With kids going back to school, new questions are coming up on when kids should be tested for COVID-19 and when they can return to school.

Keep in mind there are some conflicting and confusing pieces of advice out there and this is only promised to be up to date as of on Sept. 25, 2020 when we are publishing this. But here are some reasonable-evidenced based approaches on testing and returning to school.

Who needs to be tested for COVID?

All patients with high risk symptoms and without another explanation should be tested for COVID before returning to school. These symptoms include:

• Fever
• Cough
• Shortness of breath
• Body aches
• Loss of taste/smell
• Headache
• Sore throat
• Sustained vomiting or diarrhea (and usually a combination of these symptoms)

If high suspicion for COVID still exists after a negative test is obtained, a second test the next day may be recommended by your doctor. If the COVID test or tests are negative, the child may be treated as they normally would for that illness (for example, returning to school after they were fever free for 24 hours).

All patients with low risk symptoms and NO known exposure to COVID can be tested before returning to school based on physician discretion. Low risk symptoms include congestion or runny nose, rash or a single episodes of vomiting or diarrhea.

If COVID is negative, the child can be treated as they normally would for that illness. Patients with low risk symptoms and no known COVID exposure may be tested, but do not necessarily need to be if their medical provider feels comfortable that their symptoms do not require it. The patient should be counseled on the high-risk symptoms to look for and they should be counseled if they do discover a possible exposure or develop high risk symptoms.

All patients with any exposure to COVID, regardless of symptoms, will need to be home on quarantine for 14 days after their last exposure to someone with COVID. They can be tested during that time if they are ill, but even if it is negative, they will need to stay home for the full 14 days. If they test positive during that time, they will need to stay home for 10 days after the onset of their own symptoms instead.

When can my child go back to school?

Children with a known close exposure to COVID must stay isolated for 14 days from exposure. Negative testing does not decrease the time of quarantine and should not be used to allow a child to return to school sooner. If continued contact with the exposed case could not be avoided ( for example you, the primary caregiver), longer duration of quarantine may be required. I recommend talking with your doctor or the health department about a safe return to school dates.

Children with a known case of COVID-19 are able to return to school:

• No sooner than 10 days after their symptoms started
• Have improvement in symptoms
• Are 24 hours without any fever while not using fever reducing medicines.

If symptoms are minimal or they are asymptomatic when they get their initial test, this 10 day period will be started at the time the test was conducted.

Does my child need a negative test to return to school or activities?

The quick answer is, No.

As long as the above guidelines are followed, negative testing should not be required to return to school. Some kids may remain positive (in testing alone but they aren’t contagious) for weeks and a sustained positive test should not prevent them from returning to school or other activities. Therefore, it does not make sense to require follow up testing in most instances.

Summary

It’s never been more important to have a sustained, quality relationship with your pediatrician. As we continue to navigate these complex decisions, having a provider who knows your child and can help you make decisions can go a long way to keeping them in school as much as possible and to ensure that their classmates are safe.

“What’s school going to look like in the fall?” “Should I send my child or keep them at home?”

These are the questions that every parent is probably already asking as school districts roll out their plans for re-opening school in the context of continued COVID-19 cases in our communities. Many schools may present the option for all in person, all online or some blended method. And parents will have to consider what works best for their children.

There have been many stressful decisions in regards to COVID, but this might be the most anxiety inducing one for parents so far. School districts realize how stressful this is for parents and are taking steps to protect their students and your kids.

 “We understand that some of our families are anxious about the new school year so we are implementing strict new cleaning protocols for every campus. That means that schools will be cleaned multiple times during the daytime hours rather than in the evening as has been the practice for many years,” said FWISD Superintendent Kent P. Scribner. “We are also making a significant investment in both Personal Protective Equipment--for both adults and children—as well as cleaning supplies for campuses and other FWISD facilities. The good health and safety of our students and employees remains our top priority.”

The Texas Education Agency released these guidelines for school reopening on July 7, 2020:

• Daily on campus learning will be available to all parents who choose that option for their children
• Parents may be asked to commit to remote instruction for a full grading period but will not have to commit until 2 weeks ahead
• Health and safety procedures should be in place for student and teacher safety

In normal times, making a decision about what your child will do for school in the middle of July would seem way too late, but this year it feels way too early.

Each parent will have to make their own decision but here are some things that it would help to consider:

Childcare and Other Resources

First and foremost, it’s important to consider that children attending school is an important part of allowing parents to work and function in society. Parent’s jobs help secure food, shelter and in many cases provide health care insurance that allow children to receive care when needed. Not all parents can work from home, stay productive and keep a job. In addition, many of our children receive their most nutritious and guaranteed meal during the school year through their school lunch. Schools provide many resources to our communities and children beyond education.

