determinants of health as well as the cultures within the service area to truly influence the health and well-being of those living there. Padilla believes no other organization does culturally competent, community centered health care management better than Cook Children’s Health Plan. 

She’s concerned that boots-on-the-ground insight could all be lost If Texas’ Health and Human Services Commission (HHSC) is allowed to follow through with its decision to deny CCHP a new contract for managing the state’s Medicaid programs. Instead, HHSC seeks to award contracts to large, national insurance providers through an unfair and faulty contract review process. 

“I can tell you with my soul, that the biggest impact from going from this community based program to a national, for-profit payer is going to be the loss of the knowledge base and perspective that comes from the front lines,” she said. “We know the ins and outs here. We already know the partners we can and are working with to build services around food insecurity, housing and job readiness. We understand the cultures in the area and know how to effectively communicate with them. Any health insurance company can come in here and be a payer, but no one can come in and meet the people in the community where they are to make the most impact like we can.” 

While CCHP waits for the Texas Legislature to weigh in on the issue and deliver a permanent solution for HHSC’s Medicaid contract procurement process, Padilla remains committed to her team and the members they serve. Her singular focus is and will always be on delivering impactful health care and services to members and their families. 

Laurie Bailey, Ph.D., Director of Pediatric Research Training Program

Laurie Bailey, Ph.D., thrives on turning intricate problems into impactful solutions. Over her two-decade career at Cook Children’s, Dr. Bailey has consistently applied her problem-solving mindset to her research-focused roles, choosing to forgo the traditional post-graduate career path in academia to elevate pediatric health care.

“One of the biggest challenges that I face is that my education and training prepared me for a position in academia,” Dr. Bailey said. “There, my degree and my role make sense, but I was working at Cook Children’s as I obtained my degree and I graduated knowing two things: I wanted to be at Cook Children’s and I did not want to work in academia. I am definitely a fan of higher education, but I knew finding a niche in health care research was where I was meant to be.”

Dr. Bailey has served as director of the Research Data Science and Analytics (RDSA) department for the past five years, but recently accepted a new challenge, one where she hopes to replicate the growth and success of the RDSA department. Now, as head of Cook Children’s Pediatric Research Training Program, Dr. Bailey will focus on building academic partnerships and growing the next generation of medical researchers.

With the help of Dr. Bailey and her research colleagues, Cook Children’s is doing what few non-academic centers do — conducting multiple investigator-initiated research projects that give imagination a launching pad for the betterment of pediatric health care. This team’s work in structuring, conducting, analyzing and interpreting research studies has resulted in innovative care, groundbreaking solutions and life-saving treatments for children in North Texas and beyond.

It’s taken a lot of vision, collaboration and hard work to grow Cook Children’s research arm from a single research student to a staff of over 40 scientists, data managers, nurse specialists and interns, she says.

“There are so many things that I can think of that are incredible accomplishments, but not a single one did I do on my own” Dr. Bailey said. “I am so incredibly proud of this division of investigator-initiated research that we have developed.”

She’s carrying this same collaborative mindset into her new role as she sets out to develop a training program that attracts the best and brightest future medical researchers. 

Dr. Bailey’s faith is an integral part of her identity and daily life, compelling her to be the hands and feet of Jesus in everything she does. She regularly volunteers for an organization that provides camps and retreats for children in foster care. It’s there that she first met and began mentoring a young boy who she opened her heart and, eventually, her home to in early 2017. Months later, the two officially became a family through adoption.

She considers her colleagues and co-workers like family, too.

“Cook Children’s has been my only professional home, so I may be a bit biased, but it is more than a health care facility,” she said. “It's a warm and welcoming family. Here, compassion flows through the hallways and our team supports each other. It is a place where I like to believe that no one says, ‘that’s not my job,’ because the collective is so much greater than the sum of its parts. The magic of Cook Children's lies in the little moments of kindness and respect. It's a place where empathy and expertise blend seamlessly, making it a home away from home for those who need it most.”

Cathy Carroll, Director of Respiratory Care, Cook Children’s Medical Center - Fort Worth

For Cathy Carroll, work isn’t just a profession — it’s a personal mission. Having battled childhood asthma and now standing strong as a five-year breast cancer survivor, she knows firsthand the struggles her patients face and the strength it takes to overcome them.

“My journey to health care began at an early age due to many hospital and emergency room visits for asthma care,” she said. “I watched the nurses as they cared for me with such compassion that I felt inspired to become a nurse. As I got older, I decided nursing was not for me. However, I knew that I wanted to be in the health care field and was determined to provide care and compassion to the ill, which led me to pursue a rather new field, Respiratory Therapy, to make a difference in people’s lives.”

As director of Respiratory Care, Carroll spends her days interacting with her staff and peers, listening to and supporting their needs and guiding them as they provide bedside care. She has been a member of the Cook Children’s family for 42 years and knows the culture inside and out.

“Cook Children’s fosters an inclusive environment where diversity is celebrated. Everyone is treated with respect and dignity,” she said. “Emphasis is placed on work-life balance. It’s a culture that thrives on collaboration and strong relationships among peers and staff and is committed to the growth of all employees.”

In turn, she says, employees trust their leaders and staff take pride in what they do.

Carroll, a lifelong Texan, has two sons and a daughter-in-law. As a working mom, it’s been challenging to find a work-life balance, establish boundaries and prioritize self-care, but she’s remained intent on being both an effective leader and an example of kindness and resilience to her children.

Carmen Rodriguez, Cook Children’s Health Plan, Care Coordinator

Carmen Rodriguez has had no shortage of influential women in her life, starting with her mother, who dedicated her life to raising four children. Since graduating high school in the early 2000s, Rodriguez has had five different employers with all of her bosses being women.

“I’ve learned many great things from each and every one of them and was provided opportunities for advancement,” she said. “I am very grateful that I have been blessed with many great female leaders.”

Just as Rodriguez feels empowered by her leaders, she strives to do the same for Cook Children’s Health Plan members. In her role as care coordinator, she equips members with the knowledge and resources they need to make informed health care decisions for their families. Each day she works with parents trying to access much-needed health care services and struggling to understand how the Medicaid process works. Many of them face challenges that create barriers for healthy living and access to medical care, like financial instability, for example. Some face a language barrier — a challenge Rodriguez knows well as a native Spanish speaker from Durango, Mexico, who immigrated to the United States with her family when she was 3.

“I know first-hand how difficult it is to try to communicate with someone who does not understand you,” Rodriguez said. “My first language was Spanish, but once I learned English and for as long as I can remember, I had to help my parents translate almost everywhere they went, whether it was simply placing an order at a fast food restaurant, or translating at a job interview, or trying to translate medical terms as best as possible at doctor appointments. Having the ability to tell a member that I speak their language and hearing the relief in their voice is a great feeling.”

As a mother of four children, ages 5 through 19, Rodriguez is also well acquainted with the challenges of balancing work and family life, and says it can be tough at times. She credits her personal and professional success to her parents for teaching her the importance of hard work, education and honesty, as well as to her husband, Raul, for his hard work, love and support.

As she and her CCHP colleagues navigate the ongoing Health and Human Services contract challenge with the state, Rodriguez remains focused on being an unwavering resource for Health Plan members, just as she and her colleagues were through the pandemic. 

“There has been a lot of uncertainty with each and every challenge that has come our way, but I’ve seen how hard each and every one of us at the Health Plan has worked to push through and make things happen for our Health Plan and especially for our members and their families,” she said. “I’m grateful for the many opportunities given to me to learn and grow within the company. I just couldn’t see myself anywhere else.”                      

Mekka Livingston, Director of Employee Relations

In her role as Director of Employee Relations in Cook Children’s Talent Management department, Mekka Livingston has found her home in a workplace where she says colleagues are more like family and kindness isn’t just a value—it’s a way of life. One also modeled to her by her grandmother who would often say, “It doesn’t cost a thing to be kind.” It’s a philosophy she sees echoed daily at Cook Children’s, as well as timeless wisdom that motivates her own actions. 

Livingston finds joy in surprising a child she meets in the hospital lobby with a trip to Build-A-Bear or picking up the tab for a family in the cafeteria line to ease their financial burden. For her, moments like these aren’t just gestures—they’re fulfilling the hospital’s Promise to create magic for every child and family who walks through its doors.

One such moment stays with her: a little girl in the cafeteria, hesitant and reserved after weeks in the hospital, wiggled from her mother’s arms and ran to embrace Mekka.

“I locked eyes with her mother who smiled at me, giving me permission to embrace her child, and I stooped down and grabbed her baby girl and gave her the biggest hug.”

That spontaneous hug was a spark of healing and connection—magic in its purest form.

Outside of work, Mekka’s heart remains rooted in family, her favorite retreat from the demands of her busy work life. Her anticipation for 2025 brims with hope as she envisions a season of miracles and transformation at Cook Children’s, where she aims to be a catalyst for positive change.

For Mekka, every day at Cook Children’s is a chance to rise to new challenges, embrace collaboration, and embody her best self in her words and deeds. She describes the hospital as unmatched—its spirit of kindness, safety, and collaboration setting it apart from any other place she’s worked.

Yahaira Perez, Director of Accounting, Cook Children’s Health Plan

Yahaira Perez holds dear the memories of her childhood home in Puerto Rico. They remind her just how far she has come. 

“A few years ago, my mom gave me a gift that resembles the tiny house I grew up in in Puerto Rico,” Perez said. “She wrote ‘Te Amo’ on the back, and when I have a challenging day, I look at the small house to remember where I came from and all the obstacles, I had to go through to be where I am today.”

Perez and her husband of 21 years, plus their two children, ages 15 and 13, came to Texas nine years ago in search of a better future. Armed with a public accounting degree from Puerto Rico, Perez took a job as a staff accountant at Cook Children’s Health Plan in 2016. The organization made an unforgettable first impression.

“My orientation back in 2016 was on Halloween day and I was so confused when all the presenters in the auditorium were dressed up with their costumes,” she said.

That was Perez’s first glimpse at the magical culture of her new employer. In no time, Perez was making magic of her own, quickly mastering her role and earning several promotions that led to her current role as CCHP’s director of accounting.

Perez has always had a mind for numbers, she says, and initially wanted to be a math teacher. However, location posed a barrier.

“The college campus close to my home didn’t offer that program,” she said. “So, I asked them what they offer related to math and they told me accounting, and I decided to give it a try.”

Perez is the first generation in her family to graduate college or receive an education beyond middle school.

While she loves her job and the people she works with, it’s her personal experience with the medical center that keeps Perez connected to the mission of the health system. Five years ago, her daughter underwent open heart surgery at Cook Children’s, and Perez witnessed first-hand the shared Promise of everything for the child.

“Being an accountant and working with numbers all day, it’s hard to see the ‘magic,’ but by being a parent at the ICU, you can see why people love Cook Children’s,” Perez said. “The nurses that took care of my daughter were so nice to me. They were living the Promise to its fullest. Everything my daughter asked for they provided. She wanted to draw at midnight and there comes the nurse with the paints and the paper.”

From her humble beginnings in Puerto Rico, Perez brings a unique and valuable perspective to her role with an organization that primarily serves a vulnerable and underserved population. Her memories of her beloved childhood home, and the resilience and perseverance she learned there, inspire her to do her very best for the members the Health Plan serves and the communities it represents.

Abigail Flores, Psy.D., LPC, Director of Behavioral Health, Cook Children’s Health Plan

Abigail Flores comes from a proud lineage of hard-working individuals, whose dedication and determination shaped her path. Her family, migrant farm workers in Texas’ Rio Grande Valley, all labored tirelessly to make ends meet.

“The entire family would work picking or transporting whatever the season produced. It didn’t matter the age. Everyone pitched in,” Flores said. “There was a lot of sacrifice that took place to provide and make it. For me, it symbolizes how far we have come. I am a direct reflection of those who came before me and although my grandparents and great grandparents have passed on, they are part of my current and future accomplishments. I wouldn’t be here if it wasn’t for them taking certain risks and wanting better for all of us that came after.”

Growing up in the border town of Weslaco, Texas, Flores never envisioned herself attending college. In fact, she even declared in high school that higher education wasn’t an option for her.  But, as life often does, it had other plans.

Not only did Flores go to college, but she reached the highest of academic peaks, earning a prestigious doctoral degree in Psychology.

“When I went to college, I began in Business Administration but it just didn’t fit. Then I took my first psychology class and it all just made sense,” Flores said. “After that first course and through my educational journey I began to understand more about myself as a person and why I was the way I was and the impact of what we call Big T’s and Little T’s. Personal adversity and growth led me down my current career path of the helping professions. We could all use someone to talk to.”

Today, as director of Behavioral Health at Cook Children’s Health Plan, Flores has turned her personal challenges into a purpose-driven career. She helps others navigate their own Big T’s and Little T’s — moments of trauma, both large and small. Whether it’s coordinating care for members, offering a listening ear during difficult times, or empowering them in conversations with providers, Flores’ mission is clear: to be a beacon of hope and an advocate for her community.

“When people ask me what I do or where I work, I tell them we are a health insurance company, but it’s not your typical health insurance company,” Flores said. “You can actually call us and speak to a live person, someone who cares and is going to listen and not just email you a list of providers or refer you to a website. We are also going to follow up with you and make sure that you get what you need. We live in the same community as our members, and we genuinely care. For us it’s about building relationships and advocating for our members.”

Winifred ‘Wini’ King. Senior Vice President, Chief of Communications, Cook Children’s Health Care System

Winifred Joy King, known to many as ‘Wini,’ never lets an opportunity walk away from her, even if she feels not quite ready. That’s how she got to where she is today. Rather than listening to any doubts and fears, King took the opportunities that came her way and proved herself to become a shining star.

From her early days as a news anchor in Oklahoma to the nearly 12 years she spent as an assistant manager of promotions at The Walt Disney Company, and now as Cook Children’s senior vice president and chief of communications and employee connections, King has met every moment. She joined Cook Children’s 19 years ago as Director of Media Relations and has been shaping the reputation of the organization since. Along the way she’s racked up a reputation of her own. Fearless, sage, evolving, empowering, inspirational, tenacious and bold are just a few of the words her colleagues use to describe her.

They are traits she likely gained from her mother, an entrepreneur in her own right in the 1950s when a woman couldn’t even have a bank account in her own name, much less a Black woman. King’s dad was a member of the Army. Rather than joining him wherever he was stationed at the time, the family chose to remain at Fort Sill in Lawton, Okla., allowing her father to make and send more money home to financially support them. The arrangement meant her mom was essentially a single parent.

While holding down the fort at home and raising three children, King’s mom was a hairstylist on the side and ran what basically amounted to an Airbnb before Airbnb was a thing, managing two rental properties located behind their house. When the family had saved enough money to build their first home, it was King’s mom who acted as general contractor. She bought the lot, found the building plans, hired the builders and oversaw construction. She is, King says, her hero.

King’s first name, Winifred, was chosen to honor her Uncle Fred and as a playful tribute to Princess Winifred from The Princess and the Pea, a fairy tale her mother adored. Yet, it’s her middle name, Joy, that holds the deepest meaning to her.

“I love the idea of joy as opposed to happiness, because you can become unhappy, but you can’t get un-joyed,” King said. “Joy tends to run deep and happiness tends to be a little more fleeting. So, joy is a constant stream for me.”

To young professionals hoping to level up like King did, she has time-tested advice. Bake a little while, she says.

“The one thing I tell everybody is slow down and understand the Cook Children’s culture,” King said. “Everybody wants to hit the floor running, and I get it because you want to prove yourself and be valued. But the bigger. value comes in understanding your environment and being able to then work within that environment which, in this organization, is so much about relationships, connection and collaboration.”

We often hear the term “imposter syndrome” especially for women in business and we asked King about that. She shares: “The biggest challenge in my career was me feeling that I had value and that I had something to offer, and that was me making that declaration that I may not be worthy of that or I may not have enough to offer,” King said she learned to quieten that little voice and says “Over time I learned that I have plenty to offer and plenty to give.”

When King isn’t brainstorming new ways to foster connection and collaboration or sharing her wisdom to grow and develop in the workplace, she’s likely at home cuddling her 2-year-old Morkie, B.B., whose name is a nod to her favorite musician known as the King of Blues, Mr. B.B. King.

Angela Smith, Manager, Claims Processing, Cook Children’s Health Plan

Angela Smith chooses her words wisely, recognizing the power language holds in shaping perception. As a woman in leadership, she believes that word choice can significantly impact how one is viewed.

“Word choice is my biggest challenge,” Smith said. “It is an internal conflict between being perceived as a bossy woman or a respected leader. A subtle transition of word choice positively influences how a listener grasps the message and perceives the leader. A great leader has the necessary communication skills to shift from judgmental to neutral words.”

With 13 years under her belt at Cook Children’s, Smith has earned the respect of her colleagues who come from all walks of life, and she sees this diversity as a cornerstone of the organization’s success.

“Cook Children’s comprises many different groups with their own beliefs and cultures and believes that cultural diversity is a must for innovation and creativity,” she said.

Her greatest source of pride, however, lies in the organization’s unwavering commitment to its mission. For Smith, Cook Children’s isn’t just a workplace, it’s a place that allows her to merge her career with her passion for making a difference.

“It’s an honor and privilege to be part of an organization that truly lives up to its mission statement — Knowing every child’s life is sacred, we Promise to improve the well-being of every child in our care and communities,” she said. “Cook Children’s strives to be an extension of your family. I’m excited and proud to be part of an organization with such a stellar reputation in the industry.”

A native of New Orleans, Louisiana, Smith is the proud mother to three adult sons and the grandmother to three grandchildren.

Chris Pedigo, Senior Vice President, Chief Strategy, Education and Community Health Officer

Before Chris Pedigo ever set foot in nursing school, she was already making her mark in the world of health care. At just 16, Pedigo had a job at a family practitioner’s office, where she expected her duties to be filing paperwork and handling administrative odds and ends as part of a high school career program. But one day, when a woman arrived in labor with no time to reach the hospital, Pedigo was thrust into the middle of a life-changing moment. Called upon by the doctor to assist, she found herself helping to deliver a baby—a profound experience that would spark her lifelong dedication to nursing.

“That was the beginning of my desire to work in health care,” Pedigo said. “I thought, ‘Wow. I can do something like this.’ Having that experience really ignited my desire to choose a career where I could help people.”

Fast forward 35 years, all of them spent at Cook Children’s, and Pedigo now serves as the senior vice president and chief Strategy, Education and Community Health officer. Pedigo’s naturally inquisitive nature gives her an advantage in her current role where she analyzes data to understand the needs in the communities Cook Children’s serves. Couple that with her early experience as a nurse, and Pedigo is uniquely positioned to help Cook Children’s identify, strategize and solve the issues that create barriers to the health and wellness of children and families.

One of those “top-of-mind” issues, she says, is addressing the mental and behavioral health needs of the community. 

“If we can manage the mental health concerns of children and their families, then there are a lot of other areas we could prevent from having bad outcomes.”

Early in her career, Pedigo took advantage of the benefits Cook Children’s offers employees to further her education, maintain a work-life balance and work her way into the leadership role she holds today. She’s proud to help lead others on her team to accomplish the same.

“When individuals are considering certain roles, I feel like I can speak to all areas that play into a decision,” she said. “As a nurse, Cook Children’s helped with my educational needs and supported my career. But the organization has also helped me care for my family. All three of my children have either been in the ER or had some sort of procedure done here. I have a high opinion of Cook Children’s from all those different perspectives, and feel being able to work here is truly a privilege.” 

Pedigo and her husband, Kevin, have enjoyed 30 years of marriage—and a whirlwind of three weddings in the past three years, courtesy of their three daughters. While the whole family is undoubtedly proud of Pedigo’s dedication to health and wellness, their 92-pound Labrador might feel differently. He's on a diet with the goal of reaching a healthier 85 pounds.

Lorrainea Williams, PharmD, CPPS, MS HQS, Vice President of Quality and Patient Safety/Medication Safety

Just one day after Lorrainea Williams completed her training to become a Pharmacist, she walked through the doors of Cook Children’s, ready to begin what would become a lifelong career dedicated to Cook Children’s Promise.

As a newly minted pharmacist, Williams quickly got involved in projects working to improve patient safety and learned she had a passion for the pursuit of best practices. One quality improvement project led to another and set her on a path to become the vice president of Quality and Patient Safety. In the simplest terms, Williams’ job is to identify ways Cook Children’s can do things better.

Her biggest challenge? Picking just one project out of the many new and innovative ideas that come her way.

“The work is so good, and you can see how it improves the lives of our patients and our employees and the meaning in the work that they do. You want to do it all, every new idea,” she said. “I think my challenge has been how to prioritize that because when you work at everything all at once, nothing gets done. Progress becomes slow. So you have to pick which idea gives you the biggest bang for your buck.”

Choosing a favorite accomplishment, Williams says, would be like picking a favorite child. She’s immensely proud of any project, big or small, that produces a best practice and improves safety and quality for patients and employees. But a few she has been a part of through the years include implementing technology that protects patients, like barcode scanning and the electronic medical record.

“I'm very proud that Cook Children's has made those steps and advancements, and that I got to be a part of leading some of those efforts, because I do firmly believe that the care we provide today is infinitely safer and better than when I started 22 years ago,” she said.

Williams always knew she wanted to follow her mother into health care, but with one caveat—instead of becoming a nurse like her mom, she was determined to forge her own unique path.

“I chose pharmacy because it was very interesting to me, and you can't just do exactly what your mom does, right,” Williams said. “When I started to learn about what a pharmacist did in a hospital setting, I was very intrigued because my only experience before then was just kind of seeing what a retail pharmacist does. But when I learned that in the hospital they make specialized medications for patients on chemotherapy and that they were more involved in helping physicians make the best medication choices for those patients, that got me really excited.”

Williams' daughter is following in her footsteps by pursuing a career in health care, too. Although, much like mom, she’s carving out her own path as she trains to become a dentist. Williams also has a son who is currently in high school.

With Cook Children’s being her home away from home, Williams thinks of her colleagues as family, too.

“I think it's a family all working towards the same goal. That's my favorite thing about Cook Children’s,” she said. “With the relationships I've had here, and the work and professional opportunities that Cook Children’s has provided me to grow in my career, I would definitely recommend that this is an awesome place to work. I'd love to retire here.”

Becki Hale, EdD, Assistant Vice President, Center for Community Health, led by Cook Children’s

As assistant vice president for the Center for Community Health (C4CH), Becki Hale leads what is best described as Cook Children’s community connectors. Each day, C4CH works to lay the groundwork for healthy families through community health education, resources, and awareness campaigns that promote wellness and prevent injury.

