For more than six years, Cook Children’s online newsroom has provided the latest in pediatric health news to more than 16 million people in 230 different countries.

But during all that time, the team behind the scenes felt they had more to accomplish. At the top of their list was creating an online Spanish language presence. This month, they reached their goal with the publication of Checkup Newsroom En Español.

This new newsroom is in Spanish, with content written and approved by Cook Children’s pediatricians and health care providers.

“We know the importance of sharing up-to-date and evidence-based information with our patients and their families,” said Bianka Soria-Olmos, D.O., a Cook Children’s pediatrician and primary contributor to the webpage. “Checkup Newsroom is hugely important for getting out timely and relevant health information. With our community being so diverse, we realize making this information available in Spanish is necessary.”

The addition of the Spanish-language newsroom builds on Cook Children’s ‘Promise’ to improve the health of every child through the prevention and treatment of illness, disease and injury.

The COVID-19 pandemic has highlighted the need for credible health information in the Hispanic community. According to Tarrant County Public Health, 27% of COVID-19 cases are among Hispanics, making it the most affected group by race and ethnicity. Further, Texas’ Hispanic population has grown by more than 2 million since 2010 and the state's demographer predicts that Hispanics will be the state's largest population group by mid-2021.

“We are so happy that Cook Children’s is making so many efforts to be inclusive,” said Vicki Kelley, Family-Centered Care Program Manager, who oversees the Hispanic Family Advisory Council at Cook Children’s. “All parents want to do what’s best for their children. Having an online presence such as Checkup Newsroom gives parents a great resource to find helpful and accurate information for their kids.”

“The publication of our Spanish newsroom is a great next step in our diversity and inclusion efforts at Cook Children’s,” Wini King said. “We’ve talked about making this happen for many years, but were limited in time and resources. The timing just felt right, and with the COVID-19 pandemic, we know this information is needed now more than ever.”

It’s natural for parents to want to protect their children when they are distressed. But when it comes to anxiety, taking kids out of anxiety-provoking situations may not always be the right answer.

In fact, we should make a distinction between positive stress and clinical anxiety. Understand that an episode of anxiety/fearfulness/avoidance isn’t limited to a full blown clinical anxiety disorder.

Positive stress (like fears of taking a test, or going down a slide, etc.) is actually vital to normal child development and for teaching a child coping skills and the resiliency in learning to fail and then try again.

If a child’s anxious responses are expanding or not improving, however, they need to seek the help of a psychologist or therapist who can help assess the scope of the problem and craft a unique treatment plan that may include Cognitive Behavioral Therapy (CBT).

The psychologists we spoke to for this article found the parent often have an underlying anxiety disorder that may be untreated. While CBT is one very helpful treatment option (and one that is very applicable for straightforward anxiety in older teens and adults), kids are very different and there may be other factors mitigating the anxious response.

By attempting to protect your children from these situations, you may actually be enabling them to avoid and escape the situation. Then kids never learn to work through the root cause of their anxiety.

Here are 5 quick facts to remember:

Fact 1: Your child may not be happy or comfortable all of the time, and this is OK.

Fact 2: It’s difficult to see your child frustrated or disappointed, and this is also Ok.

Fact 3: Your child WILL get angry with you, and this is OK

Fact 4: Your child WILL say mean things to you, and this is also OK

Fact 5: You do not need to rush to fix it/ make it better.

Fact 6: Your child’s anxious behavior is NOT a reflection on you as a parent.

Anxiety affects 25% of children ages 13 to 18. Let untreated, anxiety can lead to depression, academic underachievement, poor social skills and substance abuse.

Sometimes, it’s difficult for parents to recognized anxiety. Kids can become easily frustrated with changes, have meltdowns, over-react, be difficult to soothe, be very reactive, struggle with transitions, be easily embarrassed, not be able to tolerate feedback/criticism, etc.

Parents (or others), may see these emotions as an anger, mood or ADHD issue, when there can be more to it, and testing can be helpful to decipher it.

One of the best treatments for anxiety is Cognitive Behavioral Therapy (CBT) from a licensed behavioral health specialist, and has proven to provide better symptom reduction than medication for most children. While licensed psychologists play an important role in behavioral health, in terms of providing psychological testing, as well as therapy, our licensed professional counselors at Cook Children’s are vital as well in providing and teaching very creative and useful coping skills every day.

When choosing a CBT therapist, make sure they use “exposure” technique. The goal of CBT is to teach people how to help themselves through anxiety-provoking situations, not to escape or avoid them.

Cognitive Behavioral Therapy will help the parent too, as a child with anxiety affects the entire family unit. There is no “cure” for anxiety, but there are resources to learn to manage it differently. Don’t take away the opportunity to experience bad things, or your child will become emotionally fragile and never be able to handle anything.