Medical

Healthy children, for the most part, are considered to be safe in the school environment. Children have been more or less spared from severe illness but, as with most illnesses, children with chronic medical conditions are at higher risk for severe illness. Parents of children with medical conditions may learn toward keeping their child in the online environment in order to protect them from exposure. In addition to the child, considerations must be made for other household members and extended family members with whom the child might have contact. If the child will have contact with family members who have weakened immune systems, they could bring the virus home despite not having significant symptoms.

School

Examining the policies and procedures of the school will be another important decision point for families. Is the school district taking the recommendations for safety seriously and attempting to implement them consistently? With kids involved, there will be a learning curve but districts should be considering policies in regards to social distancing, mask use and movement throughout schools at a minimum. The evidence suggests that most schools are taking the threat of COVID very seriously but each parent should make that assessment for themselves.

Educational

April and May taught us a lot about how capable our students were of learning in an online environment. While the school districts will be significantly more prepared for teaching online, there are certain kids for whom it was obvious that the online environment was not going to be the right choice for them. Children who receive services and support at school might have a more difficult time adjusting to life at home without that extra help. For others, they struggle to learn online and in-person teaching might be a better fit. In addition to the child’s learning needs, families must consider their ability to support their learner with their existing responsibilities. Teachers and school staff can help, but students at home will often require some, if not significant, guidance from someone in the home. This is especially true for younger students and those with special learning needs.

Social and Emotional Needs

Some kids have thrived in regards to their mental health with the online learning environment. Many children with anxiety in regards to school or formalized testing had significant improvement in their symptoms as they transitioned to at-home learning. Other students and families needed the structure and activity of school in order to maintain a sense of normalcy. The lack of contact with friends, teachers and other school staff affected them in very negative ways. Another consideration should be the child’s level of concern about COVID-19. Children with significant anxiety regarding the virus could anxiety, depression and other severe health and mental health issues.

Decisions regarding going back to school in the fall are complex. Each parent should consider how the effects of being at school or at home would affect their children and consider that as part of their decision.

For more information on this topic, read the recommendations of more than 50 Cook Children’s pediatricians, led by Medical Director of Infection Prevention, who worked to create guidelines for returning back to school. The AAP released similar guidelines that support opening of schools for in person instruction.

It’s likely the plans for each school will continue to change throughout the rest of the summer. Parents should consider the best option for their children and be prepared for disruptions to occur based on local case numbers.

For more on this topic:

• Cook Children's Physicians Create Guide to Help Kids Safely Return to School amid COVID-19 pandemic
• COVID-19 Planning Considerations: Guidance for School Re-entry (AAP)
• Young Athletes and COVID-19: 'When Can My Child Start Playing Sports Again?'
• TEA Issues Comprehensive Guidelines for a Safe Return to On-Campus Instruction for the 2020-21 School Year

One of the first things I like to know when ascertaining the seriousness of a child’s condition is whether the child is playing, smiling eating or drinking. If a complaint is brought up regularly, interferes with play or a child really cries, parents should consult a physician.

High Fever

New parents might find the recommendations for when to seek treatment for a fever daunting, but it gets easier with time.

For infants 3 months and younger, any fever is serious and parents should see a physician’s help immediately.

For children older than 3 months, a high fever combined with symptoms such as lethargy, changes in fluid and/or difficulty breathing require prompt medical attention.

Children who are 3 months or older with fevers of 102 degrees Fahrenheit or higher that don’t respond to fever-reducing medicine should see a doctor.

Fevers up to 101 can often by managed with fever-reducing medicine, fluids and rest. However, if your child also has a harsh cough – which may indicate croup – you need to consult a doctor.

Stomach Hurts

If your child has a stomachache, there are three red flags that may warn parents of a serious illness such as appendicitis:

1. Your child has a tummy ache and a fever.
2. Your child can point with one finger to where it hurts.
3. Your child has been vomiting.

Children don’t need to have all three symptoms for parents to seek help because any one of these symptoms can indicate that appendicitis might be a possible diagnosis. Parents should also not wait too long. If symptoms worsen in six to eight hours, consult a doctor.

My Head Hurts

Headaches and even migraines can occur in children as young as 3 years of age. Parents can give their child a nonsteroidal anti-inflammatory medicine, such as ibuprofen, or eliminate headache pain caused by hunger, fatigue or dehydration with food, rest or fluids.

Talk to your pediatrician about his or her treatment recommendations, particularly if you’ve never treated your child’s headache before.

If headaches occur at the same time each day, parents should consult their pediatrician. Headaches can occur with the flu or fever, but we become concerned if a headache is serious enough to make a child cry, interferes with play or is so bad the child is vomiting.

Related Topics:

• Let's Learn About Fevers
• Is It Strep Throat or the Flu?
• Let's Learn About the Flu
• Probiotics for Tummy Bugs: Do They Help Your Chlid?
• My Child Poops Every Day. How Can They Be Constipated?
• Is Over-The-Counter Medication Causing Your Child's Headaches?
• When It Comes To Your Kids, It's Never Just a Virus

For most of her 20 years, Shanley Stuteville has been a patient at Cook Children’s.