For their programs to be successful, it takes a village, or as Hale likes to say, a symphony.

“We approach our work through various layers of support within the community,” Hale said. “I like to think of my role as one that allows me to see the entire ‘composition of music’ and support all the incredible instruments coming together to create that musical magic. Yes, the individual instrument can provide beautiful music too, but it’s when they all come together that really creates something special.”

Hale’s path to becoming a community health organizer and advocate began in the clinical setting where she was a dental hygienist for 12 years. It was there that she discovered her love for educating others about illness and injury prevention.

“I was passionate about improving education and access to dental care for everyone, believing early on that dental care shouldn’t be a luxury but an opportunity for all,” she said. “This passion led me to further my education in community and public health, ultimately bringing me to Cook Children’s Community Health Outreach in 2009, now known as the Center for Community Health.”

Since then, Hale has held various roles within C4CH. She also achieved what she considers her biggest professional accomplishment to date — earning her doctorate degree in Education from Baylor University. Much like C4CH, she couldn’t have done it without the help of her community. 

“The support and encouragement I received from Chris Pedigo and Marilyn Nappier, our AVP at the time, was truly incredible,” she said. “Through conversations with my classmates, I quickly realized how unique and special this support was, as not everyone in our cohort experienced that same level of backing.”

Hale says good leaders have the courage to be vulnerable, as vulnerability produces compassion, which is something she says Cook Children’s displays every day. She’s proud to be a part of an organization that values and supports giving back to the community through collaboration with community members, leaders and other non-profit and health care organizations.

Hale and her husband, Micheal, have been married for 20 years. They have two dogs who, as Hale puts it, “live their best life every day.” In keeping with the compassion that she leads with in her day job, the couple often opens their home to friends and family going through a tough time, giving them a place to stay until they get back on their feet.

“We feel this is a unique way for us to support others and pay it forward,” she said.

Luciana Pinto de Violtat, Cook Children’s - Prosper, Cashier

As a Camelot Court Cafeteria cashier at Cook Children’s Medical Center – Prosper, Luciana Pinto de Violtat greets every hungry Cook Children’s guest with a warm and welcoming smile. For her, these moments are more than simple transactions—they are opportunities to spread the kind of hope and compassion she knows can make all the difference in a hospital setting.

Six years ago, life threw Violtat an unexpected curveball, forcing her to walk in similar shoes as the customers she now serves.

“I was diagnosed with a rare type of cancer,” Violtat said. “Going through that experience made me realize my mission in life is to be kind, compassionate, caring and loving. Thankfully a miracle happened and I am able to say I am cancer free without having to go through chemo. Knowing what it’s like to be a patient in a hospital and being able to walk away from it alive, only made me want to give back. Giving hope and joy to patients is what matters most to me.”

Emerging from that harrowing chapter gave her a deep understanding of the patient experience and ignited a passion to offer others a sense of hope. It was that desire to make a difference that led her into the health care world.

On her first day on the job earlier this year, Violtat says her coworkers met her with open arms, a kindness that now motivates and inspires her every shift.

Originally from Brazil, with most of her family still living there, Violtat knows what it’s like to find yourself in a new and unfamiliar environment. That personal journey helps her connect with people from all walks of life.

“Another favorite part of mine is the pure fulfillment that I feel from working here,” she said. “Every day is a new experience for me. Interacting with patients and parents from different cultures always fills my heart with joy.”

As a cancer survivor and woman from another country, she’s faced her share of challenges. Yet, Violtat has never let those obstacles diminish her confidence.

“Unfortunately, people try to take advantage just because of different looks or accents,” Violtat said. “Despite that, I always try to look for the best in everyone. Whenever someone tries to challenge my knowledge and experience just because I am a woman, I tune it out because I know my worth. Also, I am aware of my experience, and I always do my best.”

Though Violtat has accomplished much on her own journey, her proudest achievement is her daughter, who is currently pursuing a degree in Psychology.

With every smile, every kind word, and every shared moment in the cafeteria, Violtat brings her personal mission to life—proof that kindness, in even the smallest acts, can ripple outward and uplift those who need it most.

Kristen Pyrc, M.D., Medical Director, Psychiatry Outpatient Services and Partial Hospitalization Program, Cook Children’s Medical Center - Fort Worth

Meet Kristen Pyrc, MD, a child psychiatrist by day and Raising Joy podcast host by passion. When Dr. Pyrc isn’t in the clinic helping children and families navigate the complexities of mental and behavioral health, you’ll find her behind the mic with co-host Wini King leading critical conversations in hopes of changing lives and, in some cases, saving them.

With four seasons and more than 80 episodes under her belt, it’s hard for Dr. Pyrc to choose a favorite, but she is partial to the one that started it all.

“The very first episode with Dr. Powderly has been the most impactful for me,” she said. “Dr. Powderly was instrumental in starting the Joy Campaign to raise awareness of the youth suicides we were seeing after COVID. Ultimately the podcast came from that, and she was our first guest. I had never seen a physician speak publicly about their own mental health journey, and I feel her bravery and candidness set the tone for the entire podcast.”

Dr. Pyrc hails from Hooks, Texas, a small, rural town nestled in the pineywoods of East Texas. It has one stoplight, and Dr. Pyrc was one of only 68 in her high school graduating class. Her passion for health care was ignited during her junior year of high school when she traveled to Guatemala on a medical mission trip. The physicians and nurses she met there inspired her to go to medical school where she discovered her passion for Child and Adolescent Psychiatry in her third year.

With the number of children struggling with depression and anxiety in the post-pandemic and digital world, the demand for Dr. Pyrc and her colleagues is at an all-time high. That, coupled with a national shortage of mental health specialists, makes it challenging for doctors to keep pace, but Dr. Pyrc is proud of the headway that’s been made in meeting the ongoing need. As medical director of Psychiatry Outpatient Services and the Partial Hospitalization Program, she plays a key role in connecting the dots between patients, providers and resources.

“I would say creating relationships across the health care system so that everyone has the tools they need to support the mental health needs of their patients is a proud accomplishment,” she said. “We are not there yet, but I’m proud of the work we have done and will continue to do in the years to come.”

The work can be heavy at times, but Dr. Pyrc says the support of her colleagues helps to lighten the load.

“I love my patients, but without a doubt, my colleagues are my favorite part of working at Cook Children’s, particularly the team in Psychiatry and Psychology,” she said.

Working at Cook Children’s is a family affair for Dr. Pyrc. She’s married to Bryan, a physical therapist, and together they’re raising two daughters, ages 9 and 5. Completing the family is their lovable, albeit “very nervous,” golden doodle, Gary, who Dr. Pyrc affectionately confesses is a total “momma’s boy.”

Mirna Pfeil, RN, BSN, Emergency Room Supervisor, Cook Children’s – Prosper

Mirna Pfeil could not be more proud of her three sons. They range in age from 15 to 24 and, like their mother, are driven to serve. Her oldest has been a proud member of the United States Air Force for six years, having joined when he was 18.   

“My biggest accomplishment would be raising three boys into respectful young men, teaching them the value of putting family first, and instilling pride in our Hispanic culture,” Pfeil said.

Pfeil and her family are relatively new to Texas. Three years ago they moved from Pfeil’s lifelong home in California to North Texas. Pfeil brought with her 27 years of experience in emergency medical care —18 as an emergency room nurse and 12 as a paramedic. She started her emergency medical services (EMS) career at just 18 years old. Being a young woman in the industry wasn’t always easy.

“At times, I was treated as a girl who couldn't handle the toughness of being in the field,” she said. “That experience has made me resilient.”

Today, Pfeil draws upon her extensive experience and wealth of knowledge to lead other ER nurses as an Emergency Department supervisor at Cook Children’s – Prosper. She also covers two shifts a week as the ER charge nurse, which she says allows her to stay connected to the staff and maintain contact with patients.

“Working at Cook Children’s has provided me with the valuable opportunity to take on the role of a supervisor,” she said. “This experience has allowed me to acquire a new set of skills, which I am truly grateful for.”

Pfeil is also working on obtaining her master’s degree.

“This is a big accomplishment for me, being first generation American,” she said.

Even with all her success, there's one thing Pfeil deeply misses: her father, who passed away when she was 18. He never had the chance to see her many accomplishments, but she knows he would be just as proud of her as she is of her boys. Pfeil often carries a picture of him with her so that his memory is included in her life achievements.

While she’s happy to now call Texas home, Pfeil hasn’t left behind her love for the LA Dodgers. When she isn’t working, you’ll likely find her cheering her favorite baseball team to victory.

Anniese Lemond, Assistant Vice President, Compensation

From the moment Anniese Lemond stepped through the doors at Cook Children’s in July, she felt a powerful connection to the Cook Children’s Promise — and Peaks the Dragon quickly found a special place in her heart.

“Peaks is more than a prop, he’s a mascot,” Lemond said. “The Cook Children’s blue peaks are a visible sign that we are near to help, serve and deliver on our Promise of everything for the child. So when you see those blue peaks, or hold Peaks in your arms, you know that you will be cared for in a safe environment, respected, treated kindly, and with imagination because of the collaboration and commitment we all have to our patients, their families and each other.”

As associate vice president of Compensation, Lemond’s mission is to ensure her team delivers exceptional and professional compensation services to the entire Cook Children’s workforce. She’s always looking ahead, strategizing to keep Cook Children’s pay programs competitive within the market in order to attract and retain top talent.

While new to Cook Children’s, Lemond is no stranger to the health care world. Her journey into the industry began unexpectedly when her role at Motorola Inc. thrust her into the challenging task of leading a major layoff.

“That event changed the course of my career in a way that I had not imagined it would,” she said. “I then joined the University of Chicago Hospitals and, in all honesty, did not initially like working in health care because it was so different from corporate America as I knew it. However, once I met some of our doctors, nurses and technicians, my entire outlook changed. I realized that I could help remove obstacles for those who are directly caring for our patients so that they could stay focused on the important work of healing. I knew in an instant that working in the health care space was my call.”

In the 22 years since, Lemond has thrived, leading initiatives that turned struggling departments into successful ones by bringing together the right talent, tools, systems, strategies and goals.

As a woman in leadership, Lemond lets her work speak for itself, relying on results to showcase her professional value. She’s already felt the warmth, support, and dedication that permeate Cook Children’s culture, from the physicians and staff to the leadership, reinforcing her belief that she’s exactly where she’s meant to be.

Veronica Tolley, Vice President, Primary Care and Specialty Services

Veronica Tolley is living the American dream, but she has never forgotten her roots. Born in Acuna, Coahuila, a Mexican border town just south of Del Rio, Texas, Veronica immigrated to the United States with her family when she was 2.

“I have a picture that I love of me as a toddler right before my father moved us from Mexico to join him in Fort Worth,” Veronica said. “It reminds me where I came from and that the American dream and the potential that every child has in them is a real thing.”

Veronica’s parents worked tirelessly to give her and her three siblings hope for a bright future. Her mother cleaned houses by day, took English classes at night and studied for the US citizenship test “like it was her Boards,” as she describes it. And she never failed to cook a homemade meal for her family every single evening. Tolley’s father worked sunup to sundown as a construction laborer. One of his worksites was a building on the campus of Texas Christian University which, as luck would have it, later become her alma mater.

Her parents’ hard work, dedication and belief in their children’s potential paid off. Today, Veronica is Vice President of Primary Care and Specialty Services, overseeing operations for Cook Children’s Physician Network.

Charting Her Course

Executive leadership wasn’t Veronica’s first choice of careers. As a child, she dreamed of becoming a doctor. Being the first in her family to become fluent in English, she often found herself translating for her parents and grandfather during medical appointments. These early experiences ignited her passion for health care, but at the time, the path to becoming an M.D. felt unattainable.

“As a young girl I didn’t know women could be physicians let alone someone from a family with minimal means,” she said. “I would be a first generation high school graduate. College was not a certainty for me and felt like reaching for the stars, so I put the idea of medical school out of my mind.”

But the desire to work in health care never left her. When a local hospital administrator spoke to her sixth grade class on career day, she began to wonder if she could follow a similar path.

“As he talked about his role, I knew that was what I wanted to do,” she said. “If I couldn’t be a doctor, then maybe I could help others be the best possible doctors they could be.”

By 14, Veronica was volunteering at a local hospital filing records and running x-rays from radiology to the family clinic. She made some keen observations along the way.

“During my time there I kept a journal of all the things the nurses complained about and the things I saw that I thought the physicians could do better for their patients,” she said.

Those observations led Veronica to pursue a degree in sociology to learn more about how people interact with each other and how teams work. She followed that up with a master’s degree in health care administration.

After graduating, Veronica applied three times for positions at the hospital where she volunteered as a teen, never getting a single interview. Then, a job listing in the classified section of the Fort Worth Star-Telegram containing the word “supervisor” caught her eye. It was for a position at Cook Children’s — a hospital she had never heard of before. She applied and got the job as office supervisor for Cook Children’s Central Community Clinic.

That was 26 years ago. Veronica has called Cook Children’s her work home for her entire career. The little girl from Mexico and minimal means who dreamed of working in health care rose from office supervisor to practice manager to practice administrator to director to assistant vice president and, now, vice president.

Remembering Her Roots

Much of Veronica’s work of following financial trends, analyzing payor reimbursement, reviewing internal policy and procedures and developing best practices is primarily done behind the scenes, but it’s led to some big wins for both Cook Children’s and the community. She was instrumental in the expansion of Orthopedic locations throughout the metroplex, as well as a key player in evolving Cook Children’s soon to be nine Neighborhood Health Centers into the medical homes for underserved children they are today.

“The work I do, if done well and with positive intent, is the foundation that makes the best patient experience possible, and that brings a lot of purpose to my day,” she said. “When the work gets hard or seems impossible, I remember what my parents must have felt and how their children kept them motivated to keep trying to find a way. I am lucky enough to have a career because they saw the potential in me. It makes me proud to say my job helps families do the same for their children.”

Away from work, you’ll find Veronica having fun with her family, including her two children, ages 21 and 17, and her black cat, Bandit. Her home is often the gathering place for her parents, siblings and their families. They enjoy playing games like Loteria and backyard baseball, and are known to join the occasional TikTok challenge.

Whether at home or at work, Veronica carries forward the legacy of hard work, determination, and the belief in others' potential, values her parents instilled in her long ago. She is doing exactly what she set out to do — supporting and equipping doctors and their teams to be the very best they can be.

Megan Chavez, Vice President, Cook Children’s Experience

Meet Megan Chavez, protector of the Cook Children’s experience. It’s her job to strengthen trust between those giving and receiving care. That means she spends her days connecting the dots between the delivery of health care and the magic that happens when we see the world through the eyes of others and respond with respect, kindness and generosity.

It’s a perfect role for a person whose favorite quote is all about the impact one person can make on another: “To the world you may be one person, but to one person you may be the world.”

For Chavez, personal success is found in those magical moments of connection, big and small.

“It’s when I see our employees caring for each other, either by reaching out when they see someone struggling or taking the initiative to rethink a process and change the way we work for the better,” Chavez said. “Or when I walk the hallways and see evidence in our physical spaces that the experience of our families and staff were front-of-mind when that space was designed. And when I see kids, regardless of disability or life’s challenges, playing and smiling because of our amazing employees giving their all so that a child knows they are loved and safe,” Chavez said.

Elevating the experience all starts with listening. Chavez is all ears for staff, patients and families as she learns what works well and where there’s room to level up. Then, she mobilizes whatever support, tools or resources are needed to empower employees to deliver on the Cook Children’s Promise by keeping the experiences of patients, families and staff top-of-mind when making a decision.

Chavez has been in the business of enhancing experiences for 25 years, with the past four spent at Cook Children’s. She feels fortunate to do what she calls her “life’s passion” at a place that values a people-first culture and environment above all else.

“Cook Children’s believes that fostering a culture of diversity isn’t just about doing what’s right. It’s to our advantage. Our workplace serves as a beacon of empowerment for women. Their voices are celebrated, which creates an environment where women can drive innovation, shape decisions and inspire the next generation. You see that at all levels from IT to clinical to our executive suite.  There is an intentional focus on individual well-being that supports women leaning into their life’s purpose professionally and personally.”

Alice Phillips, MD, MPH, LSSYB, FAAP, Medical Director of Ambulatory, Quality and Safety, Primary Care Physician 

Cook Children’s Pediatrics Cityview 

Beware of telling Alice Phillips she can’t, because it’s a sure sign that she will. As a young woman, Dr. Phillips’ parents discouraged her from becoming a doctor. Not because they doubted their daughter’s abilities, but because they were unsure how she would balance being a doctor while also fulfilling her desire to be a wife and mother.

Today, Dr. Phillips admits their concern for her work-life balance wasn’t completely off the mark. It’s hard to juggle life as a wife, mother of two, a physician with a heavy patient load and a medical director at Cook Children’s.

“Those cultural pressures for women are real, so we have to be aware of them,” Dr. Phillips said.

Thanks to the support of her husband of 32 years, as well as Cook Children’s culture that equally values dedication to work, family and fun, Dr. Phillips found a way to balance it all, and her beloved parents were proud to witness it.

“Even though my parents initially were worried, later on, it was always, ‘Have you met my daughter, the doctor?’ They had immense pride in what I do,” Dr. Phillips said.

She says coffee helps her get through, too. Her java juice mug of choice is one gifted to her by her children featuring the face of Doc from “Snow White and the Seven Dwarfs.”

“I imagine Doc must have been a pediatrician, because he's happy and loves what he does,” she said. “The mug symbolizes a lot of those things to me. Joy in my work and joy in something my family gave me.”

“In May 2021, I was privileged to be elected by my peers at Cook Children’s to serve as the first female primary care physician to hold the position of chairman of our physician-led Board of Directors.  But this date held other precedence as well.  Simultaneous to my election, the first all-female executive team to ever lead and represent our physicians was also elected. Over the next two years, I watched and listened as strong, intelligent female voices influenced the positive culture that Cook Children’s is known for regionally and now nationally. My career continues to grow as a part of the Cook Children’s family and the support it shows for all members of its team.”

Stefanie Tanner, RN, Director of Nursing and Patient Care, Cook Children's Medical Center - Prosper

Stefanie Tanner knew she wanted to be a nurse when she was 8 years old. Back then she dreamed of working in a hustling and bustling emergency department. Today, she leads the entire team of nurses at Cook Children’s Medical Center – Prosper, and counts it more of a joy than a job.

“I often say if you love what you do, you’ll never work a day in your life,” Tanner said.

In addition to her love for the profession, the people she gets to work with, as well as the kids she gets to care for, are what she values most about Cook Children’s.

Having worked within the health care system for 16 years, Tanner brought a wealth of knowledge and expertise to the executive team at North Texas’ newest pediatric hospital.

Tanner says she faced very few roadblocks rising through the ranks as a woman within the organization, given the amount of female leaders at Cook Children’s and the fact that nursing is a female-dominated industry. The real challenge, she says, has been learning how emotion and empathy influence communication in a profession filled with naturally empathetic people.

Any hurdles she does face are met with an incredible team support approach and her faith in Jesus where she reminds herself daily to “Pray more. Worry less.”

Cook Children’s – Prosper opened its doors in January 2023, but the pace required for getting a new facility up and running has yet to slow, and that’s the way Tanner likes it.

“We have a lot of growth, so with that comes a lot of meetings, collaboration and discussions,” she said. “It’s super fun and never a dull moment.”

In addition to her role at Cook Children’s, Tanner is a member of the faculty at the University of Texas at Arlington where she teaches the next generation of nurses. She’s also a wife and mother of two young boys, ages 9 and 5. 

Suzanne Seider, Director, Talent Acquisition

For Suzanne Seider, it’s the thrill of the hunt. The search for the right fit for an open position. The satisfaction of helping someone land the job they want.

And, at Cook Children’s, the stakes are high. Seider’s job isn’t just about filling a position, but about fulfilling the organization’s Promise of “Everything for the child.”

“I want our recruiters and perspective employees to love what they do, because especially in health care, there's a patient at the end of that hiring process and job,” Seider said. “So make sure that this job is something that's going to feed your soul and help the patient.”

It’s clear Seider’s team of recruiters enjoy what they do. There’s little to no turnover in her department, which she counts a win-win for both the employee and patient experiences.

“Our promise isn’t just for our patients and their families, but for everyone that works here,” Seider said. “We can’t take care of our patients without having the resources to take care of ourselves and our families, too. We can't expect our employees to take care of our patients if they’re completely poured out. Something has to fill their teacup, too, and you’ll get that support at Cook Children’s.”

One thing Seider’s on a mission to change? The misconception that nursing is the only opportunity for women in health care. That’s simply not the case, she says, and certainly not the norm at Cook Children’s.

“We have a lot of female doctors and leaders here. In fact, most of our leadership at Cook Children’s is female,” Seider said. “I think the difficult part for women in health care is realizing there's so many more opportunities than what you think.”

When she’s not leading her team of recruiters to find top talent for Cook Children’s, Seider feeds her soul in the garden. Cultivating both food and flowers is a passion she inherited from her childhood visits to her dad’s family farm in Indiana. It echoes the sentiments of one of her favorite quotes by Henri Matisse — “There are always flowers for those who want to see them.”

“I have had the privilege to work at Cook Children’s for over 15 years.  I have worked in human resources for over 20 years, and I know that the opportunities that I have been given to learn and grow into a leadership role at Cook Children’s are hard to find in most companies.  I love working for a company that has a Promise and values that extend from patients to our staff.  It is rare to find a company that cares for its staff the way Cook Children’s cares for theirs.”

Karen Love, President of Cook Children's Health Plan

By Vivian Moore

Karen Love bears the weight of an undeniably heavy crown. With the support of all who create and experience the magic that happens under Cook Children’s signature blue castle peaks, she’s spearheading a critical crusade for children and families. 

As the President of Cook Children’s Health Plan, Love is leading the charge in challenging the recent decision by Texas’ Health and Human Services Commission to deny Cook Children’s Health Plan a contract renewal for managing the State’s Medicaid STAR and CHIP programs. Like a dame in shining armor, she has been instrumental in fighting the decision every step of the way, carrying the torch for the more than 125,000 children and families served by the Health Plan that stand to be impacted by the State’s faulty and unfair decision. 

In June, Love announced during a press conference legal action designed to stop the State from replacing Medicaid benefits provided by local community health plans with national for-profit health plans. And she has no plans to stop there. 