Tips:

• Teach by example and be aware of your own feelings/ actions
• Praise the effort
• Don’t reward the wrong behavior
• Plan 15-30 minutes a day of one-on-one time
• Allow 30 minutes of decompression time after school with activity the child needs: either physical activity or calm activity
• After a tantrum, talk about it, learn to problem solve
• Find something to be grateful for in a bad situation/ outcome

Much like a peanut allergy is the body’s over-sensitivity to peanuts, anxiety is an over-sensitivity to worry. Anxiety can include:

• Overestimating danger
• Expecting the worst

Physical symptoms such as palpitations, difficulty breathing, stomach upset, trouble sleeping and attempting to avoid any perceived anxiety-inducing situation.

To learn more about Cook Children's Behavioral Health services, click here.

You walk hesitantly out of the bedroom to find it’s not an intruder, but something that may find even more worrisome: Your child is sleepwalking.

Children walking in their sleep is not uncommon. Twenty to 25% of children may sleepwalk at least once in their lifetime. Hilary Pearson, M.D., a pediatric sleep specialist and medical director of Cook Children’s Sleep Center, sees about 10 kids per month that sleepwalk.

With her expertise on the subject, we met with Dr. Pearson to learn more about sleepwalking, including the causes, what to do when it happens, when to worry, and myths that are far from true.

Common sleepwalking myths include:

• Waking up a sleep walker will harm them.
  • You can’t hurt anyone from trying to wake them up, although waking a sleepwalker may be hard to do Dr. Pearson explains. Waking them up isn’t going to cause any physical harm, but it might prolong the event and make it more dramatic.
• You can kill a sleep walker if you wake them up.
  • “I have never been asked this, but I can assure you it is far from true,” Dr. Pearson said.
• Sleep walking only impacts the sleep walker at night.
  • This is also not true. The time spent sleepwalking is not true restful sleep, so it can cause issues during the day. Kids can also be nervous about going to sleep if they know they may sleepwalk.

So what is sleepwalking? Sleepwalking is a disorder that occurs during the deepest stage of sleep resulting in walking around or performing “complex” behaviors. These behaviors can range from simply walking around the bedroom, to getting dressed, walking out the front door and even driving. There are several causes, but the most common are insufficient sleep, stress, and inheriting the tendency.

If you see your child sleepwalking it’s important to quietly and calmly direct them back to bed.

“Interacting with the sleepwalker too much can cause more confusion and even make the event last longer,” Dr. Pearson said. “You don’t have to awaken them or “snap them out of it”, but can just guide them back to their bed. “

If it happens occasionally there is no reason to be concerned, Dr. Pearson explains. It’s normal and many of us have sleepwalked at some point. However, if it happens more than twice a week and lasts for a few weeks, or if dangerous behaviors are occurring, further evaluation may be necessary.

Some children have succeeded in getting outside of the home, or injuring themselves during sleepwalking events, both of which can be dangerous. Sometimes sleepwalking is a phase that lasts for a few months to a few years. Other times it is caused by an underlying sleep disorder, so treatment could be helpful.

If the sleepwalking occurs more often, it is recommended that you speak with your pediatrician or family physician. He or she may refer you to see a sleep doctor for further evaluation.

Sleep studies are sometimes recommended to diagnose the causes of sleep walking. These studies allow for doctors to identify things like breathing or movement abnormalities. If a sleep disorder is identified, treatments to resolve it may decrease your sleepwalking. In other cases, analysis of the child’s sleep patterns or stress levels can help with identifying ways to decrease sleepwalking.

Sleep apnea has been reported to occur in up to 40% of children with sleepwalking. Other medical conditions that can contribute to sleepwalking are: restless leg syndrome/periodic limb movement disorder, fevers and even ADHD.

A child’s sleepwalking can simply be due to lack of sleep, poor quality of sleep or can be a sign that the child is coming down with a virus.

“Some families have members that sleepwalk into adulthood,” Dr. Pearson added, “But most will outgrow that behavior during their teenage years.” Keeping sleepwalkers safe is the most important part of the process.

"Your child is here with a sore throat. I know they haven’t had a fever, but strep has been going around."

Whelp, there goes your day. Cancel all your meetings. Call your pediatrician's office. Get an appointment in a few hours. Get your child tested and see what happens next.

But for some families in North Texas, there might be a better way to get treated for illnesses.

Through a partnership with Cook Children's, students in Keller ISD join a growing list of other local school districts who can now see a pediatric provider via telemedicine as part of our School-Based Virtual Health program. All while staying at school.

Children with qualifying conditions such as earache, sore throat, pink eye and many others who present symptoms to their school nurse, connect with either a Cook Children's board certified pediatrician or a certified nurse practitioner via a secure video connection. The school nurse can use devices to show the provider the child's ears, throat, rashes, and other physical findings as well as allow the provider to listen via a digital stethoscope. Students also can be tested for both strep and flu while right there in the office.

The virtual visits are completely covered for children who are on Medicaid. For all other patients, the price of a visit is $65 for new patients and $50 for established patients.

Keller ISD and Cook Children's started a pilot program approximately three years ago in five schools. The success of the program led to the adoption of the program to the full district last fall. Funds from the Grainger Foundation allowed for the purchase of more equipment and marketing information to be distributed.