She came to the medical center at the age of 3 after she began having seizures. Even as an adult, she continues to be seen by the Neurosciences team. After receiving care for so long, Shanley knows better than most how overwhelming a hospital stay can be, especially for younger kids.

“I was in the hospital last summer for my second phase [of testing], and my nurses were mentioning they were really glad I was older because a lot of the younger kids get scared,” Shanley said. “After that, my mom suggested I should write a book to help them.”

After years of testing and needles, Shanley has a wealth of empathy for younger patients. She recalls her initial feelings of fear of the unknown, but they were quickly lost when she realized her hospital was unlike any other.

Shanley began to write in July 2018, while scheduled to undergo testing at Cook Children's Neurology Epilepsy Monitoring Unit (EMU), where she would be watched 24/7 for four days to see what the source of her seizures was. The book became a family interest when her aunt began to illustrate Shanley’s medical team and created an animated world where leads, IVs and MRI machines weren’t so scary after all.

“Soon an IV was applied to my hand. Their magical spray made it something I could stand,” Shanley wrote. “It took away the pain and for that I was glad. It did not hurt, not even a tad.”

Shanley donated 50 copies of her children’s book to the Epilepsy Unit, but despite her appointments and hospital stays she’s found other ways to give back to her medical team. As a student leader at her university, Shanley completes a lot of service hours, but her service project last year was a hospital-sized treat.

As a “thank you” to her medical team, Shanley baked over 900 cookies for the Dodson Specialty Clinic staff. It took her a period of several school semesters to complete, but she delivered homemade cookies to each floor.

Although she spends an ample amount of time at Cook Children’s trying to figure out why she has seizures, it’s not uncommon for patients with epilepsy to have periods of time without seizures. Shanley would occasionally go 100 days without seizures, and even celebrated with a cake with her nearly lifelong doctor, Howard Kelfer, M.D., a Cook Children’s neurologist. However a life without seizures was never permanent.

“She’d go long periods of time without having a seizure and then one would come back around so it was really discouraging for them because they thought she was going to be over it,” Dr. Kelfer said. “It eventually became very clear that her seizures weren’t responding just to medications. It was always, ‘well she went this long without a seizure, maybe she’ll go longer this next time.”

Shanley was eventually determined as a surgical candidate after her time in the EMU last summer. Her surgery in May 2019 removed a portion of the front lobe in her brain. While she has not had a seizure since, it will take a year of no seizure activity before it can be deemed a success.

Shanley is now able to sleep through the night, a small comfort she didn’t have before her surgery. Her surgeons were also careful in the placement of her scar, which will be hidden by her hair when it begins to grow back.

“I have to say that I wouldn’t mind if it did [show],” Shanley said. “It will always be a reminder of the wonderful men and women at Cook, as well as hopefully provide an example to other children that they can walk through this and recover too.”

Shanley remains an advocate for younger patients, and is recovering quickly after her brain surgery. Her passion for patients inside the medical center has shaped her life for the last 17 years, and she is hopeful to make it a lifelong expression of gratitude.

“Shanley and her family come to all the family support groups and they’re willing to volunteer to talk to other families,” Dr. Kelfer said. “Shanley is extremely motivated to not allow her seizures define who she is.”

Following her surgery last month, Shanley will return to school this fall where she is studying to become a pediatric occupational therapist.

Dan Guzman, M.D., a Cook Children’s emergency physician, called the day gut-wrenching for the victims, their families, and the medical staff that took care of the kids, ranging from ages 3 to 14.

Gun awareness and gun safety is a passion for Dr. Guzman. He is the medical director of the Aim for Safety program at Cook Children’s, which promotes firearm safety for children. The program is a multi-step interactive experience that provides parental awareness and teaches children the steps they should take when they encounter a firearm.

“I think most people think this ‘won’t happen to us’ because we’ve taught our kids to never touch guns,” Dr. Guzman said. “But if you aren’t taking the proper precautions as the adult and parent, it’s probably only a matter of when, not if, your life may be affected by an unintentional discharge involving someone you know, and maybe even your child.”

Firearm-related fatalities are a top 3 cause of death among children in the United States.

Dr. Guzman said before the weekend, the medical center staff sees about one child per week. Already in 2019, three gunshot wounds treated at the medical center have been fatal.

“Unfortunately, the tragedy of children falling victim to unsecured firearms continues to happen daily,” Dr. Guzman said. “These preventable incidents and the pain and suffering they inflict can be reduced by properly securing your firearms.”

As part of the program, Dr. Guzman offers these safety tips to follow:

The 3 Ts of firearm safety and children

Talk – This includes your family, neighbors and friends. When your child visits other homes, ask the owners if there are guns in their homes and how they are stored. Dr. Guzman said this question is not to be insulting, but to keep your children safe from unsecured firearms.