“Karen Love is a true champion for our Cook Children's Health Plan family,” said Rick W. Merrill, president and CEO of Cook Children’s Health Care System. “Her unwavering advocacy gives our members and families a powerful voice, and her commitment to transparency keeps everyone informed through regular updates and town halls. Now, on the front lines of our fight to save our Health Plan, Karen's leadership shines even brighter. She is a true leader who puts the needs of our members, families and team members first." 

The fight stands to be long and hard, but a crystal pendant necklace Love often wears reminds her to take heart and remain steadfast on her noble quest. It was given to her by her son during a challenging time for their family. 

“I wear it to remind me that while challenges along the way may be sharp, making it through them even stronger can be beautiful,” Love said. 

Love’s court of support includes her husband of 41 years, two children, one grandson, her many colleagues, as well as her Promise-keeping Health Plan team. 

“The incredible support from my colleagues in leadership roles is what I love most about working at Cook Children’s,” Love said. “This situation we are facing with our Health Plan contract has reminded me how many of them are absolutely willing to help in any way they can. Cook Children’s is a very warm and accepting place where those you work with truly care about you and your well-being. We are very deliberate about how we can best honor and deliver on Our Promise to children and families in our community, and our employees all know how they make a difference every day in their roles.” 

When she’s not evaluating the Health Plan’s performance, identifying barriers to strengthening the organization, and equipping her team to handle the challenges and potential changes coming their way, you will find Love looking to the stars. 

“I just got my five-year anniversary reward — a telescope that I’ve set up on the front porch to look at the night sky and all its wonders. Astronomy was my favorite science class in college,” she shared. 

Similar to searching for a distant constellation on a cloudy night, perseverance is essential in facing challenges, and Love has it in spades. Whether gazing at the stars or standing steadfast at a press conference, she continues to inspire hope, reminding us that with our Promise of everything for the child as our guide, even the heaviest of crowns can be worn with grace, strength and resilience. 
 

Kaysey Pollan, MBA, CHSP, Director of Environmental Safety and Emergency Management

Newsweek has named Cook Children's one of America's Greatest Workplaces for Women 2024. We're introducing you to some of the women who make Cook Children's such an amazing place.

If there is one thing Kaysey Pollan knows, it’s how to weather a storm. As the Director of Environmental Safety and Emergency Management at Cook Children’s, her phone is the first to ring when disaster strikes. Since 2008, she’s coordinated the emergency response operations of various municipalities and health care organizations. She joined Cook Children’s in 2013 as the Emergency Management Coordinator and rose through the ranks to a leadership role in 2017. 

Then came the emergency response of all emergency responses — the COVID-19 pandemic. 

“The pandemic was definitely the biggest challenge of my career,” Kaysey said. “The word ‘unprecedented’ was used often during that time, but it truly was unlike anything we have ever faced before. There were so many unknowns and worries for our staff, families and patients. I never thought we would face a multi-year disaster, but I am so proud of the resiliency the organization and our staff displayed. We rose to the challenge, and there were a lot, and we were able to never waiver from our Promise.” 

When Kaysey isn’t leading and guiding Cook Children’s through an internal or external disaster, she’s planning and preparing for one. It takes a lot of collaboration between local fire, police and emergency medical services, as well as other area hospitals and, of course, all of Cook Children’s departments. 

Originally from Abilene, Kaysey loves Fort Worth for its West Texas feel. Her dad was a hospital administrator, so the health care industry is a natural fit. She hit her professional stride about the same time hospitals began devoting full-time positions to lead disaster response and recovery. Pollan’s experience in local government helped prepare her to apply the core concepts of emergency management to the hospital setting. 

“A hospital operates the same as a city,” she said. “It never closes. There are citizens, in this case patients, families, and staff, that are reliant on our services. Our hallways are like streets, and everything must remain open and functional no matter what’s going on.” 

While Kaysey never wishes for a disaster, she’s proud that she gets to lead, guide and support the patients, families and staff at Cook Children’s when the unthinkable happens. And when she gets home from a long, hard day, her two “most spoiled golden retrievers in Fort Worth,” greet her at the door. 

Tara Bradshaw, MHA, Director of Retail and Administrative Projects

There was a time when Tara Bradshaw wanted to follow in her father’s footsteps and become a physician. But he wisely told her to walk a day in those shoes before she started down the medical school path. After shadowing her father’s fellow emergency department physicians in her hometown of Longview, Texas, Bradshaw realized her true calling.

“I came home, and I started telling him all the things I was thinking about during my day,” Bradshaw said. “Did the doctor like his computer? Was the patient comfortable in their room? Were the patients getting through each step of the process well? He paused after and said, ‘You sound like a hospital administrator!’”

And the rest, as they say, is history.

Fresh out of graduate school where she earned her Master of Science in health care administration from Trinity University, Bradshaw became a Cook Children’s administrative resident in January 2021. A year later, she was promoted to director of administrative projects where she participated in the transition planning for the new Cook Children’s Medical Center - Prosper.

“I never thought I would be lucky enough to watch a hospital start from the ground up, and I learned so much about each department at Cook Children’s in the year of transition planning,” she said. “It was a great experience to meet different people in every corner of the organization and understand what each person and department needs to function.”

In addition to administrative projects, Bradshaw also now oversees Cook Children’s retail spaces, like Build-a-Bear and Under The Peaks. She couldn’t be happier with her career path, or more proud to be spreading her health care administration wings at Cook Children’s.

“The Cook Children’s culture is like the Texas humidity—you can’t see it, but it hits you when you walk outside or, in our case, through the doors,” Bradshaw said. “From the front desk, in the elevators, on the floor, in the basement, and on your way out, everyone wearing a badge will greet you with a smile, give you directions to Starbucks, and would be more than happy to tell you about their role in the organization. I don’t think anyone here would pretend they could do their job alone, and the acknowledgement that we need each other makes this place special.”

Sara Garza, M.D., Cook Children’s Physician Network Locum Tenens Physician, Associate Physician Well-being Advocate

For Sara Garza, M.D., no two days are the same as she balances two professional roles. She is both a locum tenens physician, or one who fills a temporary vacancy for another physician who is away, and co-leader of Cook Children’s Office of Physician Well-being, which was recently created to address physician burnout. 

“Since taking on the role of associate physician well-being advocate, I'm in a very dynamic season in my career with no ‘typical’ day,” she said. “Any given week may be filled with project work aimed at promoting the well-being of our physicians, collaborative meetings with other departments on shared goals, organizing events, or caring for patients as a locum pediatrician." 

Prior to accepting these positions in 2022, Dr. Garza was a primary care physician at Cook Children’s Pediatric Keller Parkway for 17 years. The career change allowed her to expand her horizons and be doctor, physician advocate, wife and mother to her 14-year-old daughter and 11-year-old triplets. 

As a physician well-being advocate, Dr. Garza works to build and strengthen connections among Cook Children’s physicians and to develop resources and processes that help colleagues achieve better work-life integration. She hopes this work leads to broader cultural changes within medicine, one that values the humanity of doctors and all stakeholders in medical care. 

When the many hats she wears weigh heavy, Dr. Garza turns to her Christian faith for wisdom, peace, and perseverance.

“Cook Children's is a great workplace first because our foundational Promise to improve the well-being of every child in our care and our community aligns with a pediatrician's heart. Beyond our mission, one of Cook Children's best differentiators is that we care about each other as evidenced by our effort to build strong connections through respectful and honest relationships, as well as our courage to challenge our system to evolve and grow for the better. From my days as a bright-eyed early career physician growing a beautiful pediatric practice through many life stages — marriage, the birth of our four children, loss, and a pivotal mid-career change, our Cook Children's family has been a pillar of support.”

Deborah C. Boudreaux, MSN, RN, CCRN, C-NPT, LP, CMTE, Vice President of Nursing and Patient Services, Alliance for Children, Board of Directors, Jewel Charity, Ball Chairman 2025

These days, Deborah Boudreaux’s feet are firmly planted on the ground. But it hasn’t always been that way. As a former flight nurse for Cook Children’s Teddy Bear Transport, she spent much of her career nursing critically ill neonates from the back of an ambulance or while flying in a plane or helicopter en route to Cook Children’s Medical Center.

In addition to her critical care nursing skills, Boudreaux had to know about things like engines, fuel burn, and how to make sure the tires were rotated on an ambulance. Not the conventional wisdom of a nurse, but absolutely essential for someone caring for patients while speeding through the skyways and highways of Texas and beyond.

“In nursing school, they don't teach you how to do any of that,” she said.

And, yet, Boudreaux says she never heard the words “you can’t” from any one of her leaders or mentors at Cook Children’s.

“I don't think there was ever a door closed to me,” she said. “We're very lucky here at Cook Children’s. Having so many nurses in leadership allows other nurses to think, ‘Oh, yeah. I can do that.’”

In 2023, Boudreaux soared to new heights when she landed the role of vice president of Nursing and Patient Services at Cook Children's, following a stint as the director of Teddy Bear Transport. The new job required her to hang up her flight suit and hand over her helmet, which she admits wasn’t easy. In their place, Boudreaux cherishes a soft and fuzzy reminder of her transport days — her Build-a-Bear transport teddy, sporting a miniature replica of her former flight suit.

Boudreaux’s office is no longer in the sky, but she’s still aiming for the stars as she leads, supports and mentors the current and upcoming generation of nursing superstars at Cook Children’s.

“I have worked at Cook Children's for 37 years. Over the past three decades, I have watched our organization grow to meet the needs of our community by adding services and staff, all the while making sure that we are basing our care on the latest evidence-based practice. With all these changes, one thing has remained consistent — the support from our administration. Cook Children's has retained the feeling of a family with an open-door policy. The support from administration is palpable starting with our executive vice president, Nancy Cychol, who has been a strong female influence for over four decades. Nurses, respiratory therapists, paramedics, care partners, dietitians, physical therapists, physicians, WE all have a voice at the table. I am proud to be a leader in an organization that truly values my opinion. I hope that I will one day be included in the long list of strong female leaders.”

Shernette Kydd, Ph.D, Professional Engineer and Assistant Vice President of System Effectiveness

Shernette Kydd, Ph.D., PE, MBA, CLSSMBB, LSSBB, CPHQ, LBC, isn’t afraid to face a problem head on. In fact, she welcomes them like a kid welcomes a visit to the candy store. 

“I call problems candy, and we have lots of challenges in health care, so we call it a candy store," she said. “Folks run from problems but, as engineers, we run to them.” 

And she’s yet to meet a problem she couldn’t overcome. Partly because of her extensive engineering education and experience, but mostly a result of the legacy of faith and perseverance left by her mother. After the death of her father when she was 8 years old, she watched her mother raise six children on her own, all the while modeling Philippians 4:13: “I can do all things through Christ who strengthens me.” That verse and her faith in God powers her perseverance and gives her the resolve to find the sweet solutions in every piece of “candy.” 

As an engineering student, she was often the only female in her classes. Today, only 24% of industrial engineers are women, but being a woman in a male-dominated industry hasn’t stopped her from reaching the top. 

At Cook Children’s, she has found a place where she can develop solutions that deeply impact people’s lives on a global scale. 

“It's like a dream job,” she said. “The goal is to solve problems, and health care is something that impacts everyone. Even though I'm here in Texas, the solutions we find within health care can impact medical systems globally, because you want to share your findings with others.” 

She is raising the next generation of problem-solvers, too. She and her husband have two children, both of whom have followed in their mother’s footsteps. Their daughter is a biomedical engineer and their son recently completed his bachelor’s degree in data science. 

Nancy Cychol, Executive Vice President, Hospital Services

You may not know Nancy Cychol, but if you live in Fort Worth or Prosper, you’ve seen her work and the magic it brings. 

As Cook Children’s executive vice president and chief of hospital services, part of Nancy’s job is to ensure the environments of our medical centers are safe and suitable for children. That means it also must be fun, or as we like to say at Cook Children’s — magical. 

After all, she’s the woman behind the can’t-miss annual Christmas lights display at Cook Children’s Medical Center - Fort Worth. 

From the spectacular holiday displays to the giant rocking chair statue she commissioned as a one-of-a-kind climb and play structure (where she is pictured), Nancy is always thinking about how to make Cook Children’s a place where kids can just be kids. As a long-time pediatric nurse and a self-proclaimed kid at heart, it comes naturally to her. 

But along with the fun is a serious dedication to her work. Nancy can trace her dream of becoming a nurse to childhood when, at just 6 years old, she would draw pictures of herself as “Nurse Nancy.” Fast forward to now and she’s been taking care of kids and making them laugh and smile for more than four decades. First, as a pediatric ICU nurse in Indianapolis and, beginning in 1984, as the director of Cook Children’s Pediatric and Neonatal Intensive Care units. 

Today, “Nurse Nancy” is a part of the senior executive leadership team leading one of the largest pediatric health care systems in the country. 

“The vision of strong women like Ida Turner and Mrs. Cook continues to inspire us today. Their commitment to the children in our community, especially the most vulnerable, still serves as the foundation of the supportive and empowering environment we have today for the women at Cook Children’s. It’s an honor to be a part of a legacy where others can make a real difference in the lives of children and their families.” 

Kara Starnes, D.O., FAAP, Urgent Care Medical Director

Kara Starnes, D.O., FAAP finds inspiration in the courageous example of her great-great aunt, who served as captain of naval nurses at Pearl Harbor.

Dr. Starnes was well acquainted with that great-great aunt, who lived into her 90s. From a young age, hearing stories of resilience during the 1941 attack on Pearl Harbor, Dr. Starnes was drawn to a career in medicine. 

“She instilled in me a desire to help others through the medical field. I admired her bravery, her heart for others, her medical knowledge and her ability to think on her feet in the direst of situations,” Dr. Starnes said.

That knack for quick thinking and kindness empowers Dr. Starnes in her role as Medical Director for Cook Children’s seven Urgent Care locations. Dr. Starnes oversees 30 physicians and 70 advanced practice providers. She reviews charts, responds to parent concerns, creates new protocols, and shuffles staff to sites with a high patient census. Some days she cares for patients herself. 

Dr. Starnes also serves as Information Technology Medical Director for Urgent Care, helping identify the upgraded technology options that would benefit her department. She works to fine tune Urgent Care’s interactions with Epic electronic medical records.  

Her biggest career accomplishment so far, she said, is being trusted by administrators and colleagues to serve as executive committee secretary for the Cook Children’s Physician Network Board of Directors.

It’s tricky to balance her responsibilities at work and at home with family. But she’s learned to adapt to meet the demands as they evolve.

“I strive to be intentional and present in the moment for every endeavor, and this can be extremely challenging for me to feel that I can excel in every area,” Dr. Starnes said. “There will be days when one area diminishes in importance and another rises up, and the next day, the opposite may be true.”

Her eight-year tenure at Cook Children’s has shown her that employees stand behind the Promise to improve the well-being of every child in our care and communities. She carries out the Promise by keeping the child her top priority.

“It is a Promise that is upheld at every level, and I can rest assured that as long as I make every decision with the patient’s best interest at heart, I will be supported by my leadership,” Dr. Starnes said. “This ensures that I keep the reason I became a physician always at heart. You don’t find this culture at many health care organizations, and it is refreshing!”

Dr. Starnes grew up in Richardson. She went to Texas A&M University for a bachelor’s degree in microbiology and to the University of North Texas Health Science Center for her Doctor of Osteopathic Medicine degree.

She’s married to her high school sweetheart and has three sons -- ages 20, 17 and 12 -- and three dogs. For fun she sings and plays the keyboard in a cover band that performs at local venues.

The spirit of teamwork at Cook Children’s conjures up Dr. Starnes’ mind a Texas A&M Aggie slogan: From the outside looking in you can’t understand it, and from the inside looking out, you can’t explain it.

“I view Cook Children’s in a similar light,” she said. “The culture of Cook Children’s is a feeling that you get when you walk through the halls, a sense of camaraderie with your colleagues that you are each unified in the same vision – everything for the child.”

--

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.

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.”

On Tuesday, Cook Children’s Health Care System celebrated the grand opening of a new space dedicated to the siblings of children with medically complex needs. It’s called the Panda Cares® Center of Hope Sibling Support Center and is located inside the newly expanded Dodson Specialty Clinics building at Cook Children’s Medical Center – Fort Worth.

The Panda Cares Center of Hope Sibling Support Center offers the siblings of Dodson Specialty Clinic patients a place to play, create and connect with other children whose families face similar challenges while their brother or sister attends clinic appointments. It also relieves the stress of parents and caregivers so they can concentrate on their child’s medical appointments knowing their other children have a safe and supportive space dedicated to their well-being, too.

The complex medical needs of a child with a chronic condition or life-changing injury can strain the mental and emotional health of the whole family, including brothers and sisters, according to Audra Trussell, coordinator of the Panda Cares Center of Hope Sibling Support Center.

“We are really focused on the sibling’s emotional and psychosocial care,” Trussell said. “A lot of times, they don’t need as much attention as their chronically ill brother or sister so they may feel a little left out and dragged around from appointment to appointment. At this center, we’re able to focus on those kids, give them the care they deserve as well, help them process their feelings and what they are experiencing, and make them feel like a member of the Cook Children’s family, too.”

The center is staffed by Trussell, who has a background in child development, and Judith Siharath, Panda Cares Center of Hope Sibling Support Center assistant, who has experience in psychology and child development. Cook Children’s volunteers will also be on hand to assist.

Everything for the Child

The Panda Cares Center of Hope Sibling Support Center is a therapeutic activity center full of everything for the child, from developmentally appropriate toys and sensory play items to arts and craft supplies. Each day Trussell and Siharath will offer child visitors a guided activity that sparks their imagination, creativity and conversation.

“Every day we'll have a different activity to do that will open up a new discussion for our sibling guests because, given their family’s situation, they might not get that opportunity outside of here, and we want to make sure they feel like they are the center of attention,” Siharath explained. “For example, we have an activity where kids can make a rainbow with colors based upon their feelings. We would ask them questions like, ‘What colors represent you?’ and ‘Which color represents your inside and outside feelings?’”

The questions are meant to help kids connect with other children who also have a sibling with a medical condition and may be experiencing similar emotions related to their brother or sister’s health.

“When we're all sitting around the table and these open-ended questions are being asked to help draw the child out and give them an opportunity to speak up, they'll get to hear other siblings say some things that they may not have felt like they could say out loud, and feelings that they’ve had regarding their sibling that is a patient,” Trussell said. “So that peer-to-peer support is an important piece that we want to emphasize here, too.”

Connecting the Dots for the Whole Family

Together with other Cook Children’s sibling support programs, The Panda Cares Center of Hope Sibling Support Center connects the dots of family-centered care at the health system. It’s an extension, Trussell says, of the work Child Life Services does to care for the mental and emotional health of the whole family through offerings like the Cook Children’s Sib2Sib Program™. Through weekend workshops, camps and family events, Sib2Sib gives patient siblings the opportunity to express themselves and their feelings, receive undivided adult attention, learn coping skills and connect with peers living in similar circumstances.

Sometimes a child will express fear or misunderstanding about their sibling’s health, treatment, or injury while visiting the Panda Cares Center of Hope Sibling Support Center or any of Cook Children’s sibling support programs. For example, if a child has experienced a pet being “put to sleep” they sometimes correlate that term with death, and may think their brother or sister is going to die because they are having a procedure where they will be put to sleep.

“When we hear those things we’ll be able to share that with their parents and connect all of them with a Child Life specialist that can help explain what the procedure is, what's really going to happen medically, and what all the terminology means in good, child-appropriate language that they understand,” Trussell said.

Together, all of these programs and services connect the dots of family-centered care at Cook Children’s.

The Panda Cares Center of Hope Sibling Support Center at Cook Children’s is made possible through the support of Panda Cares®, the philanthropic arm of the Asian dining concept Panda Express®, and its partnership with Children’s Miracle Network (CMN), of which Cook Children's is a member. Following a multimillion-dollar commitment to Children’s Miracle Network Hospitals to fund Panda Cares Centers of Hope, Panda and CMN Hospitals have debuted Center of Hope locations at several hospitals in the U.S. from California and Texas to Hawaii and Washington D.C.

The Panda Cares Center of Hope Sibling Support Center at Cook Children’s is open from 8 a.m. to 5 p.m. Monday through Friday to siblings, ages 3 to 11, of patients who have a clinic appointment. Children may attend the center for 90 minutes per visit. It is free to families. Reservations are not required but parents will be asked to complete a registration and consent form. 

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.”

Cook Children's employees shared about a woman who inspires them.

By Ashley Antle

What has enough concrete to fill eight Olympic-sized swimming pools, ductwork that equals the weight of 32 male African Elephants and 160 miles of wiring that could circle a football field more than 600 times?

It is the newest addition to the Cook Children’s Medical Center campus, which adds 240,000 square feet and six new services to the existing Dodson Specialty Clinics building. The expansion, opening in March 2023, is designed to make visits to one of the more than 35 specialty clinics housed in what will ultimately be a fully integrated facility easier and more convenient for patients and their families.

“Our specialty clinics are experiencing increasing demand for services from a rapidly growing, diverse population,” said Veronica Tolley, vice president of Primary and Specialty Services at Cook Children's. “The Dodson Specialty Clinics expansion will accommodate this growth, while also allowing clinics to consolidate to one location which is a tremendous satisfier for our patient population.” 

Children living with a disability or disease often require ongoing care from one or more specialized physicians, like a neurologist or oncologist, for example. Juggling multiple appointments, medical equipment and other challenges that come with a chronic condition can be difficult. The Dodson expansion places vital and often overlapping specialty services under one roof, connecting the dots of care, collaboration and convenience for physicians and families.

What’s New

While adding space for clinic growth, the expansion also will support the addition of a Peaks Tech Zone, a sibling center, a cafe, a pharmacy, retail space and a maternal/fetal medicine clinic.

A cross between a technology lounge and in-person help desk, Peaks Tech Zone is a place where families can get guided, hands-on experience with devices and online applications recommended for their child’s care. It includes a self-service space and a consultation area for one-on-one assistance from a health technology advocate, or techspert, who will help Tech Zone visitors do everything from setting up their MyCookChildren’s patient portal so they can view their child’s medical chart to syncing their personal technology with medical devices and apps recommended by their child’s physician. Visitors can also learn how to utilize virtual care, telemedicine services and any new Cook Children’s innovation that helps them meet the health needs of their family.

The Sibling Support Center will take a load off of parents and give kids a safe, fun and developmentally appropriate space to spend time during their sibling’s clinic appointment.