Teach – Have a conversation with your kids about what to do if they see a gun:

• Stop
• Don’t touch the gun
• Run away
• Tell someone

Take – Dr. Guzman is asking gun owners to take action and store their firearms properly. And, to take personal responsibility for our children’s safety.

Dr. Guzman stressed that children are curious and impulsive which can be deadly when paired with a firearm. Storing a loaded firearm under the mattress, in a bedside table or a closet is placing your family at risk, Dr. Guzman added.

The most secure place for your firearm is in a safe with the ammunition stored separately. Unsecured firearms should always be in your possession. If you are unable to purchase a gun safe, then separating the ammunition from the firearm and using a cable or trigger lock will help reduce the risk of unintentional injury to your child.

“It’s important to assess and evaluate your home injury risk and find ways to reduce the hazards in your home whether it is related to firearms, water safety, poisonings or any other safety risks,” Dr. Guzman said. “Discussing with your children the importance of what to do when they encounter a firearm can help to reduce unintentional injury in your home.

As a pediatrician, I have been lucky to practice medicine in the post-vaccine era. Although I have watched kids struggle with whooping cough, meningitis, mumps and pneumonia, I am happy to say I have never seen many of the vaccine-preventable diseases. I rely upon my education and training to know about the diseases and recognize them should the need arise.

I do frequently wonder, ‘What was life like for families and children before vaccines were introduced?’ How did people manage the illnesses and anxiety that came with the disease?

For a firsthand answer, I only had to talk to the person sitting at my dining room table during a typical weekend family dinner – my mom.

It was the summer of 1949. While other children were skipping rocks and riding their bikes, my mom was lying in a hospital bed as one of many children struck down by polio.

The illness began as a fever with trouble swallowing and weakness in her left leg. The doctors quickly admitted her to the hospital for quarantine and treatment. Her most vivid memory of the time has to be of the spinal tap used to aid in her diagnosis. At the time, there were no child life specialists to comfort her. She was told to hold still and if she moved the test might kill her.

After 3 months in the hospital with only her mother allowed to stay, her symptoms seemed to be worsening. Her kind physician came into the room one day to visit and cheer up the family. His kindness unfortunately, resulted in him contracting the disease and being confined to a wheelchair for the remainder of his days. After all, back then doctors did not even realize the value of handwashing.

I asked my mom what people thought about polio in the pre-vaccine era. “Everybody was scared to death of catching it! They did not know how they got it but knew it was prevalent in the summer months. They tried to avoid the sun and swimming holes since those seemed to be related.”

We now understand the transmission of polio much better. Polio comes from a virus that is highly contagious. It is spread person to person through sneezing, coughing or contact with human feces. Before the successful introduction of the polio vaccine in the 1950s, the disease resulted in the paralysis of 15,000 people per year. Since 1979, no cases of polio have originated within the United States but cases can be brought in by travelers with the disease.

My mom was one of the lucky ones. Just as a conversation with her medical team was turning to placing her in an iron lung to support her breathing she began to recover. The impact of the illness, however, continues to this day with residual weakness in her legs that makes walking for her a constant challenge.

I asked her what she thought about vaccines as a mom and a grandmother. She responded, “I experienced polio and its effect on my life. I want all my kids and grandkids protected so they don’t have to go through what I did.”

Vaccine-preventable diseases such as polio and the re-emerging measles and mumps are not historically that far away from us. We cannot forget the tremendous impact these diseases have had on the lives of so many before the introduction of vaccines.

If you want to learn more, you can check out the CDC website on polio. 

Better yet, just look across the table on a sunny Saturday afternoon and if you are fortunate to do so, ask the folks who lived it. Their stories and experiences are powerful.

More Information On This Topic

• 'I'm Worried Too.' Pediatricians Concered As Texas' Nonmedical Vaccine Exemption Rates Hit All Time-High
• 5 Questions We Get Asked About Vaccines Answered
• Vaccines for Your Children: 9 Facts Parents Need To Know
• Vaccines and Immunizations
• Information for Parents

So what is difficulty breathing? How do you tell if your baby or child is having it?

In babies there are 3 main considerations to look for difficulty breathing:

1. The nose - When babies are having difficulty breathing, their nostrils will flare open and closed with each breath.
2. The area below the rib cage - Babies will begin to use their bellies to help them breathe when they are having trouble, this will look like sucking in and out of the area below the ribs.
3. Rapid breathing - Babies already breathe fast and they can breathe at a really unpredictable rates. But if you feel like the rate is faster over a sustained period, it could mean that they are having difficulty breathing.

In older children, there are some similar and some different ways you can assess difficulty breathing:

1. Watching - Just like babies, you can watch an older child under their ribs to see if they are breathing harder than normal.
2. Assessing activity - Are they able to go about their normal activities or are they getting short of breath?
3. Say the alphabet - Can they say the alphabet without breathing? How far can they get?

Obviously these aren't perfect assessments and children should be seen if you are worried. Any change in alertness or change in color (blue or duskiness) is an emergency.

This may not be one of the questions you expect to hear from a pediatrician during a well-child visit, but it’s always on the checklist for Vanessa Charette, M.D., a Cook Children’s pediatrician in Fort Worth.

Dr. Charette asks this question for a few reasons. For one, she’s genuinely interested and she’s even gotten some great recommendations of books to read to her children.

“I also ask because I want your child to know that adults around them think reading is important and I am hoping this small question may help them grow up with a love for reading,” Dr. Charette said.

It’s never too early to begin reading to your child.

Ear and brain structures for listening begin working between 25-39 weeks of gestation. At about 28-30 weeks, connections between the brain and the ear start happening.

“For the auditory brain to develop, babies need to listen to language, music and all different kind of sounds,” wrote Becky Clem, an education coordinator for Rehab Services and a speech-language pathologist and listening-spoken language specialist. “Reading aloud is a great way to help children learn to listen and talk. Reading aloud to that growing baby in utero is a jump start to listening, talking and future reading. Reading aloud to children of all ages has huge benefits.”

Clem said the first three years of a child’s life is the most important time for learning. Reading aloud to children boosts their vocabulary, listening and talking skills.

Research on reading aloud to children tells us that it:

• Is the single most important thing to help a child get ready to read and learn.
• Helps a child learn more, unique words. Children who know more words do better when starting kindergarten.
• Helps a child’s brain develop. Language development is vitally important from birth to 3 years.
• Helps a child love to read.
• Helps a child learn.
• Helps parents bond with their child.
• Sets an example for children that reading is important and fun.

Of course, your toddler won’t sit still, but Dr. Charette says parents shouldn’t worry about reading the entire story to them. “Look at the pictures, point things out on the pages, have them find things on the pages,” She said. “The Richard Scarry books are great for this and we read them over and over when my kids were this age.”

For the school-age child that maybe doesn't love reading yet: Dr. Charette suggests getting them books on topics they love. Does your child love Legos? Then Lego® books it is. Do they love animals? Then try National Geographic kids’ animal fact books. They have lots of pictures and fun, short reading sections. Is your kid funny? Then try a joke book. But Dr. Charette warns as only a mom can: "This leads to the most ridiculous knock-knock jokes being read aloud to you.”

“For your older school-age or teen child: Be a two-person book club,” Dr. Charette added. “I have done this a few times as my children became older and they loved it when I read a book at the same time they were reading it. It allows them to talk to me about the story. They were so excited to share with another person what is happening with the characters and what may happen next.”

Clem understands that families lead busy lives in today’s world, but she offers these tips for reading aloud into your day and week:

Some ideas for fitting reading aloud into your day and week:

• Visit your local library. Get a free library card for you and your child. Check out books weekly. It’s FREE!
• Visit read aloud storytime at the library.
• Read aloud at breakfast time.
• Keep books in the car to read while waiting at appointments.
• Make bedtime book reading a family tradition.
• Have a family storytime every week.
• Keep waterproof books in the bathtub for a quick read during bath time.
• Read together as a family every day.
• Have older siblings read aloud to younger siblings.

For more on this topic, read Becky Clem's blog, "Raising Bookworms."

"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

Children initially begin to walk between the ages of 12 and 15 months. In the early stages of walking, you may notice your child “waddling” with their feet wide and their arms out like an airplane. Once a child has become more comfortable with walking, you may notice them becoming “brave” and attempting to walk fast or even run. As a child goes through these stages of development, you may find your him or her falling several times during the day.

It’s normal for children to fall frequently as they are learning to walk. In the early stages of walking/running, a child is learning to plan movements, find their balance and explore new-found independence.

As children gain more control of their body, you will find they begin to walk with a narrower base and their arms are at their side. A child will walk/run with decreased hesitance and you should notice less falls. This will occur within the first 2-3 years of learning to walk.

When should you be concerned about your child’s falling? There are many different reasons why children lose their balance throughout the day.

• Pay attention to when your child is falling and ask yourself a few simple questions:

• Did the type of shoe he or she is wearing change? Often times children have difficulty finding their foot placement with new shoes, especially ones that are heavy (such as a boot) or non-supportive (such as a sandal or slip-on shoe.

• Are they only falling when reaching a curb or changing surfaces? Sometimes vision can play a big role in a child’s ability to maintain balance with walking and running. If you suspect a visual deficit, you should contact an eye care specialist.

• Does your child only fall when playing with peers their age? Children have to think constantly about their next move when walking/running during play. You may find that they will trip or fall when attempting to keep up with peers their age. This could be the cause of decreased coordination, meaning they are having a difficult time organizing movements during play, causing them to fall.