“There are many times when parents have to bring siblings to patient appointments, and sometimes the presence of siblings ends up preventing needed clinical care from being able to happen,” said Jill Koss, director of Family Support Services. “This Sibling Support Center will allow parents to focus on their child who is a patient and, even more importantly, will allow siblings to be the focus of specific programming designed to support their emotional, psychosocial and developmental needs.”

The Sibling Support Center is generously sponsored by Panda Cares through Children’s Miracle Network Hospitals charities. It will be located on the first floor of the Dodson expansion and open to patient siblings ages 3 to 12, Monday through Friday, for up to 90 minutes per visit. Programming will include creative arts activities, play supporting growth and development, music, dramatic play, video games for older children and more.   

The new space also makes way for the Jane and John Justin Institute for Mind Health, which will put commonly overlapping specialties that treat the mental and physical diseases and disorders associated with the nervous system under one roof. Those specialties include Neurology, Neuropsychology, Neurosurgery, Pain Management, Physical Medicine and Rehabilitation, Psychology, Psychiatry, Developmental Pediatrics and Developmental Psychology. The Justin Institute is designed to eliminate barriers to care like multiple appointments with multiple providers in multiple locations and to simplify the patient’s access to their medical team. For children and their families, it will make a day of doctor’s appointments much easier. For medical providers, it enhances their ability to coordinate care. The Justin Institute is slated to open fall 2023 in Cook Children’s Dodson Specialty Clinics building.

A new 10-level parking garage for physicians and visitors will support the facility and will be easier to navigate. No more driving around and around wondering if a space will be open from one level to the next. Using dynamic signage, an intelligent parking system will alert drivers to the number of spaces available as they approach a level of the garage, making self-parking more efficient and reliable.

“Following substantial completion and certificate of occupancy, many of our clinics who currently reside in our existing Dodson facility will begin moves to the new facility through a managed transition plan beginning in late March and continuing through 2024,” said Kim Arnold, space utilization and transition manager. “Countless thousands of children and their families will enjoy this new facility, the exciting features and benefits designed to serve them. We cannot wait to implement the transition of our clinics and services, and open the facility for our patient families.”

As a result, some experts say many children are behind in their social and emotional development. In the first and second grade, kids are struggling with basic skills they’d typically learn in preschool and kindergarten, like taking turns, working in groups, keeping their hands to themselves, sitting quietly for a period of time, standing in line or unpacking their backpack on their own.

“Since the pandemic, I've noticed a lot of regression in kids,” said Amy Arriaga, a pre-K teacher at Fort Worth Independent School District’s Mendoza Elementary. “They have regressed to like they are at 2 or 3 years old and not 4 and 5. I’ve noticed an increase in separation anxiety. Now that we’re starting to go back to normal somewhat and mom and dad say you have to go to school, kids are like, ‘but you’re not going to go with me?’ I’ve also noticed more aggressive behavior and not being able to keep their hands to themselves.”

There’s also been a loss in the mastery of fine motor skills, according to Arriaga. She said most kids used to start pre-K with some basic skills, like how to properly hold a crayon and recognition of some shapes, letters and numbers. That’s not the case this school year.

Teasha-lee Frattarelli, D.O., is a developmental behavioral pediatrician at Cook Children’s Child Study Center. She said what teachers are likely seeing is a lack of typical or normal progression of pre-K students due to fewer opportunities to experience and practice their pre-academic skills, social skills and emotional self-regulation skills with peers and teachers outside of their family.

“I don’t think the children are regressing with their skills,” Dr. Frattarelli said. “It is actually a lack of progression that teachers are reporting which is likely due to the unprecedented experience during the pandemic, particularly when isolated with their family without an opportunity to attend school or daycare in person.”

The early years of education are the ones where kids get hands-on experience with life lessons that shape their social skills. What might look like play and entertainment to the untrained eye, be it in the classroom or on the playground, is actually reinforcing behavioral expectations, healthy relationships and emotional regulation in a way that appeals to kids.

Playing together in centers teaches little ones how to share, work together and relate to each other. A game of Mother May I challenges kids to listen and follow directions. Storytime on the carpet helps busy little ones learn to sit quietly and process what they are hearing.

“Teachers teach those behavioral expectations,” said Kathleen Kyzar, Ph.D., associate professor of early childhood education at Texas Christian University’s College of Education. “What does it look like to stand in line? What does it not look like to stand in line? What does it look like to have to sit in our seat appropriately? What does it not look like? Now we’re going to practice that. We’re going to teach you explicitly what we expect of you when you’re in school.”

Mastering social and emotional skills is as important to a child’s foundation and future as reading, writing and arithmetic. There is research-based evidence that positive social skills promote positive academic skills, according to Kyzar.

But the pandemic disrupted all of that and now teachers and parents are playing catch up to help kids reach their social and emotional milestones.

“I would say the pandemic has definitely taken people off of their typical developmental trajectory,” said Casey Call, Ph.D., LPC, associate director of professional practice and associate director of education at TCU’s Karyn Purvis Institute of Child Development. “In intervening with children there are two big areas that we focus on. One is building healthy relationships and the other is practicing regulation. The students who haven’t been in a classroom consistently or had any early childhood education have the potential to really get off of their developmental trajectory in these two skills.”

Regulation is the ability of a child to adjust, manage and cope with their environment and situation. As babies, they solely rely on their parents to regulate their environment for them. Eventually, they’re able to point to a blanket if they’re cold and then rely on someone else to give it to them. That’s called co-regulation. In time, they can self-regulate and get up to get the blanket and cover themselves with it.

It’s the co-regulation and self-regulation pieces that some kids are lacking because those are the pieces that require teaching, mentoring and practice. But young children haven’t had consistent opportunities to practice those things outside of their homes and in situations with others where they must manage big emotions and big behaviors. Those immature relationships and regulation skills are evident in many early childhood and elementary classrooms today.

“Early childhood teachers are setting the stage for understanding one’s emotions and being able to regulate behavior,” Dr. Kyzar said. “So engaging in turn-taking so that we understand that it’s my turn now and then it’s going to be my friend’s turn and I need to wait. Those are skills that are setting them up for academic learning later on and being resilient, listening to each other, and learning to problem-solve.”

For kids, consistency is key. It plays a huge role in their feeling of security. Kids who feel safe and secure are less anxious, better able to focus and have more energy to spend on learning. Consistent classroom routines set the stage for learning. Preschool and kindergarten teachers usually spend the first half of the year just going over classroom routines. Once those routines are in place, learning can begin. But with so many stops and starts to the school year, teachers have had to start again, and again, and again in teaching routines and acceptable behavior just to get kids ready to learn.

That’s why it’s so important to reinforce these activities at home. Practicing, modeling and reinforcing social and emotional skills at home — taking turns, keeping emotions in check during conflict, listening well, following instructions, being patient — can help set kids up for success in school and in life.

The good news is that helping kids get back on their developmental track with these skills doesn’t have to be complicated. Kids engage, speak, process and learn through play. Fun is their universal language. When they’re playing and having fun, they’re also practicing important life skills. For example, a game like Simon Says reinforces regulation while players listen, wait and think about their response. And as you play with your child — or cook with them, take a walk with them or participate in any activity they enjoy — you’re modeling what a safe and nurturing relationship looks like.

“I think the stress that parents have been feeling has been really overwhelming,” Dr. Call said. “With everything they have on their to-do lists sometimes parents can spend all of their time on structure, things like setting and enforcing rules, correcting behavior, and making sure school work is complete, while the nurture, or the joy and play, gets pushed down to the bottom of their list. When stress is high, we need to make it a priority to balance nurture and structure.”

Parents, teachers and kids will inevitably play catch up on meeting these social and emotional milestones in the months and years ahead, and time will tell the depth and breadth of developmental and learning loss due to the pandemic. If your child is struggling with social skills and regulating their emotions, set aside a little time for some fun. If you feel they are particularly behind or struggling to cope, talk to their teacher or pediatrician for guidance and help.

That was the case for Zander Hunt, the 11-year-old son of Aaron and Emily Hunt of Amarillo, Texas. Diagnosed with kidney cancer at age 7, Zander spent years undergoing grueling chemotherapy and radiation treatments, but the cancer continued to spread. By January 2020, it was classified as stage four. Zander’s prognosis was grim.

The family made a last-ditch effort with an aggressive chemotherapy treatment which shrank the tumors, but Zander needed surgery to completely remove them. The procedure required specialized care. That’s when the family turned to Cook Children’s Medical Center and found Marty Knott, D.O., Ph.D., pediatric surgeon, and Kelly Vallance, M.D., MPH, pediatric oncologist.

Dr. Knott performed surgery to remove a number of tumors from Zander’s body.

“The care we received at Cook Children’s was a breath of needed fresh air,” Aaron said. “We didn’t know what to expect after our first hospital experience but the attention and expertise that Zander and our family received was superior. We will be forever grateful!”

Dr. Vallance pledged to the Hunts to do everything in her power to find a drug treatment for Zander’s cancer. Finally, the family had a glimmer of hope.

“I remember feeling almost desperate for anything,” Emily said. “At that point you’re tired. The chemo and radiation have taken every bit of life out of them at some point. They’re always recovering from treatment. You just see your kid for this prolonged period of time withering away. I was desperate for anything that could help him without hurting him.”

Finding a treatment match proved to be difficult. Turns out a medication for Zander’s specific cancer markers and tumors does not exist. Dr. Vallance presented the family with one last option — try a medication that is commercially available for adults, but not approved for children or his specific type of cancer. Because of this, getting the expensive treatment covered by insurance was a long shot. The hospital would need to be granted compassionate use to trial this drug with Zander.

Dr. Vallance turned to Cook Children’s research pharmacy team, led by Micha Koentz, PharmD, and they went to work to obtain compassionate use approval.

Koentz and her small team, which includes another pharmacist and a pharmacy administrator, are responsible for dispensing investigational drugs being used in clinical trials and research at Cook Children’s. There are currently more than 100 medication studies open at the medical center. The research pharmacy team also handles any requests for compassionate use medications and works through a gauntlet of regulatory bodies for approval to use them. These drugs are either still being studied by drug companies but not yet on the market, or are available but approved for adults only, like in Zander’s case. Sometimes medication is available for children but not covered by insurance and is far too costly for most.

Once a request by a physician is made, one of the research pharmacists contacts the drug company to get their buy-in. Then, a request must be made to the Food and Drug Administration (FDA). After FDA approval, the request is sent to Cook Children’s internal review board for final approval. If all agree that the benefit outweighs the risks for the child, the drug can then be issued by the drug company, which they provide free-of-charge to the hospital. That means it’s also provided at no cost to the patient.

“It truly means access to a drug that is otherwise not available or affordable,” Koentz said. “This can buy the patient and family more time.”

Managing compassionate use requests — contacting drug companies, pleading the patient’s case, writing treatment plans and working with regulatory bodies — has become a personal passion for all three members of the research pharmacy team. The process can take anywhere from a few days to a few weeks, but the small but efficient team has streamlined the process to a point where they can usually obtain approval from all within two weeks or less. They know that when a child is facing the end of their life, time is of the essence.

The compassionate use request for Zander was approved. In September, he will have been using the medication for two years. All the while his scans have been clear. There is no sign of cancer advancing in his body. Best of all, he has gained back his childhood.

“He goes to school, plays on a club soccer team, has friends and a normal life,” Emily said. “This medication is working for him. We've gotten two years that we didn't know we would get, and they've been two years with clear health, like he was a healthy little boy. We're so thankful to all of the people we've worked with at Cook Children’s, because it changed our entire experience with kid cancer and with medical treatment.”

Sometimes a patient using a compassionate use drug lives another few weeks or months. Even so, there is comfort for the family in knowing every treatment option was exhausted, Koentz explained. Other times, the medication adds years to a patient’s life.

“It truly is the last option,” Koentz said. “Under compassionate use, we’re looking at anything we can do to really give the patient one last try at something that might work.”

In addition to one last try, these drugs give kids the opportunity to go home.

“A lot of our drugs are oral agents,” Koentz said. “It’s a pill that you swallow by mouth. So if you are at the end of your life, you really don’t want to spend that time in a hospital hooked to IVs. This really is a nice way for patients to go home, take an oral drug and hopefully add some weeks, months or years to their life.”

Koentz has issued compassionate use requests since her arrival at Cook Children’s research pharmacy in 2014. She said back then they would do one here and there. Because of her dedicated team, they now request and receive approval for multiple a year. In 2020 and 2021, nine compassionate use requests were approved. This year, the research pharmacy team is already working on their sixth request.

Pediatric cancer patients have fewer options for treatment than adults. While just as devastating, when compared to the prevalence of adult cancers, pediatric cancers are rare. So drug companies tend to focus on the research and development of adult cancer medications because the market for those is greater. That’s why compassionate use medications are critical in pediatric cancer care.

It’s also why Koentz went into research pharmacology. In pharmacy school all she learned about were drugs that are FDA-approved and commercially available at a pharmacy.

“Then I started working in pediatric oncology and quickly learned that some of our patients have to get research drugs because there’s just not a whole lot of options out there if they progress or if they never have their disease depressed,” Koentz said. “They really have to try other options. A lot of times our pediatric cancer patients will go to clinical trials. So I got really into clinical trials because I have a passion to further advance pediatric oncology. I want more options for our kiddos.”

As for Zander and his family, including his five brothers and sisters, they’re making the most of the time they’ve been given for more moments, more smiles, more laughter and more memories, and they’re relishing the normalcy.

“Zander told me the other day, he doesn't remember what it's like to be sick anymore,” Emily said. “I thought that was really impactful. He said he can remember being in the hospital and all of the doctors and the surgeries, but he can't remember what it feels like to be sick anymore.”

Let’s imagine a scenario that no parent wants to think about.

Let’s say your child starts acting weird over the past few weeks. She seems tired. She’s sleeping more, and laying around all the time.

She starts to drink more water. It sure does seem like a lot of water – way more than on a hot day outside. She’s starting to pee more often. She’s waking up at night to refill her cup over and over.

She’s starting to lose weight. She’s complaining her vision is blurry. She started to vomit yesterday, and cries today that her stomach hurts. She’s acting exhausted.

You take her to the pediatrician, who checks her blood sugar. The number is so high, the monitor cannot read it. It only says “over 500”.

You rush her to the ER, where you get the diagnosis: diabetic ketoacidosis. Your child is a new diabetic, and you had no idea until this moment. DKA is life-threatening and requires ICU care, the ER physician says.

“The problem is…we don’t have any PICU beds available currently. The unit is completely full.”

In the spirit of our ongoing efforts to be real and transparent with you about the status of children with COVID in Tarrant and surrounding counties, allow me to share with you what my colleagues have shared with me. I asked them, “Are the high numbers of COVID patients in our hospital affecting your other patients?”

The following quotes are nearly word-for-word (though I took to liberty to make a few large medical terms more understandable, and keep patient details anonymous):

Dr. Scott Perry, Neurology: “I’ve got plenty. Several surgeries canceled. Surgeries that could potentially stop seizures in children where their condition is life-threatening. Several workups canceled while we wait for more room. Trying to manage people at home throughout the night so they don’t need the emergency room. I am so exhausted from this, from dealing with the pandemic and the risk of losing highly trained people as a result. The list goes on…”

Dr. Samson Cantu, Gastroenterology: “From the GI standpoint, we have had to second guess our decision to proceed with planning for gastrostomy tube (feeding tube) placement in our failure-to-thrive patients. All new feeding tube placements require hospital admission for 48 to 72 hours. Given the scarcity of inpatient beds, we are very limited in having a scheduled admission, despite a feeding tube being a true life-line for several patients.”

Dr. Charles Saadeh, ENT: “With airway surgery, we have to take into account worst-case-scenario hospital resources that necessitate PICU bed availability. I have had two patients so far that have had a delay in care. Cook has been so very diligent about accommodating patients that need to go when they are delayed, but it’s definitely a case-by-case discussion with each family. We wouldn’t be offering supraglottoplasty (a complicated surgery that allows children with airways disorders to breathe easier) if things weren’t relatively urgent to begin with, so this is certainly a difficult position for us.”

Dr. Teena Thomas, Endocrinology: “More than once last week, when I received a transport call for a new onset, I was not always sure that I would be able to admit a new onset in DKA to the PICU because of the lack of bed availability. On my last day of call, we had to divert a very young new onset to another hospital… I have never not been able to admit a new onset here. I checked on the child the next day and the hospital they went to did not actually have PICU availability either (they had to some shuffling to get the kid to the PICU). Last week, my diabetic patients also had to spend a lot more time in the ER because of lack of bed availability in the PICU or the endocrine floor.”

Dr. Michelle Marcincuk, ENT: “I had an entire day of surgeries cancel because there were no beds to admit the patients to post-op. These were kids with trachs, airway obstruction, swallowing dysfunction. I had a child with a mass on the face that needs a biopsy. Had a little one with a draining fistula on the neck. All had to be postponed. Two kids were hoping to get their trachs out. But had to cancel.”

(Imagine the day finally comes when your child gets the breathing tube taken out of their neck…and your day is yet again postponed, and sometimes for a YEAR. Keep reading.)

MM: “Since the hospital has been full, I can’t say whether we will get to do their surgery the next time they are scheduled. It’s just a complete guess as to whether or not there will be a bed available for them on the day we reschedule. And since we don’t decannulate (breathing tube taken out) kids in the winter, if we don’t get them done soon, they may miss their window of opportunity to get decannulated this year and may have to wait a whole year more for their next chance. That’s a whole additional year with a trach due to COVID. None of my patients have COVID. But their health is being affected by the COVID surge. 

The health of these kids is suffering because of this pandemic. Even though they themselves don’t have it. And their parents have done everything possible to keep them healthy. The parents have taken days off work preparing for this surgery. When the surgery is cancelled, they have to take even more days off for the new surgery date, putting their jobs at risk due to absences. And some patients drive 5-6 hours here for surgery, only to arrive and be told that they can’t have the surgery and have to drive back home because the hospital is full. Then you think of the wasted time the surgeon experiences when this happens. Basically, it’s a day that they can’t see patients because of the last minute, unexpected cancellations. We have a huge list of kids waiting to be seen in clinic, but most of the time these cases are cancelled last minute and it’s too late for new patients to be booked into clinic. So both the surgery patients and the new patient for clinic who are waiting for appointments are affected.”

Dr. John Honeycutt, Neurosurgery: “It is frustrating from several different levels. However, we are ONLY delaying non urgent or elective surgeries. Cases for brain tumors or other surgeries where delay could cause harm we are still full steam. But it is very frustrating to families that have planned, taken off work, mentally prepared and then have to delay. It’s extremely hard for them. Nobody’s outright angry or screaming, all seem to understand, which is so cool. We see all this in media about people screaming and yelling about selfish things, but they miss the vast majority of people that are just trying to get by in life and care for their community and others. They are frustrated, but make the sacrifice for the better of others. That is missed and it is refreshing to see that personally.

As a team, we are so used to being full steam, so for us to transition to a lull is a bit of a challenge (easier for younger docs, harder for me). But we understand too. We see the ICU, ER and hospitalists and nursing staff overworked and stressed. Sad to see.

Finally, our service line has not had our neuro PICU for a year and a half since it is now the COVID unit, and last week we lost our neurosciences floor to be the second COVID floor unit. So we are scrambling hard, being extra sure our patients get what they need since they are now scattered throughout the hospital. Exhausting for our team.

We are fine, just adapting to the new norm which I pray is short lived.

Dr Karthik Srinivasan, Pediatric Hospitalist: “As pediatric hospitalists, we care for children who require hospitalization. I recently took care of a cute infant who was not admitted for COVID and improved within a day. I was excited to discharge him home, as was his mother. We had a pleasant conversation, and the mother was very thankful. She seemed to trust Cook Children’s and all our staff. As I was leaving, I mentioned that her son was too young for the vaccine but wanted to know if family members had received it. “No. No. We’re not going to talk about that” was what I got, and the tone and mood took a 180. There was an awkward silence. The family was out the door within the next 20 minutes. 

As of about two months ago, we were fortunate to have ZERO COVID positive patients admitted to our service. Now, we are up to about 40% of our service as a whole. About 75% of these children are admitted directly because of COVID, not just incidentally being positive. This is very different than in months past.

Clearly, the delta variant has been a game changer that is much more easily transmitted. We recently set our service’s all-time record for the number of hospitalized children we are taking care of, which can be directly attributed to COVID. We started last year utilizing one floor as the typical “COVID unit.” This grew to two floors, and most recently we have started filling up a third floor, anticipating even more as I write this. 

We are seeing children in all age groups being admitted due to COVID. Although we are noting that obesity is a risk factor, we are admitting some children without any apparent predisposing factors. More recently, about 3-4% of older teenagers who are testing positive in the Cook Children’s system are being hospitalized. Beyond infancy, our highest rate of hospitalization and many of our sicker patients are older teenagers, the vast majority who are vaccine eligible but have not received the vaccine.

On a typical call shift, it is not unusual to be called on at least a couple of children who are admitted for COVID and are appearing sicker. And it is a process to see them. For staff member safety and our own protection, there is extensive protective equipment required to see them, and this needs to be worn anew upon entering and completely removed upon exiting the room. Additionally, for some of these sicker children, multiple specialists may be involved in their care, leading to several phone calls. This is all while the Emergency Department anxiously is paging for several additional patients needing to be admitted. Admittedly, in these times, it can be near impossible to return their calls in a timely manner.

As we are stretched thin, the medical care we provide may not be as efficient as you are accustomed to. We need your patience, understanding we are all in this together. If your child gets sick and needs to be hospitalized, we are here for you and your child. But the best weapons we have against this is preventing the illness in the first place. Go back to the basics that have been preached by Cook Children’s physicians for quite some time now. Mask up, socially distance, and get your vaccine if eligible. Even if your child cannot get the vaccine, have family members and friends get it if eligible. Please trust us on this as you do with the care of your child. To be clear, virtually all the physicians at Cook Children’s were vaccinated well before the word mandate was even thrown around. We preach what virtually every major physician organization has advocated for and what we have practiced ourselves. Do it for yourself. Do it for your child. Do it for your neighbors. Do it for us.

We strive to keep our “Promise” to you and your children, but we need your help.

Dr. Christine Ellis, Pediatric Hospitalist: “Page comes through as I barely walk through the doors of the hospital that another one of my patients is in respiratory distress. Seconds later, I hear the “Med Alert” overhead- of course, it’s my patient I was just paged about from the COVID unit. I skip making my morning coffee and checkout from the evening physician and run upstairs to the COVID unit.