• Try to pay attention to how your child is falling, sometimes a child may have a difficult time clearing their toes when walking/running and will fall. This would be good to mention to your pediatrician for possible referral to a physical therapist.

If your child is falling more than 10 times per day and doesn’t fit into the above categories, it may be beneficial to talk to your pediatrician about a physical therapy evaluation to assess your child’s needs.

About the author

Morgan Hubbard, PT, DPT, is a physical therapist at Cook Children's. Physical therapy at Cook Children's focuses on large motor and functional skils to enhance development, restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's has Rehabilition Services in locations in Fort Worth, Hurst and most recently in Mansfield. If you would like to schedule an appointment or speak to our staff, please call 682-885-4063.

My question to you is...what in the world am I talking about? Our children’s vocabulary is very important, and if we use words such as “this” and “that,” we lose out on opportunities to teach our kids new words. I took a course recently that said that children between the ages of 4 and 5 demonstrate the most significant growth in vocabularies.

A child the age of 4 has a vocabulary of about 1,200 words, but a child the age of 5 has a vocabulary of 5,000 words. That is a HUGE growth in words.

Your child's vocabulary is so important. Think of each skill your child develops as building blocks. Starting from infancy, your child begins by cooing, which turns into babbling that then turns into words and eventually sentences. Research shows that children with higher vocabulary results in better decoding abilities. All that to say that their reading skills will benefit from having better vocabulary.

So what can I do to help my child?

1.Be specific when talking to your children. If I changed the story above to something more like this, it would all make sense…..

The other day I went on vacation. We went to South Padre Island. I enjoyed it because we went parasailing and fishing. My son caught a fish but his line got tangled with someone else’s. We couldn’t stop laughing, but eventually we helped him untangle the line and get it on the boat.

Now isn’t that so much better.

2. Try teaching your child new words or even different variations of the same word. For example: “The elephant is big” can turn into “The elephant is gigantic.” or even “The elephant is enormous.”

3. Use the same word in many different ways. Think about the word “run." The dog ran fast. I ran next to him, but I could not run as fast. My brother tried to run, but he fell down. After I ran, I was really tired. Running is fun.

4 .Make learning new words fun. Instead of doing flash cards (snooze), find something that is interesting to your child and think of words based on the activity. If your child likes playing with farm animals, think of several words you could teach your child involving farm animals. As you play, introduce those words you wrote down.

5. Read books to your child. Books offer so many new and wonderful opportunities for learning words. You don’t have to necessarily read all the words, just talk about the pictures. Try thinking of words you can use multiple times throughout the book.

Vocabulary development is critical for children. It helps with building sentences and it’s important for reading as well. Markus Zusak put it well when he said, “The words. Why did they have to exist? Without them, there wouldn’t be any of this."

I spend a good portion of my day asking my daughter to give my son a little space; sister loves hard!

Recently, my son was playing in the kitchen (right next to me) when my daughter suddenly came in, sat behind him and looked like she was doing the Heimlich on him. As I was telling her to back away slowly, I noticed he was trying to put something in his mouth and wasn’t able to due to her pestering... and then I wanted to throw up. It was a button battery. A tiny battery that he could have swallowed without difficulty, and without me ever knowing it.

Last year, more than 470 children visited the Cook Children's Emergency Department after swallowing a "foreign body." Most objects that children ingest can be passed without much concern, but a battery is not one of those things. A battery lodged in the esophagus is a medical emergency. Essentially it can erode the lining of the esophagus. They are very dangerous and can be deadly without treatment.

As a previous pediatric ICU nurse and currently a primary care nurse practitioner at the Willow Park office, I knew this. I warn others of this danger. So how did it almost happen 2 feet from me?

I suddenly remembered my daughter was wearing a headband that lit up the day before, and she accidentally pulled the back off spilling the batteries. I thought I had picked up all the batteries, but one was hiding under the kitchen mat.

After thanking my daughter for her brother obsession, I went on a mission to locate all the button batteries in the house.

Keeping these babies safe is a hard job, for ALL of us! Doing a quick scan of the house to make sure no batteries they could easily swallow are in their reach is a good step towards safety.

-Sperry, NP

For more on this topic, read:

• Number of Kids Seen in ER for Swallowing Small Objects Doubles Over Past Two Decades
• Button Battery Injury Prevention Safe Kids
• Choosing Safe Baby Products
• Is Your Home Safe for Baby?
• Is This an Emergency?

This would be stressful for any mom, but Alexa's son has high-functioning autism. She was worried about who would be sitting next to him on the flight and would they be tolerable of her son. 

The story had such a happy ending because of a wonderful man named Ben Pedrazza, who even messaged Alexa with a photo of the two of them on the flight. 

"He did ask if we were there yet several times but he was a great travel buddy," he wrote. 

Isn't that awesome?

With this story in the news, I thought it would give us a chance to talk about autism. I often get asked about it in my office. Some parents want to know if their child should be tested or how they would know if their child has autism. So let's take a look at what pediatricians look for as far as the signs and symptoms of autism spectrum disorder.

Not one single test can diagnose autism. This is not surprising given the complexities of the neurodevelopmental condition, some of those we do not understand fully. What is known is that the earlier it is diagnosed the earlier interventions can be started and the outcomes tend to be more positive.

So what do you look for? What are the signs?

The real answer is it can vary depending on the child, key to early diagnosis requires a partnership between the parent and the child’s doctor. Any concerns a parent has about development should be looked into further. In other cases, concerns may arise after standard developmental screening which occur at each well-child visit. Standard autism screening should occur between 18-24 months of age.

Autism, or ASD (Autism Spectrum Disorder), is a neurodevelopmental condition that may include difficulties with social skills, behaviors of repetitive nature and difficulties with verbal and nonverbal communication. It’s estimated that 1 in 59 children are affected by autism in the United States today. ASD is a complex disorder that presents with varying degree symptoms ranging from mild to severe. There is no single cause, and at this time both genetic and environmental factors are thought to contribute. More importantly no reliable studies to date have shown a link between ASD and vaccines.

Some early signs include:

• Delays in development like delayed babbling or cooing
• Lack of social smile by age 6 months
• No pointing or waving by age 12-14 months
• No single words by age 15 months

Having a pediatrician recognize these signs is one of the reasons it’s important to keep your child up to date with well-child visits. The visits typically include questionnaires about development and this is an opportunity to identify any of these delays early.

Some children may have delays only in one area and no other difficulties. Standard screening tools exist to help your doctor identify other problems which may indicate autism as a possible diagnosis.

One of the most widely used screening tools is MCHAT-R (Modified Checklist for Autism in Toddlers, Revise). This checklist is a series of 20 yes/no questions. The scoring of this screening tool gives a low, medium or high risk for ASD. All children with medium/high risk results should have appropriate follow up which may include referral to a developmental pediatrician or a trained psychologist for formal ASD testing.

What if the screening is negative, but the parent has concerns?

A detailed history regarding the concerns also may lead to referral for further testing even if the screening is negative. The reason for this is because ASD has such a wide presentation of symptoms it may eventually be diagnosed when symptoms are more subtle.

Since every child with autism is different, the treatment recommendations will vary for every child depending on the difficulties they are having. The current evidence supports the following effective treatments for autism: ABA (Applied Behavior Analysis), speech therapy, occupational therapy and treatment of any other co-existing condition of course.

We know early diagnosis leads to early intervention, which has been shown to improve behavior, skills and language development. Early intervention helps with the outcomes of children diagnosed with autism. It’s important to bring up any concerns to your child’s primary care provider as soon as you have any worries or concerns.

An early diagnosis may also start you on an incredible journey with a child as interesting and amazing as Landon.

For more on this Topic:

• Autism
• Cook Children's Child Study Center
• New Self-Defense Class Empowers Teens with Intellectual Disabilities to be a 'Hard Target'
• The Autism Spectrum: A Pediatrician's Explanation
• Avery's Journey: An Autism Spectrum Disorder
• Autism Spectrum Disorder: The Need to Wander or Elope
• Julia Brings 'Sunny Days' to Kids with Autism
• Living with Autism
• What Is Autism?

In his veto statement, Gov. Abbott called the bill “an unnecessary invasion of parental rights and an unfortunate example of over-criminalization.”

Texas law already requires children younger than 8 years old or shorter than 57 inches to be secured in a car seat and that the car seat be installed according to the manufacturer's instructions. The current law does not specifically mention car safety guidelines for children under 2 years old.

Following the veto, Chris Turner, D-Grand Prairie, who authored the bill said to The Dallas Morning News: “The governor’s veto sends the irresponsible message that it doesn’t matter if a child under age 2 is rear-facing. It does matter, because it is proven to save young lives.”

In much of the medical community, the talk among experts has shifted away from the age of the children to simply keeping them safely in a rear-facing car seat as long as possible. In 2018, the American Academy Of Pediatrics updated its recommendations on car seats for children. The AAP recommends children remain in a rear-facing car safety seat until they reach the highest weight or height allowed.

Benjamin Hoffman, M.D., FAA, the lead author of the policy statement and chair of the AAP Council on Injury, Violence and Poison Prevention, said newer car seats allow children to remain rear-facing until they weigh 40 pounds or more, meaning most kids can remain rear-facing past their second birthday.

“It’s best to keep your child rear-facing as long as possible. This is still the safest way for children to ride,” Dr. Hoffman said. “Car seats are awesome at protecting children in a crash, and they are the reason deaths and injuries to children in motor vehicle crashes have decreased. But that also means we just don’t have a large enough set of data to determine with certainty at what age it is safest to turn children to be forward-facing. If you have a choice, keeping your child rear-facing as long as possible is the best way to keep safe.”