I throw down my bag, quickly place on my PPE and walk into the crowded room to see my teenage patient breathing over 60 breaths a minute and oxygen saturations decreasing despite maximum support on a non-rebreather face mask. PICU team arrives shortly and my patient is whisked away to our pediatric ICU for higher level of care. I try to comfort the mother quickly as they start to roll to the elevator for transfer.

I take off my n95 mask, make my coffee and get the rest of my checkout from last night’s physician that stayed late to talk to me. I finally slump into my chair to start rounding on all my other children for the day and all the emotions flood over me. 

SADNESS for the patient and family as they go through this difficult time with a very sick patient.

FEAR for my patient’s respiratory status as I am afraid that he is on a long road that will require possible Bi-Pap or even intubation.

FRUSTRATION sinks in as this patient, like many of my other patients, was eligible for the COVID-19 vaccine and is not currently vaccinated. This child likely would not have these severe complications if he was vaccinated. They were completely healthy except for obesity (which significantly increases chances for complications as well). All of this could of been prevented.

As the day goes on, I go between our now two full non-ICU COVID units and see patient after patient similar to my first child of the day. Some children too young for the vaccine but when I talk to their parents, no one in the house is vaccinated either. I continue to march room to room. EXHAUSTION hits me. My face hurts from my n95 mask but I sign up as the COVID physician the next day.

As I drive home to my family I try to find HOPE. Hope that tomorrow will be a better day. Hope that tomorrow another sweet child does not go to the ICU for a now preventable disease. Hope that our community continues to step up and get vaccinated and wear their masks appropriately. Hope that vaccines are available for our younger children soon so my patients and my own children at home can be more protected.

❤️ Dr. Ellis

Dr. Laura Romano, Pediatric Hospitalist: “Our hospitals are full. Our ICUs are full. Due to the surge from the delta variant, we do not have any beds. This means that patients at outside hospitals or clinics who need specialized care cannot be transferred to our facilities. This means that there are children who have to wait longer for necessary and sometimes life-saving treatment.

I've seen a lot of people say that wearing a mask or getting vaccinated is a "personal choice" or "my body my choice." Your choice to not wear a mask and to not get vaccinated is putting our children and our patients in jeopardy. The time for personal responsibility is over. It has already failed our children and that failing has led to unprecedented COVID spread in a few weeks since schools have returned without mask mandates and without vaccine mandates. This spread will continue unchecked and we won’t have the beds or the space to help our patients. It's simple math at this time.

I've seen people posting that health care professionals need prayers because we are tired and overwhelmed. Yes, we are exhausted. We are tired. We are running on empty and are experiencing burn out that we have never felt before. Yes, we appreciate your thoughts and prayers. But what we need more is for YOU to get vaccinated.

The time for talk is over. You need to get vaccinated. You have to get vaccinated. It is the only way to end this.

If you don't care about your own health and wellbeing, please care about your children's health. Please care about my patients' health. Please care about your nieces and nephews. Please care about your neighbor's children. They need your help. We desperately need your help. 

And if that's too much to ask, if it's too much to ask you to care about a child, then wear a mask. It's literally the least that you can at this point.

The time for talk is over. We need action. We need it now. I know how some of you will react to seeing this: another COVID post. Some of you will say that this is a joke and a political hoax. Some of you will say that this is baseless fear mongering by the mainstream media to make you afraid of what will amount to a slight cold or a flu. Please know that none of those statements are true.

This is virus that spreads easily. This is a virus that is now causing severe and life threatening disease in children. Please, please, please listen to medical professionals who are quite literally begging you to get vaccinated. 

If you don’t want the vaccine for yourself, please get it for your kids, your nieces and nephews, your friends’ kids, or even for the children in your neighborhood since a lot of us don’t have the option to vaccinate our kids against a deadly and fatal virus. 

If you have any questions about the vaccine, please reach out to me or your family doctor. We would love to talk to you about it! You have entrusted your children to us throughout the entire lives. We need you to put your trust and faith in us again. Please get your vaccine. 

And if getting vaccinated is too much to consider, then please just wear a mask. Please. Children are literally dying from this and we have the ability to stop it.

Dr. Bianka Soria-Olmos, Pediatrician at Cook Children's Pediatrics Haslet:

"Se sabe que la variante delta es altamente transmisible, desafortunadamente ha causado que los casos de COVID pediátricos aumenten significativamente recientemente. Esto, a su vez, ha provocado un aumento de las hospitalizaciones por COVID en nuestro propio hospital.Ha habido varias partes diferentes del hospital que se han convertido en unidades dedicadas al tratamiento de niños con COVID-19.Esto significa que a medida que más niños requieren atención para su enfermedad COVID-19, hay menos camas disponibles y personal para cuidar a otros niños que pueden requerir pasar la noche en el hospital por una condición médica no relacionada con COVID-19. El aumento actual está provocando retrasos en los procedimientos que no son de emergencia o electivos, dado que algunos de esos niños requieren habitualmente de hospitalización, seguimiento posoperatorio o recuperación.

Como pediatras y especialistas en pediatría estamos acostumbrados a atender a TODOS los niños de inmediato en el momento en que necesitan intervenciones o tratamiento, lamentablemente nos estamos dando cuenta de que esto puede no ser posible y no podemos evitar sentir una avalancha de emociones: frustración, tristeza, temor. Nosotros también somos humanos y lo que nuestros ojos ven todos los días crea una montaña rusa de sentimientos que tememos que nadie más pueda entender.Sin embargo, tenemos la esperanza de que si compartimos solo un pequeño vistazo de lo que nuestros ojos ven y presencian todos los días, esa bondad y abnegación ganarán y que nuestra comunidad hará lo correcto.Le pedimos a usted (nuestra comunidad) en este momento que considere que sus decisiones y acciones de la vida diaria pueden afectar y afectarán la trayectoria de esta situación.Le pedimos que nos ayude haciendo lo siguiente: vacunen a TODOS los adultos y adolescentes elegibles en su hogar contra el COVID-19 y se use cubreboca cuando estén fuera de su hogar. Estas simples acciones de bondad no solo lo protegen a usted y a sus seres queridos, sino que también pueden comenzar a aplanar la curva de infección de COVID que necesitamos en este momento para ayudarnos a cumplir nuestra promesa a todos los niños del norte de Texas y nuestra comunidad."

Dr. Diane Arnaout, Pediatrician at Cook Children's Pediatrics Forest Park: 

The actions we all take in our daily lives will make a difference for these hardworking doctors, our amazing and exhausted hospital staff, and most importantly, the kids.

Don’t send your kids to school sick. If in doubt, get a test. Move the parties, get-togethers, and playdates outdoors – fall is coming, and it’ll be beautiful out.

With winter approaching, I worry about our already-strained hospital system. COVID is already putting us under pressure – and the flu will bring new challenges for us all. Please get your family vaccinated against the flu now. Kids need to be in masks in school – last year’s nonexistent flu season can attest to how well they work.

We are counting on our community to do what’s right. Please help us help your kids

I ask you to put yourself in the place of the parents of one of these children, who desperately need urgent or critical care, and who may not be able to get it because of the number of patients in our hospital.

There are 41 patients currently in Cook Children’s with COVID. 63 beds and four units that are using vital resources of staff, oxygen, ventilation, life support.

Cook Children’s will always strive to accommodate all of our community’s needs. But I beg to you ask yourself: what can I do to help?

• Send your child to school in a mask. Ask them to keep it on at all times unless outside or eating.
• All children in school over age 2 should be masking indoors. School districts should strive for universal masking right now.
• Quarantine all children who come in contact with a COVID+ child if unmasked and for longer than 15 minutes indoors.
• Get your kiddo the COVID vaccine if they’re over age 12. It’s safe and it’s effective.
• Please keep your sick children home from school.
• Postpone indoor gatherings for now- it’s not going to be forever. Just for now.
• Move the party outside.
• Open windows when you have people over.
• Limit the number of people who can attend sporting or theatrical events at schools so there can be spacing between families.
• Mask up and put at least six feet of distance between you and other people in meetings.

This won’t last forever, but Cook Children’s needs your help to be able to always have a bed available for your child should you ever need one.

As the medical director of our Infectious Diseases department, Dr. Mary “Susi” Whitworth has told us, “we never want to get to the point where we cannot prevent a preventable death.”

Angie, Cason's mom, told Good Morning America that she worries her son might get reinfected with the novel coronavirus at school. She’s urging students to wear masks for the sake of her immunocompromised son, and all kids under age 12 who can’t yet get vaccinated for COVID-19.

Read the full GMA story here.

Partners from health care and other fields are teaming up in an expanded collaboration geared to brainstorm and implement strategies to prevent suicides in North Texas.

Participants represent a variety of vantage points including mental health, housing, poverty alleviation, youth services and education. Yet they share the same concerns about the escalating rates of anxiety and depression that can lead to suicide. The Center for Children’s Health, led by Cook Children’s, summoned the partners together earlier this year through the Adverse Childhood Experiences (ACEs) Task Force.

“It just works better from a community perspective if it’s really a community-driven need and a community-driven response, than if it’s just one organization pushing it out. We need everybody’s support in tackling this issue,” said Lenee Bassham, who oversees the ACEs Task Force in her role as director of child safety.

The Task Force has existed since 2017, working to mitigate the effects of trauma on children who live with domestic violence, neglect/abuse, a parent’s incarceration or other chronic adversity. The Center for Children’s Health last May bumped up the Task Force membership to about 25 people in an effort to address the implications of the COVID-19 pandemic.

In meetings over the spring and summer, the participants shared their observations, concerns and vision for improving access to mental health services in Tarrant County. Organizers hope that the dialogue will eventually lead to agreement on top priorities and a plan for action.

One theme that already has emerged? The need for a clear and consistent message that could be promoted by schools, medical providers, agencies or anyone who works with families. Bassham cited the Cook Children's Aim for Safety® initiative as an example of cohesive communication. Aim for Safety® simplifies the need-to-know message into three steps to prevent accidental gun injuries: “Safe storage. Safe children. Safe play.”

A similarly cohesive message when it comes to suicide, she said, could equip parents to know the warning signs and to find help for kids and teens who struggle with mental health. And the appeal broadens when multiple voices weigh in to shape the message’s content.

“When we have everyone’s buy-in, it’s much better to push messaging out in the community,” Bassham said. “We could take years on a messaging campaign, but we don’t want that to happen. We want to move as quickly as possible.”

The urgency stems from a dramatic rise in suicide attempts, which experts link to emotional distress during the COVID-19 pandemic. Cook Children’s, for instance, saw 261 patients hospitalized due to injuries following suicide attempts from January-July 2021. That compares to 143 hospitalizations for injuries in the aftermath of suicide attempts from January-July 2020.

In response, Cook Children’s has launched the Joy Campaign, a series of news articles and materials that spotlight the efforts being made to turn the trend around. The Joy Campaign focuses on avenues of hope and resiliency.

Bassham said the ACEs Task Force members plan to meet again in September to continue the teamwork approach. Their discussions could eventually pave the way for proposals that raise suicide awareness and improve the outlook for families in the Fort Worth area.

The World Health Organization (WHO) describes community engagement as an essential and effective aspect of suicide prevention globally. WHO advises that the process should involve stakeholders from diverse backgrounds who know the community’s demographics. Diversity improves the input by enlarging the group’s base of skills and creative thinking.

“Prevention of suicide cannot be accomplished by one person, organization or institution alone; it requires support from the whole community,” according to a WHO publication in 2018. “Each community can adapt and design its own plan, tools and activities to ensure that these best fit the community and are acceptable and appropriate to the local context.”

Bassham said it’s too soon to predict just yet what concrete action might arise from the ACEs Task Force talks. Each partner brings a unique viewpoint to the conversation. Let’s hear from three of the members.

Lachelle Goodrich, licensed professional counselor

Lachelle Goodrich suggested that the Task Force develop a process map that breaks down the path to treatment for suicidal kids in North Texas. She envisions a chart that directs parents when to act and places to turn, depending on the child’s age.

“Sometimes parents just don’t know the questions to ask or the signs to look for,” said Goodrich, who also serves as director of the Stop Six Choice Neighborhood Initiative for Fort Worth Housing Solutions. “Parents are stuck because we don’t know where to begin, where to start. ‘Do I call a therapist? Do I go to the hospital? What do I do?’”

She urges parents to have courageous and regular conversations about mental health. Be your child’s biggest advocate, and don’t be afraid to reach out for intervention, she said.

“The more I work with teens, the more they educate me. I feel like it’s my duty to turn around and educate the parents and the community.”

Ottis Goodwin, Fort Worth Independent School District

When an assessment finds that a student is considered at-risk for suicide, the Fort Worth Independent School District provides a list of area options for treatment. But that list doesn’t indicate which facilities have current openings for new patients, said Ottis Goodwin, director of Family & Community Resources for FWISD.

“When we give families that information, we have no idea who’s full and who’s not full,” Goodwin said. “The family may show up and not be able to be admitted.” He would like to see a system that tracks up-to-date bed availability.

Another suggestion from Goodwin: Closer ties between the district and the inpatient facilities, to ease students’ transition back to campus after hospitalization.

“Oftentimes we don’t know that they’re coming back into school, so we don’t really have a good support plan for their return, because it wasn’t communicated to us,” he said.

Last school year, Goodwin distributed magnets and crisis contact information sheets – developed by the Joy Campaign, in English and Spanish – to counselors and other staff throughout FWISD. He applauded the Task Force for tackling the weaknesses where improvements could be made.

“The fact that we’re together and having these conversations is huge. We need those people pushing and organizing like what Cook has been doing. If you get the right people at the table, then you can make the change.”

Virginia Hoft, Mental Health Connection of Tarrant County (MHC)

Through the Recognize and Rise education campaign at MHC, executive director Virginia Hoft shares information about healing in the aftermath of trauma. Hoft would like to see the Task Force find a way to identify gaps and duplications in local mental health services.

Hoft also recommends adopting age-appropriate curriculum that equips young children with skills for coping with stress. Don’t wait until junior high to talk about suicide, she said. “Just like we’ve done with ‘Stranger Danger’ and drug education, it’s information that kids need to grow up with.”

By working in tandem, the ACEs Task Force partners and other advocates can make a collective impact to prevent suicide and improve mental health in our region, Hoft said.

“What brings me hope is the open-mindedness around having collaborative conversations about how we can work on this in the most efficient manner, to get us all rolling in the same direction.”

We, the physicians at Cook Children’s Health Care System, are directly connected to the district or school either as concerned parents or as pediatricians who care for the children we mutually share with your district/school.

We are writing to you to express our concerns about the Delta Variant of COVID-19 and to recommend that our school district implement safety protocols beyond those that have been in place this summer to address this exigent threat. The rapid increases in COVID-19 cases, hospitalizations and deaths locally and throughout the US in recent weeks are alarming and require an appropriate response. Indeed, we are seeing rising COVID-19 cases in our practices.

Please find below the Cook Children’s 10-Point Guide for Safely Reopening Schools crafted by Marc Mazade, M.D., Medical Director of Infection Control and Prevention at Cook Children’s Medical Center.

We stress key recommendations to mitigate the spread of this infectious new variant of the COVID-19 virus with the start of this school year:

• Strongly encourage universal masking for students and staff in accordance with CDC and American Academy of Pediatrics recommendations.
• Minimize contacts for each student to the greatest degree possible.
• Encourage and support all opportunities for eligible children to receive COVID-19 vaccination.

The Cook Children’s Promise states: “Knowing that every child’s life is sacred, it is the Promise of Cook Children’s to improve the health of every child through the prevention and treatment of illness, disease and injury.” Please help us honor the health and sanctity of our children’s lives through your sincere attention to these recommendations. We would welcome the opportunity to collaborate with the district/school in promoting the health and safety of our community during this new and troubling phase of the pandemic. We will gladly provide additional data if it would be helpful, and we are available to answer any questions that arise.

We appreciate your time and look forward to further conversation on this important topic.

With respect and care,

Cook Children's Physicians

But for some patients with severe seizures who have not responded to medications or who have had significant side effects with medications, epilepsy surgery might be the best option. The goal of epilepsy surgery is to identify and resect the area of the brain that is responsible for the generation of seizures. However, identifying this brain area can be challenging.

Thanks to new techniques developed by Christos Papadelis, Ph.D., director of Research at the Jane and John Justin Neurosciences Center at Cook Children’s, the ability to better locate the source of epilepsy has improved. Working with researchers at Boston Children’s Hospital, Massachusetts General Hospital, and Harvard Medical School, Dr. Papadelis developed a novel biomarker, or medical sign, that can identify the area in the brain causing seizures with non-invasive strategies and high precision. Using premiere imaging technology such as magnetoencephalography (or MEG) and high-density electroencephalography (or EEG), the team measured the magnetic and electric activity generated by the human brain to locate the biomarker and source of seizures. This work was recently published in the Annals of Neurology, a widely-respected journal produced by the American Neurology Association.

Improvement in precision of locating the source of seizures decreases the risk that a child will suffer from disability due to surgery. It also increases the odds that children will recover function and improve their quality of life without negative consequences. While still not easy, this research will allow parents to feel even more confident about their decision to move forward with such a complex procedure as epilepsy surgery.

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.

Parenting can be hard. Everyday stresses can decrease patience and make parenting even harder. Always try to slow down, take advantage of every moment, and seize the opportunity to turn negative experiences into positive ones.

Consider the following ways (as recommended by the American Academy of Pediatrics) to show your child your love this Valentine’s Day and every day.

1. Use Words with Care
Choose positive and encouraging words, and those that model consideration and gratitude, to help build your child’s building self-esteem. The opposite can occur when negative words or sarcasm (which is typically not understood by children) are used.

2. Spend Time Together
Hold the time together (even if limited) with importance. Celebrate the quality of the time, not the quantity. Try to take time for one-on-one activities with each child. Ensure the time is uninterrupted by cell phones or other devices. Switch off the electronics and play board games or enjoy an outdoor activity.

3. Have Heart-to-Heart Conversations
Make sure you take the time to listen to your child’s response to common questions like “How was your day?” Ask about challenges they may be experiencing and let them finish the story before you offer a solution. If you worry your child is anxious or depressed, make sure to discuss your concerns with your pediatrician

4. Give Hugs First
Human contact has shown to be a calming measure for anger and other situations in which the child may be in a bad mood or grouching. A quick hug, cuddle, pat on the back or nod or some other sign of affection can be used before talking through the difficulty. Consider waiting to discuss it further until after some time has passed when they are feeling better.

5. Always Listen
Ensure your child knows you are always listening and ready to respond promptly and lovingly. Being available to listen when your child wants to talk, even if it’s not a good time for you. This shows your child that they are a priority and tends to help with reciprocating when it's their to listen.

6. Discipline with Love
Use positive, non-violent discipline instead of physical and verbal punishments, which can negatively impact the physical and mental health of children. Clear and consistent rules are important from an early age. When rules are followed, offer praise. When they’re not followed, calmly describe consequences and follow through with them.

7. Forgive Mistakes
If you respond too harshly, make sure to apologize and explain how you will change your response in the future. No one is perfect, so forgive yourself when you react harshly. Teaching forgiveness will also teach a child to accept their own mistakes and build their confidence.

8. Create a Love for Reading
Start reading to your child during infancy. Many studies show children who are read to early and consistently have increased school success. Some studies also show that a parent-child bond is strengthened by spending time reading together.

9. Cook and Eat Together
A good way to enjoy each other's company is to spend quality time cooking and eating together. This also gives parents an opportunity to teach kids about good food choices.

10. Foster friendship
Help your child build positive relationships with friends, siblings and other family and community members. Consider helping your child volunteer or participate in other opportunities in which you can help those in need together. Encourage them to play sports or other activities that require teamwork. Spend time with neighbors doing fun activities. This can be especially hard during the pandemic, but technology can help keep people connected.

11. Adopt a Pet
Consider bringing a pet into your family. Animals can increase physical activity, enhance overall positive feelings and also give children an opportunity to connect with someone they care about. This can also offer an opportunity to develop the sense of responsibility when age-appropriate.

12. Model Health and Safety
Keep your child healthy by taking them to their wellness checks at age-appropriate intervals. Model a safe and healthy lifestyle, including nutritious eating, adequate sleep and exercise.

13. Give Affection and Attention
Make time every day to talk. Children and adolescents are more likely to make healthy choices if they are well connected with family members.

14. Use Words of Affirmation
Don’t forget to say “I love YOU!” as much as possible.

Valentine Heart Attack

Here is a great idea for Valentine’s Day (and you have plenty of time to get some of these heart messages on display for your child before Feb. 14). Give your child a ‘Valentine Heart Attack’ by cutting out paper hearts and writing nice, positive comments about them. Then, use the hearts to decorate their bedroom door. You can write one or two a day for a week leading up to the holiday, or if you are in a time crunch, write them all the night before and decorate the door with all of them.

Download free heart templates here.

Happy Valentine’s Day!

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.

But many people question the safety of a novel immunization for a novel virus, especially parents with young children. Moderna recently announced plans to begin testing its coronavirus vaccine in children between the ages of 12 and 17, while Pfizer and AstraZeneca began their pediatric trials in October.

We were able to talk to Jason Terk, M.D., physician at Cook Children’s Pediatrics Keller Parkway and a nationally known advocate for vaccines, who answered a few questions about the COVID-19 vaccine.

Tell us about the COVID-19 vaccine and why people should feel safe receiving it.

The vaccine is really showing a lot of promise because we've gotten data that shows that the efficacy (that's how well the vaccine works at protecting against COVID-19 disease), is much more effective than what we might've expected. We were hoping to get something around 70% and the two vaccinations that are being considered for emergency use authorization have efficacy of about 95%, which is really fantastic. I think that that bodes well for the potential of these vaccinations to make a real difference for us.

While trials in children are just beginning, should parents go ahead and get the vaccine?

Well, the quantity of vaccinations that we have available is going to be limited initially. The CDC, FDA and the state health departments are all working together to determine what priority groups need to be getting it first. The elderly nursing home population, healthcare workers, and first responders are going to be the first individuals recommended to get the vaccination. Obviously we need to protect the health care workers so that we can continue to do our jobs providing care to our patients. Unless you have some serious underlying health condition that makes you high risk for complications from COVID-19, you will not as a parent be among the first groups of individuals  recommended to get the vaccination. But once we have plenty of supply, I certainly encourage parents to get the vaccination for themselves.

When is the vaccine going to be available for children?

Trials in children are only just beginning. We need to prove that the vaccine is just as effective and just as safe in children because children are not little adults. We also need to make sure that it works as well for them too. I have no reason to expect that it will not be as effective for children. It's going to be important to stay tuned for that. Once the vaccine is available for myself, I'm definitely going to be in line to get it. And I am unreservedly optimistic about its impact for myself and for the rest of us.

What gives you that confidence that it is a safe choice for you to get the vaccine?

In medicine, we're data driven and we have really good data that shows its effectiveness, as well as what the safety profile is with the 30-40,000 individuals who were involved in the Phase 3 trials. Right now, what we've seen from a safety point of view, is that it is producing some side effects that are very similar to other vaccinations out there that are routinely recommended and they're fairly mild for most people. The two vaccinations that are currently under consideration for emergency use authorization require two doses. One of them requires two doses separated by 21 days. The other one requires two doses that are separated by 28 days. It appears that after that second injection, that maybe about half of the individuals have some side effects like achiness and, and maybe sore joints and, and some injection site soreness and things like that, but it doesn't last very long. It's generally gone after a few days. We've had the pandemic going on now for about a year. And we've had these vaccines that are under consideration now for about six months in the clinical trials. People in those clinical trials will be followed for at least 2 years to monitor for any problems. I have no reason to expect that there will be safety concerns.

Will children receive the same vaccine as adults?

Very good question. We won't really know the answer to that until the clinical trials are completed in children. Sometimes kids require lower doses of the same vaccination that we need to get as adults. And sometimes they get the same dose. What you're looking for is to get the desired therapeutic point of protecting against the disease at the lowest dose to minimize side effects. So that's what they'll be working on for kids too.

Should people who have already had COVID-19 get the vaccine?

So the current recommendations coming from the CDC is that prior COVID-19 disease should not be a determining factor about whether you should get the vaccine, because we do not know how long natural disease will give you immunity. It certainly gives you some protection for a period of time, but how long that lasts? We really don't know. Probably because of limited supply, individuals who were shown to definitely have had COVID-19 will probably not be the first ones that will be recommended to get the vaccination. That’s getting kind of ironed out right now and we'll get more specific information on those recommendations in the next several weeks I expect.

Where should people look for more information as they make the decision on getting the vaccine?

I think that it's important to talk about information and how people get information. Unfortunately, there is organized resistance against vaccinations generally, and against efforts to try to vaccinate the population against COVID-19 specifically. Consumers of this information need to know that that those sorts of agenda-driven organizations are working to prevent the end of the pandemic. We really need to be very careful and make sure that the things that we're reading or watching on social media are evidence-based. These vaccinations are going through the same – and even greater – rigorous processes and scrutiny that all the other vaccinations that we have gone through. I have every confidence that this is going to be a game changer for the human population. We all need to get vaccinated and support this challenging effort.

Are you hopeful that a COVID-19 vaccine can help end the pandemic?

Absolutely. This is our way forward to try to get back to normal. It's not going to be an immediate thing, but it's going to be a lot quicker now that we have such effective vaccinations. It will take some time for us to really get back to normal as we know it, but we're getting there.

For more information about vaccines and COVID-19, visit https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines.

For the latest on how COVID-19 is impacting kids and Cook Children’s work to protect them, visit the medical center’s newsroom at checkupnewsroom.com.

The latest set of eyes to see it? Ellen DeGeneres! The uber-famous comedian and talk show host interviewed the Yielding family about their journey with “keulemia” and surprised them with a special gift during the holiday season.

You can view their interview here.

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

The past nine months have been marked by upheaval, uncertainty, isolation and change with the youngest among us feeling the weight of it all, and doctors at Cook Children’s Medical Center are sounding the alarm.

“I’ve been employed as a psychologist at Cook Children’s going on 26 plus years and never in my time have I seen such an intense number of patients with severe anxiety and depression,” said Lisa Elliott, PhD, manager of the behavioral health clinic at Cook Children’s. “It’s not uncommon for us to have high acuity patients periodically, but that’s become the norm for weeks and weeks where 70 to 80 percent of our total number of visits for anxiety and depression are severe.”

Dr. Elliott attributes the uptick, in large part, to fallout from COVID-19. 

A June 2020 survey of parents published in the medical journal “Pediatrics” revealed that, since the start of the pandemic, more than 1 in 4 parents reported a decline in their own mental health, and 1 in 7 reported worsening behavioral health in their children. Both a decline in parental mental health and child behavioral health were reported by 1 in 10 families, according to the study “Well-being of Parents and Children During the COVID-19 Pandemic: A National Survey.”

Cook Children’s mental health experts say screen time, social media, academic performance pressures and lack of sleep all stress a child’s mental and behavioral health. All of those stressors have been exacerbated this year by pandemic-induced factors such as school closings, virtual learning, social distancing and isolation, according to Kathleen Powderly, M.D., a pediatrician on the medical staff at Cook Children’s. If ignored, these pressures can be a breeding ground for anxiety and depression.

And mental health experts are bracing for what is yet to come during the holidays as it’s not uncommon to see an uptick in depression and anxiety in children this time of year, particularly when there has been a significant family change, like in the case of divorce or loss of a loved one, according to Dr. Elliott.

So what is a parent to do? How do we help our children process these pressures to protect their mental and emotional well-being?

“We have to instill hope and stay calm and reasonable about it and, at the same time, not show fear.” Dr. Elliott said. “This is critical because we are going to set the tempo for our children. We will be what they follow. So it’s critical that we are calm and follow the safety guidelines, but tell our children this is not the way it’s going to be forever.”

And what better time than the holidays to model, teach and inspire hope?

Generosity Breeds Health and Hope

As stressful as the holiday season in tandem with a pandemic can be, it also presents a unique opportunity to teach children a concept that studies show actually improves mental health. It’s long been known that generosity and giving incite the same increase in one’s happy hormones as exercising. Giving makes you feel good—emotionally and mentally.

“Research shows that in addition to eating healthy and getting quality sleep, there are three things we can do to help keep depression at bay,” Dr. Elliott said. “One of them is exercising and another is socializing because they both increase endorphins. But the one that has the most long-lasting impact is philanthropy work. Doing things for others.”

A 2018 study published in the journal “Psychosomatic Medicine: Journal of Biobehavioral Medicine” showed a correlation between giving and increased activity in parts of the brain associated with altruism, reward and parental care and behavior. It further demonstrated that acts of generosity toward a targeted, or known, individual in need resulted in reduced activity in the amygdala—a positive given the amygdala is an emotion processing brain structure that signals the fight-or-flight mode when under stress. Increased activity in the amygdala is often seen in individuals with anxiety.

In addition to the chemical reactions philanthropy produces in the brain, doing good for others can help reframe one’s focus. Seeing the pain, suffering and circumstances of others gives perspective on one’s own struggles.

“Volunteer work helps create compassion because it draws concern away from ourselves,” Dr. Elliott said. “That’s why doing for others is so valuable for children. It teaches them compassion and optimism, and helps them develop gratitude.”

It also promotes the concepts of empathy and resilience, which are important building blocks for emotional and mental strength and valuable coping skills that help children deal with other challenges that come their way, according to Dr. Elliott.

This year, the need for generosity and service to others is especially great, given the economic impact of the pandemic. COVID-19 safety guidelines may require outside-of-the-box thinking to safely, yet personally, meet a need, but don’t let that stop you. It’s a great opportunity to get creative with your child.

With the help of Cook Children’s certified child life specialist Lauren Lasrich, MS, CCLS, we’ve compiled a list of ideas to help you and your family get started.

• Pack a grocery bag full of items and ingredients needed for Thanksgiving dinner for a neighbor in need. Let your child help create the menu and shop for the items together, either online or in the store. Deliver the groceries to their doorstep with a homemade card created by your family/child.
• Gather the family to rake leaves and clean up the lawn of an elderly or disabled individual. You’ll help a friend and get some sunshine and exercise for yourself and your family at the same time. Sunshine and physical activity are mood boosters!
• Adopt a family in need for the holidays. Check with your child’s school to see if they collect Christmas gifts for students in need and offer to purchase something on the student’s/family’s wish list. Get your child involved in the shopping process, be it online or in store.
• Together with your child, research a local organization or charity that promotes a cause you connect with and find out how you can help them meet the needs of those they serve. Create a family donation jar and save change to donate to the charity.
• Organize a neighborhood food drive and collect non-perishable food items from your neighborhood to donate to a local food pantry. Let your child decorate a donation box and put it on your porch so that your neighbors can safely deliver their donations.
• The end of the year is a great time to reduce and reuse! Go through your house and collect gently used household and clothing items you no longer need/use to donate to a local charity.
• Write letters/draw pictures to deployed military members or health care workers. For information on how to do this, or other ideas for supporting our troops, check out How Can I Support the Troops? 5 Ways You Can Help Deployed Soldiers at uso.org.
• Do a drive-thru Christmas caroling tour in your neighborhood. Let your neighbors know ahead of time when you plan to be out caroling so they can step outside and enjoy the show. Decorate your car ahead of time as a festive and fun family activity.
• Make toiletry kits and donate them to a local homeless shelter.

Not only will these activities help others, but they’ll give your child a project to look forward to.

“I tell people, especially during the pandemic, you have to have one thing to look forward to,” Dr. Powderly said. “It may not be the same thing that you enjoy previously, but you have to have something to look forward to because it gives you hope, and that’s what we all kind of need a little bit more of right now is hope.”

What to Watch For

Knowing the signs and symptoms of anxiety and depression can help you help your child before things get severe. For children, look for three or more of these symptoms, according to Dr. Elliott:

• Excessive worry for more time than typical. The difference between normal worry and anxiety disorder is the severity.
• Difficulty controlling worry.
• Easily fatigued.
• Restlessness and difficulty concentrating.
• Irritability.
• Muscle tension.
• Sleep disturbances.
• Sudden change in grades and school performance.
• Disinterest in a previously loved activity.

If your child is experiencing any of these symptoms and you are concerned about their mental or behavioral health, Cook Children’s is here to help. To access any of the hospital’s behavioral health services, call 682-885-3917. For emergencies, call 911.

As of Oct. 12, the number of patients who have tested positive reached 1,657, with four of those patients currently in the hospital.

Pediatric cases of COVID-19 have been climbing along with overall cases in Tarrant County. On Sunday, Tarrant County Public Health reported an ‘uptick’ with 794 new cases.

“I’ve been asked frequently about the number of infected children, as well as the number of infected adults locally and throughout the state. We’ve noticed over the last couple of weeks that we’ve had more positive cases here,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. “Part of the reason we have more cases here is because we are doing more testing. If you double the amount of testing you do, you would expect to double your number of positive results. If you more than double your number of positive results, that means there’s more disease in the community.”

Cook Children’s COVID-19 positivity rate was near 2.5% in August. Today, our overall positivity rate is 5.3%. Dr. Whitworth says that rate is in line with statewide and national data for children. She says throughout the pandemic, less than 10% of all COVID-19 cases occurred in children under 15 years old.

“It is disturbing that our percent positivity rate is going up, and we also see that in Tarrant County,” she said. “Tarrant County is hovering around 10% positivity rate, while the state has dropped to around 7%.”

There are a number of reasons why this may be occurring, including people going out more and becoming tired of wearing masks and social distancing. She also says there are some cases at schools, but those haven’t been tremendous numbers.

So what can you do to protect yourself and your family?

• Wash your hands often, for 20 seconds with soap and water, or use hand sanitizer.
• Keep at least six feet away from others.
• Wear a mask.
• When around others, remember being outdoors is safer than indoors.

“As the holidays approach, I have wrestled with how to handle this and I know everyone else is wrestling with it too,” she said. “It’s going to be difficult to not be involved in crowded gatherings, but they’re not going to be very safe this year. Those are some of the things I think we can do.”

She says another important way to protect yourself and your family is to get a flu shot.

“There are decades of safety data with flu shots. They are safe. You can’t get the flu from a flu shot. You might be a little achy afterwards, but that beats having the flu where you might be in bed for a week with high fever and miss work or miss school.”

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.

When parents report a croupy cough, it means different things. Some parents call bad/deep/dry/wet/rattly coughs croupy.

When I think of “croupy cough,” I mean “barky” like a dog or a seal. We are seeing quite a bit of croup this winter so I thought a quick update might be in order.

Age (When will my kid stop barking?)

The disease typically occurs between 6-36 months (can be as young as 3 mo but usually not older than 6 years).

Season (What time of year does my kid bark?)

Infections typically occur in the fall to mid-winter.

Time (When will my kid bark?)

Most ER admissions for croup occur between 10 p.m. - 4 a.m.. Unfortunately, things really can get worse at night.

Pathology (What makes my kid bark?)

Initially, the virus infects the nose and throat and then spreads downward causing swelling in the area just below the vocal cords. When looking with a camera at this area, there is a lot of swelling and redness (inflammation). The vocal cords themselves can also become swollen, causing them not to close as well. This is what can cause children to have a hoarse quality to their voices when they speak. The speed of the air as it travels through this area coupled with the swelling and inflammation causes the noisy breathing and barky cough.

Recurrence (Why does my kid get croup over and over again?)

Research has shown that some children are more prone to croup than others. I think that this has something to do with shape of the area around their vocal cords, consequently putting them more at risk for difficulty breathing and barky cough with any viral infection.

Treatments (What do I do for my little seal?)

All the treatments listed are intended to reduce the swelling in the vocal cords and below, helping your child to be more comfortable.

1. Warm steam – We used to put kids in croup tents where we pumped a humidifier in to get the humidity way up. To achieve the same affect, you can turn on the shower in the bathroom and just sit with the child. You can also run a humidifier in the child’s room.
2. Cold steam – Open the freezer door and put the child’s face in front of the steam the freezer emits.
3. Steroids – Giving the child steroids by mouth (or a shot in severe cases).
4. Racemic epinephrine – This is a specific breathing treatment that currently can only be given in the office or hospital.

Two take home tips:

1. The next time your child is barky, feel free to come in and tell us that your child is “croupy.” However, if your child isn’t sounding like a little seal, it’s helpful to try to find a different word to describe the sound of his or her cough, as there are many different causes for the different sounds of a cough.

2. If I start to explain this process to you in the office, stop me and say, “I got this. I read your blog about it.” Nothing would make me happier.

"There are a lot of patients who need specialized care or even higher levels of care and it’s really important that in this rapidly growing community that we have that available to these families," said Dr. Hogan, pediatricitian at Cook Children's Pediatrics Prosper Trail.

Dr. Hogan is one of 24 Cook Children's pediatricians currently treating patients in this region of North Texas. She says patients like hers need a place to access specialized and emergency pediatric care without having to drive 30 minutes to an hour away from home.

"A lot families have hardships and are not able to drive that far, or take off work all the time to go to these visits, and having this inpatient hospital and specialized care right her will make it easier for all the families," Dr. Hogan explained.

Construction of Cook Children's Medical Center North is in the initial phases with plans to have a full service hospital completed in 2022. The new hospital will be located on a 23-acre site in Prosper at Windsong Parkway and Highway 380. Having started in October of last year, phase one is already underway with plans to open a primary and urgent care clinic in the fall. An outpatient surgery center and specialty clinic with imaging and lab services will open in 2020.

"I'm really excited about the hospital opening up and being able to refer my patients to specialists, right here in Prosper, and being able to send my patients to get the specialized care that they need, having higher levels of care right across town," said Dr. Hogan. "I think that is going to be really wonderful for the families here."

Currently, Cook Children’s operates eight primary care offices in and around the Town of Prosper. The expansion near Windsong Ranch marks the first time in Cook Children's 101 year history that a full-service hospital has been built outside of Fort Worth.

"Just like the Town of Prosper is family, a close knit community, so is Cook Children’s," said Dr. Hogan. "We are all here wanting your children to be healthy and do better in life and be able to get the care they need to grow up to be happy and healthy adults."

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

L. Frank Baum, The Wonderful Wizard of Oz

Anxiety in children is a normal part of life, just like it is in adulthood. When a child is frightened, for example by a scary movie, they may have trouble getting to sleep. However, when anxiety cannot be comforted and is out of proportion with the given situation that can be a sign of an anxiety disorder in children.

Childhood anxiety occurs in about one-in-four children at sometime between the ages of 13 and 18. However, the lifetime prevalence of a severe anxiety disorder in children 13-18 is about 6 percent. Left untreated, anxiety in children can cause problems in school, at home and continue into adulthood.

Especially during this time of year, you may notice your child feeling anxious in preparation for standardized testing. 

As we approach STAAR tests in our area, we hear a lot about kids becoming anxious.

Sometimes it’s easy to spot: the outward nervousness, nail-biting, jitteriness, moodiness, irritability and outright refusal to participate in a specific activity, like school or when it's test time. Other times anxiety is not as easy to see, but can still be just as debilitating and lead to further behavioral, as well as physical, problems.

Some of the less distinct signs of anxiety can include frequent stomach aches, headaches, trouble sleeping and difficulty concentrating. It can be difficult to discern whether these symptoms are due to some kind of illness, something your child ate or an emotional stressor of some kind. There are things parents can do to better understand anxiety, including learning what is normal and what needs their attention.

“Normal” Anxiety:

Separation anxiety usually begins around 6 to 8 months of age, and we accept it as pretty much a normal stage of development. A child that had previously been happy while getting passed around to anyone and everyone, making funny noises and faces, may suddenly become a little weary of the aunt she doesn’t see regularly. This fear of a parent leaving may not subside until she is 2 to 3 years old. By then, a child will usually cry for a short period and, with some hesitance, calm down and connect with the new person. In order for children to overcome this stage of separation anxiety, they must feel safe in their home environment, trust people other than their parents, and trust that their parents will return. Parents will play a significant role in preparing their children to deal effectively with daily stresses.

Anxiety and Fear

It’s important to remember that fear is a normal human emotion. Fear is an unpleasant feeling of apprehension caused by the presence or anticipation of danger, according to New Source Counseling. But not all fear is bad. A healthy level of fear can protect our children and us from danger.

Anxiety is slightly more broad and pervasive than fear, but can still be useful when within normal levels. Anxiety is feelings of worry, nervousness or agitation, or an uneasiness of mind and body. It’s often about something that is going to happen rather than current threats. Fear is an element of anxiety, and when these emotions get out of hand they can cause serious disturbances in our children’s lives.

Remember the following four “S’s” to assess the extent to which your children’s anxiety or fear is affecting them.

1. Surplus: Is your child’s anxiety exaggerated from what is “developmentally normal”? Is the fear or anxiety there even when the source of danger isn’t? Is it virtually impossible for them to stop the worry?
2. Storm: Does the fear match the level of danger? Are they easily upset and out-of-control and inconsolable? Do they react negatively when you try to help?
3. Spoiler: Is the anxiety or fear significantly interfering with everyday activities? Does it negatively impact sleep, eating, relationships, and/or activities your child used to enjoy?
4. Stuck: Does your child’s fear or anxiety last longer than is expected? Is the fear or worry present all day, or for weeks or months? Are they having feelings like worry, panic, or agitation that will not go away?

If the answer to these questions is “yes,” it may be time to seek some help in treating your child’s anxiety or fear.

Preventive:

I often tell parents they are their child’s most effective preventative therapist. Every child has fear and anxiety from time to time, but a parent can comfort and give kids the skills they need to effectively deal with their worries. At the youngest ages (newborn to 2) it's important to provide a safe, positive and responsive environment. As kids grow up, separation anxiety is normal; but it's still important to prepare kids for changes and for separations from their caregiver, get them used to new people, and reassure them that they are safe and loved. When specific fears arise (fear of spiders, the dark, clowns, etc.) parents can help their children with age-appropriate discussion, educating the child about the object of their fear, precautions they can take, and possible solutions. It is important for parents to validate children’s feelings but still comfort them.

If your child worries persistently or excessively about a specific issue, like a test, teach him or her how to problem solve and take appropriate action to eliminate worries that can be controlled. It is also effective for parents to teach basic relaxation breathing and progressive relaxation or alternating between tensing and relaxing the muscles, at a young age and practice it with your children. This is a great activity to practice at bedtime. Another popular and effective coping skill which can be practiced during times of calm is known as

 “5-4-3-2-1” Coping Technique :

Breathe in for 5 seconds, hold the breath for 5 seconds, and breathe out for 5 seconds. Continue this pattern until you find your thoughts slowing down or until necessary. While focusing on breathing, focus on the following external thoughts:

5: FIVE things you see.

4: FOUR things you can touch

3: THREE things you hear

2:  TWO things you can smell

1: ONE thing you can taste

Of course, sometimes even parents and children need a little help. If these techniques still don’t seem to alleviate the anxiety – get help early!

Be sure to ask your pediatrician if a counselor or a play therapist, or even a psychiatrist or/and medication may be needed, especially if the symptoms are interfering with experiencing a childhood full of life and laughter! Research has shown that the earlier that childhood anxiety is treated, the more successful it is treated!

Assure your kids that everything will be fine and they will do great on their tests. 

Good luck!

And yes folks, that means Q-tips. Look at what our medical director of Emergency Services has to say:

“Q-tips and cotton-tip swabs cause numerous ER injuries we see at Cook Children’s,” Corwin Warmink, M.D., medical director of Emergency Services said. “I know people hear this all the time, but children should not be putting cotton-tip swabs in their ears. They can cause damage and sometimes the damage can be severe.”

Natalie Roberge, M.D., an Ear, Nose and Throat specialist at Cook Children’s, says problems from placing cotton-tip swabs in the ear can include:

1. Pushing the wax further into the ear canal causing impaction.
2. Laceration/bleeding of the ear canal.
3. Increased risk of otitis externa from the trauma. It's called swimmer's ear, but really any trauma to the ear canal can lead to otitis externa.
4. Perforation of the ear drum. Some will not heal and require surgery. Rarely the middle ear ossicles will also be damaged.

So how do you get earwax out of your child's ear? 

Well maybe you don't.

Earwax is a normal, protective coating to the ear. Some kids make more than others.It doesn't need to be removed except in extreme circumstances and should not be removed by parents.

If you can see some earwax on the outside, it's OK to clean it off but there's never a need to place something in the ear canal to remove it.