Nationally, car crashes remain a leading cause of death for children. The American Academy of Pediatrics states that over the last 10 years, 4 children under 14 died each day.

Last year at Cook Children’s, 37 kids, who were 2 years of age and under, were involved in motor vehicle crashes, including five deaths (the most in at least five years). According to Cook Children's Trauma team, there have been 205 children in that age range invovled in wrecks and 12 deaths since 2014.

Spinal cord injury is a major concern for children who have transitioned from rear-facing to forward-facing or booster seat too soon. Melodie Davis, director of the Pediatric ICU, Transitional Care Unit and Rehabilitation Care Unit at Cook Children’s, said a young child’s head is so heavy as a toddler that it whips and causes damage.

“Properly used car seats protect children from injury and death,” Davis said. “Infants and toddlers are at risk for head, neck, and spine injuries during car crashes because their heads are large and heavy compared to their bodies. When placed rear-facing, the car seat can better support these high-risk areas because the seat is able to absorb the force of the crash. Unfortunately, we see significant neck injuries with cord damage in incorrectly used car seats. Another common injury includes traumatic brain injuries because of the force of the crash. Following proper car seat use guidelines can significantly decrease injuries and death in children.”

Using the right car safety seat or booster seat lowers the risk of death or serious injury by more than 70 percent, according to the AAP. Parents are suggested to check the instruction manual and the labels on a car safety seat to find the manufacturer’s weight and height limits. When a child is approaching the limit, it’s time to think about transitioning to the next stage.

“We hope that by helping parents and caregivers use the right car safety seat for each and every ride that we can better protect kids, and prevent tragedies,” said Dr. Hoffman.

Halley Hogan, M.D., a pediatrician at Cook Children’s newest location in Prosper, Texas, took some time to answer our questions about what’s going around.

What kind of bugs are you seeing in your office right now?

We’re seeing cases of Influenza B, norovirus and group A strep.

Is the flu season still in full swing or are we nearing the end? 

We are begining to see flu activity throughout the state of Texas. Flu activity will likely remain high for several more weeks.

What should parents know about the difference between the flu, norovirus and rotavirus? 

Norovirus is the virus that causes the “stomach bug.” It causes vomiting and diarrhea and can affect anyone.

Rotavirus most often affects infants and young children. It can cause fever, watery diarrhea and vomiting. What we worry about most with rotavirus is infants/young children becoming dehydrated. It is recommended that children get the rotavirus vaccine at 2 months, 4 months, and 6 months of age. Vaccinated kids are less likely to get sick from rotavirus and can have less severe symptoms if they do get rotavirus.

Flu is caused by the influenza virus. Flu affects the respiratory system, and can cause fever, chills, cough, sore throat, runny/stuffy nose, body aches, headache, and fatigue.

With many schools back in session after spring break last week, what does that mean for these illnesses? Are kinds more at risk being in school?

Flu is spread when people with the virus talk, sneeze, or cough, sending flu droplets to the people close to them. It can also be spread by touching a surface that has flu virus on it and then touching your nose, mouth, or eyes. If you have the flu, you are contagious one day before symptoms start and up to 7 days after becoming sick.

Norovirus can also spread easily. Kids can get norovirus by sharing food or drinks with someone who is sick, or by touching surfaces contaminated with norovirus and then touching their mouths. You are most contagious with norovirus while you have vomiting/diarrhea, but you can still spread it for two weeks after you are better.

Many times, children with flu or norovirus return to school while they are still contagious and this increases the spread of these illnesses and can cause outbreaks in schools.

Are there any questions or concerns you’re hearing from parents?

Yes, parents often ask “How can we decrease the chances of siblings/other family members/friends getting the flu?”

The best way to decrease your risk of flu is getting the flu vaccine every year. It is recommended for everyone 6 months of age and older. Wash your hands often with soap and water or an alcohol-based hand rub. Try not to touch your eyes, nose, and mouth. Cover your nose and mouth with a tissue when you cough or sneeze, and wash your hands after.

Meet Halley Hogan, M.D., Prosper Trail's Pediatrician

 

Dr. Hogan was raised in the Dallas area. After earning a Bachelor of Science degree in biochemistry from SMU, she attended the University of Texas Medical Branch in Galveston for her medical degree. She then completed her pediatric residency at University of Texas Southwestern in Austin. Dr. Hogan is board certified by the American Board of Pediatrics and a fellow of the American Academy of Pediatrics.

Dr. Hogan provides comprehensive health care to children of all ages. She has a passion for pediatrics and loves getting to know families, with the philosophy that providing the best primary care depends on developing personal relationships with her patients and their families. She has a special interest in preventative medicine and promoting healthy, happy childhoods for all children. Outside of work, she enjoys spending time with her husband and their two young sons, as well as reading and traveling. Make an appointment with Dr. Hogan here.