Even if I see a lot of earwax during a checkup, I don't clean it out unless there is a concern for infection, a problem with hearing or there is discomfort from the wax.When it is time to remove it, we have a few options:

1. Drops to break down the wax. These can be bought over the counter but should not be used in patients that have a history of tubes or who might have an ear drum rupture.
2. Ear flushing - In the office, we can use a flushing of fluids to remove the wax from the ear.
3. Ear curettage - The most common and my preferred method is to use an ear currette to pull the wax out of the ear. This is done with extreme care because the child must be older or held properly to make sure they are safe.

I get asked a lot about earwax from parents. I hope this advice helps. 

Related to this topic:

• What's Earwax?
• Let's Learn Something: Ear Infections and Tubes
• 7 Ear Infection Myths Every Parent Should Know
• Another Ear Ache. Is It Time To See An ENT?

The Dallas Morning News reports that person from another state who had mumps traveled to Dallas for the National Cheerleaders Association All-Star National Championship, which took place Feb. 23-25 at the Kay Bailey Hutchison Convention Center. 

At this point no Texas residents have developed mumps in connection with the case, but people are urged to watch for symptoms. 

This is another reminder about the value of vaccination in preventing what can be serious illness. Mumps cases decreased 99 percent after the introduction of a successful strategy for vaccination.

Here's a quick look at mumps cases over the years according to the CDC:

*Case count is preliminary and subject to change

** Cases as of Jan. 27, 2018 Case count is preliminary and subject to change

Out of 50 states and the District of Columbia, Texas only ranked higher than Utah, South Carolina, Wyoming and Mississippi for HPV vaccination coverage, according to researchers at The University of Texas System and UT Health Northeast. HPV is the most common sexually transmitted infection and is responsible for 90 percent of cervical cancer cases as well as thousands of oral cancer cases each year.

The study found that only 39.7 percent of females and 26.5 percent of males in Texas between the ages of 13 and 17 were up-to-date with the vaccine in 2016. The national average was 43.4 percent.

“This study is particularly frustrating because a routine vaccine recommended by the CDC and other leading health organizations around the world can prevent HPV,” said Jason V. Terk, a Cook Children’s pediatrician. “A simple shot can mean the difference in life and death. Unfortunately, most Texans are not getting the importance of this message.”

The Texas System Offices of Health Affairs states that about 90 percent of men and 85 percent of women in the United States will contract HPV at some point in their lives.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Waiting until you think HPV is a risk is too late. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s the good news that Dr. Terk wants parents to know: HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9.

"This is a relevant issue for all parents,” Dr. Terk said. “We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends.”

Let’s Not Send Zombies Off to School: Work on Sleep Schedules NOW

My kids are currently out of town for their annual summertime week with my mother, and that leaves us parents with some time to relax, eat out, watch Game of Thrones, and —drumroll—strategize about our parenting strategies. Yes, I know, that last bit sounds redundant and altogether less fun than the others. But —let’s face it—this parenting thing doesn't quite happen by itself—it takes total, multilevel “stategery.” This week, my husband and I must rethink the ever-changing and ever-challenging media rules in our household, reassess our approach to sibling tensions and our kids’ overly astute eye for even the slightest inequity between them, and, of course, discuss the sleep plan.

The sleep plan— OMG, I almost forgot! Yikes—we are just 3 weeks away from the start of school, and our kids are sleep-schedule disasters. We let it happen. We let them gradually follow their tween and teen circadian rhythms right into the swirly whirl of unstructured summer existence. We allowed for the full release of their inner night-owl. Recently in fact, our kids have tucked us parents into bed, they themselves dropping off much later (or sometimes really early the next morning), only to awaken around lunch-time the following day. Oh, Nellie.

So now, I’m calling on all parents with a sleep conundrum on their hands like we have. I’m calling on all parents who allowed their children to drift onto a late schedule. I’m also calling parents of rising kindergarteners, who up to now have let their job-schedule dictate family sleep patterns, but who now must have their kids alert and ready for circle time at 8am! I’m calling on all parents who perhaps have never had a good sleep schedule for their kids, or at least not as good a schedule as they would like. And I’m calling on the Sandman, that character of myth who sprinkles the gift of sleep and good dreams. Because, together, we have got to take action. We must rearrange the timing of our kids’ sleep, and we have no time to spare. The consequence of inaction is a big one, for without our intervention, school drop- off could look like a scene from the Thriller video, complete with the plodding, the stumbling, and the blank-eyed stares but without any good dancing. Let’s go.

1. Set a goal for optimal hours of sleep. First we must figure out just how much sleep to strive for. According to the American Academy of Sleep Medicine, whose guidelines are endorsed by the American Academy of Pediatrics, a grade-school child should sleep for 9-12 hours, while teens should sleep 8-10 hours at night. To know exactly how much our individual children need, however, we need to do a little observing and tweaking. Even if children have — (ahem)— less-ideal sleep habits this summer, it is helpful to calculate how many hours they have slept on the average, during periods when they have seemed well-rested overall, in order to awaken refreshed. My kids are ages 12 and 14, so they per the guidelines should sleep 8-10 hours. In fact, in watching them it does seem they awaken pretty chipper with 9-9.5 hours of sleep, provided they are not sleep-deprived to begin with (ie post- science project or sleepover), in which case they need 10 or 11. Of course, children’s needs can vary based also on the amount of exertion in a day, so be open for minor variations— they (and you) will have to follow their bodily and behavioral cues. If you have a younger child, take note of fussiness as a true signal that your child needs more sleep. My kids always tease me for blaming everything on sleep, and— in the course of occasional emotional outbursts, my kids have been known to preemptively say, “And, no, the reason I’m reacting this way has nothing to do with being sleepy— you always blame sleep.” Note: I see my tendency to blame bad attitudes on sleep deficits not just as smart (and based on known truths about sleep and its link to behavior) but also as compassionate— wouldn’t my kids prefer I blame their orneriness on a sleep deficit rather than on their having a character flaw or generally being troll-like?

2. Translate those goal hours into a target bedtime and wake-up time. Knowing the number of hours we want our children to snooze, we next need to plot out a reasonable bedtime and wake-up time to achieve these goals. This can be trickier than it sounds, as many factors are at play such as school start times (maybe for more than one sibling and at more than one school), how long it takes your child to get ready and eat breakfast in the morning (a plug for breakfast, which is proven to help learning), and how long it takes to get to school. And this is without even mentioning how your will fit your own hygiene and responsibilities into the picture! In the case of my kids, sleeping from 9:30pm until 6:30am (or from 10pm until 7am), will get them the 9 hrs of the sleep they seem to need. Thankfully for our family, these hours work pretty well with our distance from the school and with the school’s start time—phew. I know that for some families, taxing work obligations and bus schedules may make such a schedule impossible. As with everything in life, we must simply do the best we can. Where this schedule puts the squeeze on my family is in the evenings, as we sometimes get home late from work or sports games and then get a late start on dinner, which makes a bedtime of 9:30 a challenge. Still, sleep needs to be a priority. It just has to be. So maybe we need to eat some tuna fish for dinner, or maybe we need to plan ahead for those nights and have some frozen or pre-made options on hand. If we want our kids to be happy, well-behaved (or at least behaving at their best), and alert for good learning and school performance, they need to get as close to their optimal night’s sleep as possible.

3. Take 15 minute baby-steps from the current bedtime to the target bedtime. This step is the heart of our plan and the reason for our need to start our sleep plan ASAP. You see, while procrastination may work in other circumstances, sleep patterns change only as fast as a 15 minute nightly increment, or so the sleep specialists say. So, let’s consider my kids, one of whom currently has a self-imposed bedtime of—again, gulp—something like 12:30am (don’t judge). We need to move that 12:30 am bedtime back 3 hours to 9:30 pm, and to do that the most effectively and with the least consequence of his turning into a zombie, we need to move his bedtime 15 minutes earlier each night. Being 3 hours off-target means being twelve 15-minute steps away from the goal bedtime or twelve days of sleep preparation away from reasonable. We have cut things close! My son’s first night home, he should go to bed at 12:15am, the next night 12 midnight, the next night 11:45pm, etc. Ideally, he would also move the wake-up time 15 minutes earlier each day, so that he would he still get his 9 hours nightly— that is, wake-up at 9:15am on day1, 9am on day 2, etc. That said, I will be totally honest and admit that he actually has pre-season sports obligations at school for some days before school starts that will start at the school start time of 8am. SO, he will be getting less sleep than we wanted, and we really should have started this plan two weeks ago. Oh well. He may slowly turn into a bit of a zombie, but hopefully the worst of his sleepy haze will be over before school starts. We will all just have to do the best we can. He may have to throw in a cat-nap here and there (nothing longer than an hour, which might completely wreck our efforts), or he may have to follow his body’s cues to get to bed a bit earlier than the schedule. And that is fine.

4. Prioritize good sleep hygiene. In addition to trying to get onto a good schedule, we will all need to apply principles of “sleep hygiene,” or healthy habits to promote sleep.These principles are not rocket-science, but they require some forethought.

• No screen time in the hour before stated bedtime. This means having no TV even anywhere nearby, since the lights of the TV will awaken the mind even if out of view. And definitely no video games.

• Digital devices should spend their nights in some other room altogether—not the bedroom. Use an alarm clock to wake-up rather than a smartphone, and don’t buy that bit about night-screen lighting and “Do Not Disturb” settings—the devices are still better at a distance. People still glance at their phones for texts and checks, and that means a part of their brain is still “on” (and interested in how many “likes” or hearts a post has gotten) rather than shutting down

• Plan on a minimum of 30-45 minutes to get ready for bed and to calmly wind down.

• Consider reading an enjoyable, non-school-related, non-stressful, not-too-exciting book or magazine. Or choose downright dry reading material, for that matter (would you like to borrow a medical journal?).

• Consider listening to calming music or sounds of nature (not peppy music!).

• Consider scribbling a short list of gratitudes for the day— peaceful thoughts!

• Consider meditating or breathing deeply— an app like Headspace or CALM can be very helpful in achieving this goal. If new to meditation, you might also check out Goldie Hawn’s book Ten Mindful Minutes, which is aimed at introducing kids to these concepts and skills.

• Consider enjoying a bedtime story with your your parents (even if they are big kids now).

• Consider a warm, relaxing bath, which can really help relaxation (but may add time to the projected bedtime preparations, so you must account for that).

• Make your room dark and preferably a bit cool, and then consider total quiet vs white noise based on your personal preference.

• Exercise earlier in the day will help your quality of sleep, but do NOT do any high-energy, cardio exercise right before bed—endorphins will start flowing and wake you up.

• Eat a healthy diet with dinner preferably not immediately before bedtime (if necessity requires such timing, then a lighter meal will allow for better sleep).

• Do not discuss big life questions or worries right before bed! Parents, keep in mind that kids often ask big questions (such as “What happens after someone dies?”) just as you are kissing them goodnight. But don’t fall for it! Tell them you value their question and will discuss it in the morning.

• Try visualization of one of your favorite places—even imagining walking around there and entering different rooms can be a pleasant descent into dreamland.

• If your child tends to run through a list of worries at night, consider making a “worry box.” Have your child write a few concerns on strips of paper and put them in the box. Then explain that these concerns should be thought about only in very small and deliberate doses at ANOTHER time (for example you can offer to take one strip of paper out tomorrow in the day, to allow the child to worry for 5 minutes max). Let us limit worry time if we can, as thinking about worries makes worries grow, doesn’t solve anything, and shortens sleep.

We all want to be sure our kids are awake and alert for the start of classes, so let’s get right to work on this. Or, shall I say, let’s get right to sleep! I certainly don’t want any zombies anywhere near me! But all this talk about sleep makes me feel like yawning. I mean, doesn’t your pillow call you, too? What time did I go to bed last night? It was only. . .only. . . ZZZZZZ.

While it’s a fun time of year that many student-athletes look forward to, it's also time to freshen up on our knowledge about concussions so that we don’t put our kids at risk for severe long-term symptoms.

Mismanaged concussions can lead to severe headaches or a prolonged feeling of “fogginess” which can harm our athletes’ ability to learn. And it’s not just high school football players we need to be concerned about. Any athlete can suffer a concussion, including young children. 

So what should parents know? 

A recent study in Pediatrics looked at how long it took for athletes to recover following on a concussion depending upon rather they returned to play or were immediatly removed from the game. Those who went back in to play were nearly 9x as likely to suffer symptoms for more than 21 days. They also had worse scores on neurologic testing and had more severe symptoms than those that were removed.

Not removing an athlete from play is not the only mistake that parents and sports teams can make in regards to concussion management.

Here are 8 ways that parents and sports teams mismanage concussions that could be putting kids at risk:

1)They don’t recognize that a concussion has happened. If you notice a hard hit or hit to the head and see any of the following: headache, confusion, memory loss, nausea or vomiting or excessive fatigue, you have to assume it was a concussion until proven otherwise. If you notice any of those symptoms during an athletic event, even without an observed injury, you should still be very concerned. You don’t have to lose consciousness for it to be a concussion.

2)They trust the athlete to report their symptoms. Highly motivated student athletes know better than to report all of their symptoms because they know that it will get them removed from play. If you notice a hit and see the athlete acting different in any way, you must consider that a concussion despite the fact that they may say that they are “fine.”

3)They insist on a trip to the ER after a concussion. Most concussions can be handled by the trainer in conjunction with a doctor who has some advanced knowledge of concussion management. If the child is conscious and alert enough to talk with you, it can probably wait until the next day as long symptoms aren’t worsening or the athlete’s alertness isn’t decreasing. All that said, if you are worried about the athlete’s symptoms, go to the ER.

4)They insist on head imaging (CT or MRI) after a concussion. Head imaging is usually not necessary after a concussion assuming that symptoms are steadily improving over time. Remember that a head CT does involve radiation so minimizing its use is important.

5)They let the athlete return to play in the same game. As the study above mentions, this can be devastating to the child’s recovery. Prolonged and severe symptoms may be the result, leading to impairment for school work and a longer time to return to the sport.

6)They wake the child up overnight to check them after a concussion. This old teaching is one that still hangs on in the parent and trainer community despite a lack of evidence that it helps in any way. In fact, because rest is commonly what a concussed athlete needs, it could theoretically recovery worse. Would I walk in a few times at night and check on my son if he had a concussion? Sure, but I wouldn’t wake him up to give him a mental status exam.

7)They allow the student to participate in school activities too soon. After concussions, it’s not uncommon for students to need a slow return back to full activities, including school work. I don’t like this time period to be too long, but a couple days of half schoolwork might be necessary. You should work with a doctor who is able to fine-tune the play for your child.

8)They allow the athlete back into the sport too soon. An athlete that has had symptoms of concussion should not return to exercise until they are completely symptom free. If their main symptom is headache, they should be headache free before returning to light exercise, moderate exercise, sport specific practice and finally games. If symptoms return at any of those steps, they must step back to the previous level of activity until symptoms are gone. Again, working with a trainer and doctor who understand return to play protocols is critical to keeping your child safe.

Watching your student-athlete closely after a concussion, removing them from play the minute you notice symptoms and being cautious with their return to play will protect them from prolonged symptoms. It is critical that we remember that they are students first and that not protecting them after a concussion can result in prolonged impairment from school work.

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Researchers in Pediatrics found that only track and field and swimming were safer as far as the number of injuries to athletes, but because of the high risks of cheerleading stunts the injuries were often times dangerous.

The study found:

• The most common injuries are concussions at 31 percent, but lower than all other girl sports.
• About one third of those injured, were participating again in a week.
• Forty-one percent of cheerleaders were out for one to two weeks.
• Eleven percent were out more than three weeks.
• Five percent were out for either the season or were career ending injuries.
• Most of the injuries were to girls, but boys also were injured because they were usually at the base of the formation.

The Cook Children’s Emergency Department admitted six cheerleading injuries from Oct. 9, 2014 to July 28, 2015, a low number compared to a sport like football. But four of those six required surgery at Cook Children’s.

Amanda Vick, PT, DPT, a Cook Children’s SPORTS physical therapist, was a cheerleader in high school. She points to the focus of cheerleading become a year-round sport, including athletic competitions, summer camps and competitions, leading to the increase in the number of injuries.

Plus, cheerleading has changed over the years to include high level gymnastic tumbling runs and stunts. Most common injuries seen at Cook Children’s are fractures, strains, sprains and concussions. She says more regulations could help lower the amount of injuries in cheerleading.

“Cheerleading has not historically been recognized as a sport, at many levels,” Vick said. “This means cheer may not be under the control of an athletic department. Cheerleading does not have to follow certain rules and regulations that other sports monitor and improve for safety. Therefore, increasing safety awareness is key for protecting cheerleaders.”

Due to this change in the demands of cheerleading, it is important for coaches and cheerleaders to understand proper techniques during stunts and tumbling, strengthening, leg and arm alignment, core activation and different risks related to floor surface and practice time.

Read more on Vick’s advice to protect cheerleaders here.

About the source

Amanda Vick, PT, DPT, is a Cook Children's SPORTS physical therapist.The SPORTS Program at Cook Children’s offers educational material for parents, coaches, trainers and nurses for sports-specific injuries. Our team of experts have specialized training in pediatrics and collaborate together to share their knowledge in growing bodies and dynamic training principles. 

Imagine you are 5 years old. It’s a beautiful day and you are stuck in the house with a fever. Your wonderful mother gives you little orange tablets that taste like oranges. You think taking these little tablets that look a lot like M&M’s will make you feel better really soon. What a wonderful Mom! Then she leaves the bottle with the little orange flavored tablets on the table just a few feet away. What would you do?

I was the child that decided if a couple of little orange things would make me feel better than the bottle of little orange things would get me well quicker and I could get back to playing with my friends. What I didn’t know was that there were enough tablets in that bottle to cause a very large overdose. After I took the pills, my mom noticed that I wasn’t responding to my name. I was nearly unconscious. So I was given a trip to the emergency room at our local hospital. I was fortunate that someone noticed and that it wasn’t something worse. 

A recent study in Pediatrics found that 640,000 emergency department visits were made in the U.S. from 2004 to 2013 because children were able to to get medication without adult supervision.

When I became a mother myself, I was very diligent in keeping medications away from little hands by keeping the medications in a high or locked cabinet. We can protect our children from an accidental poisoning at home by looking at things from their eyes. Everything that looks like candy is interesting to them.

Every year Cook Children’s receives more than 600 children due to poisonings. Seventy-five percent are medication related. Children can be accidentally poisoned by finding medication belonging to a friend or family member at their house or in their purse or bag. Or by getting into a cabinet that contains household cleansers like bleach or window spray. Remind your friends or family members to keep medication and household cleaners out of the reach of your children. Often Grandmother’s medication looks like candy, just like my little orange pills, or the cleanser bottle looks like lemon/lime drink.

Sometimes it’s as simple as not measuring a liquid medication correctly. Ask your pharmacist for a medication measuring spoon or oral syringe so you give the correct amount of medicine to your child. The spoons in your kitchen will not always measure the same amount as a medication spoon.

Also, make sure to keep the poison control number (1-800-222-1222) near your phone in case you need it.

Rosanne Thurman is director of Pharmacy at Cook Children's. Cook Children's pediatric pharmacists are available at the medical center to make sure your child's medicines are safe and effective.That includes helping parents understand what their child's medicine is for, the best times to take the medicine, the right dose, side-effects and any possible drug interaction with other medications that their children may be taking, such as other prescriptions, over-the-counter medications like cough syrup or antihistamines and herbals. They can even tell parents what food and drinks might cause an interaction.

While the increase in self-injuries may not seem that extreme, Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Behavioral Health for Cook Children’s in Denton, said the study does not tell the entire story. Sometimes the degree of cutting, for example, may not be severe enough to receive medical attention.

Elliott presents to schools, churches and community organizations on the issue of teens and self-harm injuries. She also treats patients in her practice.

“It can be difficult to determine the prevalence of these types of injuries accurately due to the secretive nature of self-harm prevalence,” Elliott said.

Elliott says that the most accurate numbers show that 20 to 23 percent of teens engage in some type of self-injury. The age of self-harm abuse typically begins between the ages of 12 to 14 years old.

Research shows that gender differences appear only to be associated with method of self-injury. Females are more likely to use cutting. Both genders use burning and self-battery. Caucasians are significantly more likely to engage in self-injury than non-Caucasians.

Methods of self-harm include:

• Cutting (70 percent of self-injuries)
• Carving
• Scratching/biting
• Burning/abrasions/branding
• Hitting themselves
• Picking/pulling skin and hair
• Head banging
• Tattooing
• Excessive body piercing

Injuries are most commonly found on arms, hands, wrists, thighs and stomach.

"This is something we see quite often, mainly in female teenagers, and it has increased dramatically in the last several years once it became a 'thing' that teenagers do and have seen or heard about," said Corwin Warmink, assistant medical director in the Emergency Department at Cook Children's. "It is a response to stress and anxiety and gives the performer a sense of control and eases their anxiety. It is not a suicidal behavior, but some studies have shown people who perform self-injury are more likely to commit suicide than people who do not. It also can be indicative of a more serious mental disorder."

So why do kids harm themselves?

“Kids who repeat self-harm injuries are often trying to ease some type of intense, overwhelming negative emotion such as anger, pain, anxiety or frustration,” Elliott said. “That’s the most common reason, but the second most common reason is self-punishment. They are expressing anger at themselves. This is strongly connected to self-derogation and criticism.”

Other reasons for self-harm include:

• Interpersonal influence – as a means to garner affection/caring from others, to identify/connect with others who have self-injured, to “belong” or fit in with a peer group.
• Stress management.
• To feel a sense of control over their own body, feelings or life situations.
• To provide a distraction from painful emotions through physical pain.

Kids who engage in self-harm behavior are more likely to tell and seek help from a peer their own age than tell a parent. Usually, adults only become involved if that peer tells a grownup and asks for help for his or her friend. Other times, a teacher or coach hears talk among other teens and steps in to help.

Elliott offers these tips to identify if your child is involved in self-harming behavior:

• Dressing in long sleeve shirts/hoodies even in hot weather.
• Wearing concealing outfits.
• Avoiding activities such as sports and swimming.
• Making excuses for having cuts, marks, wounds on body.
• Finding razors, scissors, lighters, knives in unusual places such as under the bed.
• Spending long periods of time locked up in bedroom or bathroom.

For more information

To schedule an appointment or refer a patient to Behavioral Health Services, please call 682-885-3917. To have Lisa Elliott speak more on this topic at your school, church or community organization, click here.

However, some moms and dads may not realize the harm they are doing their newborn by not getting themselves or their older children vaccinated for whooping cough, or pertussis.

Because the immunity of a newborn isn’t fully developed, babies are at high risk for contracting potentially fatal illness and disease.

A new study published in the journal Pediatrics stresses the importance of the entire family getting vaccinated, at least those old enough to receive the immunization. The study says babies who contracted whooping cough were now more likely to get the infection from a sibling than a parent.

The study states that pertussis “is poorly controlled” and that the incidence of pertussis in this country is on the rise.

In contrast to previous studies, data now shows that infants are contracting whooping cough more often from their siblings than from their mothers. Doctors suggest that this may be because of vaccine effectiveness wearing off over time in these older children. They then contract pertussis more easily and the younger siblings (including infants) are more likely to be exposed.

Five vaccine doses are recommended by age 6, with a booster shot at age 11 or 12. Booster shots also are recommended for adults.

Infants are at greatest risk for disease and death from whooping cough, especially during the first 2 months of life before pertussis immunizations begin. That means that everyone in the family should be vaccinated when a newborn is being brought into the family.

While the parents, adolescents and caregivers who will have direct contact with the baby should all be up-to-date on their immunizations, the two most important vaccinations for adults to receive are influenza and combination booster for tetanus, diphtheria and pertussis (Tdap).

“Tdap is recommended for all pregnant women during each pregnancy to prevent the baby from getting pertussis if coughed on in the first few months of life before the baby has time to get immunized,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “The mother makes antibodies that go into the baby’s bloodstream during the pregnancy. Those last until the baby gets his or her 2-month shots.

“It’s very important for everyone in the family, including parents, siblings and grandparents to have the vaccine. Pertussis can be deadly if a child contracts the disease in the first 3-4 months of life.”

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

About 3 percent of kids suffer from severe selective eating, to the extent that they can't eat out at a restaurant, said lead researcher Nancy Zucker, an eating disorders specialist at Duke University Medical Center in Durham, N.C.

Severely selective eaters are more than twice as likely to be diagnosed with depression or social anxiety, when compared with kids who'll eat anything, according to findings published online Aug. 3 in the journal Pediatrics.

Alaina Everett, a Cook Children’s licensed psychologist in Denton, says severe picky eating can be treated from a psychological/behavioral perspective as well as through oral-motor and sensory therapies and trying new foods for children who have severe selective eating can be terrifying.

“The fear is only intensified when parents make threats or express anger and frustration,” Everett said. “In our psychology department we emphasize the belief that kids do well if they can. Likewise they will eat well if they can. But there are obstacles that get in the way. Whether the original issue is a sensory processing disorder, oral-motor weakness or a gastrointestinal problem, all these kids have one thing in common, anxiety.”

From a psychological standpoint, these kids have had unpleasant experiences with food and the lingering trauma may be real. This is especially true for well-meaning moms who hide veggies in their kids’ favorite foods. If you have a seriously picky eater, Everett says this strategy will back-fire big time.

So how much anxiety can meal time actually cause?

“It is not uncommon in my practice to see children cry, scream, hide under the table, and quite literally shake at the sight of a novel food or when asked to join me at the table,” said Amanda Fyfe, a speech-language pathologist at Cook Children's in Arlington and Mansfield. “The anxiety severe picky eaters cope with is real and it can be intense. These kiddos often have months or years of negative food experiences fueling this fear, and unraveling it takes real work on everyone’s part. “

Fyfe says severely picky eaters:

• Have a significantly limited food repertoires (think 10 foods). These foods are probably similar in some way, although figuring out the rhyme or reason to what your little guy will or won’t eat can be mind boggling. It may be that his safe foods are the same color or have the same texture.
• Frustrate us with behavior that makes mealtime at home a catastrophe and eating out unheard of. He may refuse to eat with your family or cry and scream at the sight of the casserole you’ve so lovingly prepared.
• Refuse foods based on ALL sensory properties, including appearance, smell, texture, and taste. A picky eater may not even tolerate an offensive food on his plate. The sight of a non-preferred food may cause gagging, retching, and vomiting. Eating is more than simply chewing and swallowing. Interacting with, smelling, touching, and tasting are ALL important steps in the eating process. And disruption can occur at any step.
• May struggle to meet nutritional demands

“A child will not eat the broccoli and pork chops if you wait him out. He just won’t,” Fyfe said. “In fact, he may grow more and more rigid in his food selection because he IS hungry and grumpy. If a food or experience causes a child stress, discomfort, or pain, he will avoid it, plain and simple.”

Fyfe says these children are hypersensitive to foods in ways most of us might not even consider when planning our meals. Foods have to pass many tests before deemed acceptable for consumption, believe it or not, and severely picky eaters really put their meals to the test.

The first and possibly the most important test his dinner must pass? What it looks like. Children are acutely aware of the color of the food and may question why the color, shape, or size changes from bite to bite or from meal to meal. In addition, they might become overwhelmed by the smell of a particularly pungent food (think roasted broccoli, guys) and lose all ability to even consider tasting it. The texture of yogurt or pudding may cause a gag with incredible force. All of these reactions to food can lead to increased behavior disruption and meal time chaos.

“They can taste everything,” Everett said. “Zucchini pasta does not fool anyone and they are likely to stop eating pasta altogether. Presenting motivators like extra video game time can help, but it doesn’t solve the underlying anxiety. The scenario will just repeat itself when the next new food is presented.”

If your child shows signs of extreme picky eating, you will need some help. Talk to your child’s pediatrician about scheduling a feeding evaluation with a speech-language pathologist to determine the origin of the feeding woes and develop strategies to improve the eating experience for the entire family. A child psychologist may also be used if necessary.

http://www.npr.org/sections/health-shots/2015/08/03/428016725/could-your-childs-picky-eating-be-a-sign-of-depression

https://childhealthanddevelopment.files.wordpress.com/2012/03/kaytoomey.pdf

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

You decide to seek out some information online and you find this:

“Although data to make specific recommendations as to when it is safe for infants to sleep in the prone or side position are lacking, studies that have established prone and side sleeping as risk factors for SIDS include infants up to 1 year of age. Therefore, infants should continue to be placed supine until 1 year of age. Once an infant can roll from supine to prone and from prone to supine, the infant can be allowed to remain in the sleep position that he or she assumes.”

AAP SIDS and Safe Sleep Guidelines

“Heh?”

Hopefully none of us really talk this way, but I have a feeling sometimes it’s close. Doctors have a notoriously bad rap for their handwriting; fortunately, we’ve mostly fixed that with electronic records. Unfortunately, some of us aren’t known for our amazing verbal communication skills, either.

A study released in Pediatrics this week highlighted this fact. The authors surveyed mothers of 4-6 months old babies about the education they received from their doctor when their baby was a newborn.

They asked the mom if they received advice on the following topics: vaccination, breastfeeding, sleep position, sleep location and pacifier use.

All of these seem like pretty basic newborn information. Most doctors would want to cover them during that time frame. They all are included in very specific guidelines with clear instructions for how the American Academy of Pediatrics wants us to educate our patients?

How did the doctors do? The following percentages reflect the number of mother’s who reported receiving correct advice for the respective topics:

1. Does it seem like we’re speaking in a foreign language?

For many cases, the study showed that either the doctors failed to mention some pretty important topics or they weren’t presented in a way that parents understood or remembered.

One of the reasons I love to write is that it forces me to have clear thoughts about the medical issues I deal with every day and to focus on clear strategies for communicating those thoughts to patients. Of course, I’m not perfect. Here are some of the communication mistakes I (and from the results of this study, other doctors) make and some strategies for the way things should go (with help from you of course):

Some people describe the first few years of medical school as being more or less a foreign language study. During those years, medical students learn terms that most people don’t need to know. We use them as a way to communicate with other doctors as we begin to learn from “real” patients in the later years. The problem is we sometimes forget that we can’t talk that way all the time if we want to be understood by our families.

How can you help us while we work to get better?

Don’t be afraid to ask questions or to stop us if you don’t understand. Your child’s health is important to us. We know that you have to understand our instructions if we want to have any chance to help your child stay healthy or get better when they are sick. Ask us to slow down or to re-explain a certain concept again if what we say doesn’t make sense.

2. Have we given you the best opportunity to hear us?

This newborn study is a perfect example of this. A newborn mom is tired and stressed and getting health advice from the nurse, the doctor, their family and the Internet, so what usually ends up happening? We rush right through with the messages that are important to us and hope that mom gets them in 5 minutes.

Thanks for coming in. Good luck, mom!

Other examples are when we deliver bad news or just simply have a baby with an ear infection that is screaming in pain while we get louder and louder to make sure we are “heard.”

How can you help us while we work to get better?

Some are easier than others. When we’ve delivered bad news, there’s probably nothing either of us can do to help in that situation. But we should definitely slow down and wait a minute to let you think before we plow through into “next steps.”

If your baby is fussy and you can’t concentrate, feel free to ask if a nurse could come help for a second while we talk. Even if the baby stays in the room, just having them out of your arms makes it easier to listen. During those newborn visits when you are sleep deprived, ask for resources that you can take home and read when your mind is a little more clear (if that every actually happens for any of us with newborns).

3. We try to cover everything, but did we focus on what you want to learn?

This has another medical school analogy. Some people refer to the first few years of medical school as “trying to drink from a firehose.” There is so much information coming so quickly, you have to learn how to decide what is important enough to waste brain space on and what can be discarded (or “Googled”) later. So, when it comes to giving advice, we assume that you can do the same. The other assumption we make is that you actually care about the things that are important to us.

How can you help us while we work to get better?

First and foremost, please bring a list of questions. This helps us to focus on the things that are important to you, which are the things that you are going to remember anyway. As I get to know my “listers” better, I tend to grab (nicely) the list out of their hands and start writing the answers down (in ugly doctor scrawl) as we go along.

This is another time when asking for resources can be really helpful. Ask us to highlight or point out sections that are related to what you have talked about in the visit. Now, for this strategy to work, the resources have to come out of the diaper bag before they get formula and other baby fluids spilled on them - better yet, maybe they can just be pulled up on your phone …

I work hard to avoid these mistakes. But as I said, I’m not perfect. Communication is vital between a pediatrician and a parent. In the medical community, it looks like we have a lot of work to do.

Fortunately, we have some great examples at Cook Children’s to learn from.

But we can all get better with your help and feedback.

“Mom, my legs hurt.”

It wouldn’t be so concerning except that it’s happening four nights a week, for months. Right?

So, what do you do?

Watch The Doc Smitty in Cook Children's latest My Kid Minute video on growing pains:

To learn more about growing pains from The Doc Smitty, read his blog on the topic.

Even skilled physicians may not be on the lookout for something as uncommon as CHI in newborns, which could be the difference in preventing irreversible damage and improving the quality of a child’s life.

That may all change following an article published in the Journal of Pediatrics titled, “Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants and Children.”

Paul Thornton, M.D., medical director of Cook Children’s Congenital Hyperinsulinism Center and Endocrine and Diabetes program and an Endowed Chair, led the team of experts from around the world in creating new screening for physicians to recognize and manage neonates at increased risk for a persistent hypoglycemia disorder.

“Infants with uncontrolled hypoglycemia caused by CHI are at risk for seizures or permanent brain damage without early identification and screening,” Dr. Thornton said. “These new guidelines will help physicians who recognize these symptoms shortly after birth and then provide the specialty care which may make the difference on whether this child has a productive and fulfilling life.”

The article states that “failure to investigate a neonate, infant, or child with suspected hypoglycemia increases the risk of delaying a definitive diagnosis and instituting effective treatment.”

But quickly identifying the specific cause of hypoglycemia allows for timely and appropriate treatment to begin and decreases the risk of permanent brain injury from persistent and recurrent severe hyperglycemia.

Dr. Thornton was chosen as the principal author of the article because he’s internationally known in the field of CHI. He leads a highly skilled team of specialized physicians and supporting specialists to treat hyperinsulinism.

Cook Children’s Hyperinsulinism Center is the only one of its kind in the Southern U.S. and the second in the country.

Davelyn Hood, M.D., president of the CHI Board of Directors said her organization “is thrilled beyond words” that long-awaited hypoglycemia guidelines have been published this month in the Journal of Pediatrics.

“We consider this a sentinel moment in time for the entire congenital hyperinsulinism community,” Dr. Hood said. “Many patients born with this congenital HI are discharged from newborn nurseries without adequate study of their hypoglycemia, often with tragic consequences. These guidelines give us hope.”

Dr. Hood said she believes the guidelines will save countless lives and improve the well-being of HI children everywhere. She also praised Dr. Thornton for all of his work for CHI patients.

“He cares for children across Texas and the U.S. with one of only two dedicated Hyperinsulinism Centers in the country,” Dr. Hood said. “He speaks to clinicians around the globe about the proper management of hypoglycemia and leads HI research to better understanding of the disease and best treatment options. Most importantly, Dr. Thornton, brought the HI research community together, took all of their collective knowledge regarding hypoglycemia and its underlying causes, and articulated that into clear guidelines for clinicians of all types that care for neonates, infants and children. Dr. Thornton is a definitely a ‘CHI Super Hero.’”

More about Cook Children's Hyperinsulinism Center

One of only two such programs in the nation Cook Children's Hyperinsulinism Center uses a specialized team approach to treat this rare disease. Hyperinsulinism affects many areas of the body, so to truly treat the disease, each child is seen by top physicians, nurses, researchers and specialists in the field. These medical professionals have spent additional years of intense study and have dedicated their practice to focusing on hyperinsulinism so that your child will has access to the medical care that treats all the symptoms. It is this level of treatment that has helped earn our program a distinguished international reputation for extraordinary care and achieving positive results.

A disturbing trend on social media, the #kyliejennerchallenge, has left some teenagers in pain and not the look they were hoping for … to say the least.

So what is the challenge?”

“Kids suck into a container, often a shot glass, to increase blood flow to the lips, giving them a temporarily fuller, more pouty look,” said Justin Smith, M.D., a pediatrician and medical advisor for digital health at Cook Children’s.

Why should you tell your teenager not to do it? Dr. Smith has a few reasons:

• Pain
• Bruising
• Chapping/cracking – any cracking can lead to infection
• Cuts (some severe) from shattered glass

About the source

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

How do you know when it is something else or when it could be more dangerous?

A report last week from the CDC described a cluster of infections caused by shigella, a bacteria that can cause severe diarrhea.

Shigella is common, causing an estimated 500,000 cases of diarrhea in the United States annually. But this group of infections is unique because it has been found to be resistant to the most common type of antibiotic used in adults used for shigella. Most cases have been located on the East and West coast and many have been associated with travel outside the United States.

Fortunately, there were no cases of this more severe form of shigella reported in Texas so I feel that we are pretty low risk at this point. I did want to take a second to tell you about warning signs that might alert you that diarrhea might be more than a stomach bug.

Here are some symptoms that might alert you that should trigger a call to your doctor:

1. Severe vomiting with decreased urine frequency or other signs of dehydration.
2. Fever more than 102.
3. Blood or mucous in the stool.
4. Severe belly pain.
5. Diarrhea that last more than one week.
6. Let your doctor know if your child has traveled recently.

What are Salmonella and Shigella?

Two of the most common bacterial causes of infection are salmonella and shigella. They are both fairly frequent causes of severe diarrhea in children.

They can both be transmitted by contaminated food or water but can also be spread from person to person. Salmonella is more frequently caused by transmission from contaminated food, but also can be contracted from infected reptiles. Shigella is more frequently acquired from other children and is much more contagious than salmonella.

(Just to give you an idea, stool of a child infected with shigella contains 100,000,000 bacteria per gram of stool. Ingesting just 200 bacterial cells is enough to cause infection. Because of this, outbreaks of Shigella are common in child-care settings.)

The most common symptoms with both infections are diarrhea, abdominal pain and fever. With shigella, fever is often higher and children are more likely to have blood or mucous in their stools.

For either infection, your doctor can run stool studies to confirm the diagnosis. This may not be necessary if there are known cases that the child has been exposed to.

Both infections will typically go away on their own in seven days or less. Most healthy children do not require antibiotics. I do not routinely recommend anti-diarrheal medications in children because they can prolong symptoms with some infections.

If you suspect your child has one of these infections, consult with your doctor and keep them out of day care until we are sure they will not put other children are risk.

If you want to start, visit Cook Children's guide to choosing a pediatrician. Then, go check out your doctor on healthgrades.com or vitals.com or any of the other rating sites you can find. What you’ll likely find is a sampling of a small handful of raters. These sites are a sample size and can be heavily skewed by one great (if you like your pediatrician, let people know) or one terrible one. 

So, where else can you go for advice?

Friends

Ask your friends who have kids what doctors they use. This especially works well if you have friends that are similar in belief systems, medical philosophy and personality. If they like their doctor and you’re similar to them, chances are you’ll like them too. Good old fashioned word of mouth (it’s actually more commonly via Facebook or what I like to call “word of mouse") is still probably the best way to learn about the doctors in your area.

Practice websites

Practice websites are helpful in determining the practical aspects of the practice you are considering. Look at office hours and availability of care after hours via phone, etc. If having a doctor that is up to date with latest medical knowledge and technology is important to you, make sure that their website looks professional and is updated. This is also a place where you can find a little bit about the doctor’s personality (from their bio) and see their picture but these often become pretty predictable. Everyone likes to spend time with their family and has a few particular interests in pediatrics like obesity or development. They also went to medical school and residency somewhere (in case you were wondering).

Ranking websites

There are several of these out there. Some of the most popular ones are healthgrades.com and vitals.com. I like vitals.com because it allows people to leave narrative comments and not just rate with stars. Some of those comments can really give some insight into what the doctor is like. These website are not without fault-because the number of reviewers is often small, they can be skewed heavily by someone who has a negative experience (this is a good reason to go over and rate your doctor that you like).

So, how do you know if your doctor is the best?

The right question is this: How do you know if your doctor is the best for you?

I think this comes down to two basic questions:

1. Can you ask your doctor any questions without fear of judgment or feeling silly?

2. Do you trust the doctor’s answers to your questions?

If you can answer a resound YES to both of these questions, then you are in the right place. If not, you should probably be looking elsewhere.

The documentary describes how Laettner bullied not only the opposition, but his own teammates. And where does the documentary say he learned such behavior? His older brother.

A University of Nebraska-Lincoln study gives a detailed look at bullying from siblings the Journal of Family Violence. The researchers talked to 400 undergraduates and found that students said they were bullied more by their siblings than by other children.

Last year, another study conducted by the University of New Hampshire discovered that 32 percent of children who said they were victimized by a brother or sister reported higher rates of mental-health issues.

Lisa Elliott, Ph.D., clinic manager of Cook Children's Behavioral Health in Denton, Texas, said she has seen several kids lately in her office dealing with problems related to siblings. Elliott, a licensed psychologist, said this goes beyond sibling rivalry or teasing. She is seeing abuse and parents need to be aware of the role they play in this issue. Especially if they are favoring one child over the other. Often times that "favored" child becomes the bully.

“Parents have to be careful that they don’t show favoritism, either directly or indirectly, intentionally or unintentionally,” Elliott said. “The perception of favoritism among siblings is one of the most harmful things parents can do to their children. It’s harmful to the child’s self-esteem, it increases bullying amongst siblings and it often creates very entitled children in the one who is favored.”

A study published in the journal, Pediatrics, showed that kids who had been bullied by their brothers or sisters for a prolonged period of time were twice as likely to report being clinically depressed when they grew up.

"I certainly think in most families there is likely to be some level of conflict or disagreements among siblings at different times," said Joy Crabtree, a licensed psychologist at Cook Children's Southlake Urgent Care and Pediatric Specialties.  "However, I think parents need to be aware of when it may be crossing a line, such as physical altercations, repeated name calling or degrading of a sibling etc. Sometimes it can happen out of ear shot of the parents so it’s important to talk about everyone maintaining respectful communication in the family. If a child feels uncomfortable or targeted, he or she needs to let mom or dad know because it may not be happening in front of the parent. If targeting is occurring, limits and boundaries need to be set so a negative pattern does not continue."

Research conducted by the Universities of Oxford, Warwick, Bristol and University of College London said that bullying among siblings is particularly upsetting because these children have no way out. Bullying includes persistent verbal or physical abuses, as well as just ignoring the other siblings for long periods of time.

“I see children in clinic who are upset about favoritism or jealous of a child or he or she feels an older sibling is being parental or bossy. Sometimes I see feelings of inferiority. But what I hear when it comes to bullying is something very different,” Elliott said. “This is abuse, either physically or verbal. These are siblings and they know each other better than anyone else. That familiarity allows them to say very hurtful comments that the sibling knows is a sensitive or private matter. Sometimes, I see ganging up on a sibling, where multiple brothers or sisters gang up on a child. In those cases, you see extreme physical aggression between siblings that can be every day and makes life miserable for a child.”

Elliott gives the following tips for parents to watch out for sibling bullying:

• All physical bullying needs to be addressed immediately and not tolerated.
• It is critical to understand the causes for the bullying to address whatever those reasons are –

1. If a child is feeling inferior help, build that child’s self-esteem.
2. If you are inadvertently showing what is perceived to be favoritism by one child, modify your behavior and be sure to praise each child equally with positive behavioral anchors.

• Don’t label your children as the “bright one”, the “musical one” etc.
• Finally, it is critical to teach your children how to problem-solve conflict effectively and how to have empathy for others.

We have been trained to assume that chest pain is caused by the heart and an emergency, which is right in adults. But, one of the basic principles of pediatrics is that children are not “just little adults.”

Chest pain is a perfect example.

What are some common causes of chest pain in children?

1. Muscular or rib pain - This is the most common cause of chest pain in children. Pain can be caused by a bruise, muscle strain or after repetitive coughing.

2. Lungs - Asthma and pneumonia are two common lung causes of chest pain.

3. Stomach - Reflux can cause chest pain (think “heartburn”).

4. Psychological - Stress, anxiety and panic attacks frequently show up as chest pain.

If most chest pain in children is not an emergency, when does it become one?

1. The pain is severe, especially if it has the classic findings of heart pain (crushing pain, under the breastbone, moving to the left arm or up the jaw).

2. The pain is associated with difficulty breathing.

3. The pain has is associated with other symptoms (fever, nausea/vomiting for example).

What are some other findings that suggest the heart is the cause of chest pain?

1. The pain is associated with exercise or limits the child’s ability to exercise.

2. The child has lightheadedness, dizziness or faints with exercise.

3. There is a family history of heart problems or sudden death, especially if early in life.

If your child has any chest pain, a visit to your doctor is important so that they can ask you questions and perform an exam on your child to determine the cause and right treatment.