Enrollment at Keller ISD has increased significantly over time. Although registration can be completed on the day of the visit, there are now over 1,000 students pre-registered for visits. More than 150 appointments have been completed this school year. About half of those visits have allowed the student to stay at school. Staying in school means decreasing lost educational time, faster time to diagnosis and treatment as well as prevention of many parental headaches and frustrations.

Interested in more information about Cook Children's School-Based Virtual Health program?

Click here to find out more about the program and how your school might become involved. If you would like to donate to this program, click here and type in "telemedicine" when prompted.

But choosing the best place to go for your child's care  can be a difficult one for some parents. After all, Cook Children's offers several options within its system, ranging from primary care, urgent care, the neighborhood clinics and the emergency department.

So how do you know where to go? To begin with, visit the handy infographic to the right or click here.

"Every patient who comes into our Emergency Department is important to us. However, some patients may be able to receive the care they need from their primary care physician, a neighborhood clinic or an urgent care center," said Corwin Warmink, M.D., medical director of Cook Children's Emergency Department. "The best thing a parent can do is know what constitutes an emergency, so they know where to go when that time comes."

When it comes to choosing where to go, Kara Starnes, D.O. medical director of Urgent Care at Cook Children's, advises parents to think about the severity of the issue.

For instance, your child's Cook Children's pediatrician can see a number of ailments, including allergies, the flu, migraines, pink eye, sprains and vomiting.

During times when your pediatrician's office is not available, the Urgent Care Centers at Cook Children's can handle the same ailments, along with most fractures (broken bones) and cuts. Fractures with severe deformities or open fractures should not come to the Urgent Care but instead should go to the Emergency Department (ED). The ED has more equipment to handle the most severe cases, and the child can be admitted quickly to the medical center for continuing care.

If your child has multiple injuries, neck injuries or head injuries with loss of consciousness and/or vomiting, they should go to the ER. These kids typically need the ER because the UCC is not as equipped in imaging and other sophisticated tests available at the medical center.

"Possible surgery, such as appendicitis, is tough for parents to determine because most of the time, abdominal pain is caused by something simple like constipation," Dr. Starnes said. "But severe abdominal pain, testicular pain or swelling, bleeding when vomiting or severe bleeding with bowel movements are reasons to go to the ER."

You should visit the ED with your child in case of a medical problem that could cause death or permanent injury if not treated right away.

Daniel Guzman, M.D., a Cook Children's Emergency Department physician, adds “when in doubt of the severity, always visit the higher level of care such as the Emergency Department” and if immediate attention is required call 911.

And of course, we are right in the middle of flu season. Last week (Jan. 5 to Jan. 11, 2020), 837 kids were tested for the flu. Of those kids, 141 tested positive for Influenza A, 187 for Influenza B and another 102 for RSV. 

For those kids, Cook Children’s has a variety of options for care including the primary care offices, neighborhood clinics and urgent care locations.

“If your child is over 3 months old and has a fever, even a high one, it’s OK to see your pediatrician as long as they are breathing comfortably and drinking well,” said Diane Arnaout, M.D., a pediatrician at Cook Children’s Forest Park. “If your child has mild wheezing, we can give breathing treatments in the primary care offices. If you’re not sure whether your child’s issue is an emergency, our nurses can talk to you over the phone about symptoms and help you decide between the ER, urgent care and a primary care visit.”

Man…this is a tough one.

Remember when your child was a toddler, and you taught them to poop on the potty? It was all leading up to this moment. Everything we have taught them along the way was an effort to allow them to become more independent.

But, now that they are, why does it hurt so much?

This time can be painful and confusing, but it can be handled with grace on both sides.

Unfortunately, it’s not always easy.

Here are 8 mistakes that parents make when their child starts to pull away:

1. Holding on too tight. Not allowing your child to spread their wings can create resentment and frustration. Yes, they are your baby, but they don’t want to be treated like one. It’s OK to let them try new things and make mistakes. Be there to help them learn from them.

2. Not holding on tight enough. Even though they seem more independent and don’t seem to want you around, they are still immature and still need someone to protect them from the big mistakes. Monitoring their technology use and being aware of their friends are essential examples.

3. Taking this transition time personally. They might act as they hate you…they might even say that they hate you…but they probably don’t actually hate you. While you might get your feelings hurt from time to time, it’s important to remember that this transition is healthy and not a reflection on your parenting skills.

4. Making judgments too quickly. If your teen starts to tell you something about their life or feelings, they can see right through your judgy looks. Practice in the mirror…whatever it takes. Just listen without (apparent) judgment.

5. Giving up too quickly on family time and family plans. You’re going to get shot down over and over. It’s OK to make family dinners a requirement as often as you think it fits your family best. Also, make a point to involve your teen in planning family time. If they choose the activity, they are more likely to be a willing participant. You can also leverage that to say, “Remember when we all played Fortnite together? Now it’s your sister’s turn to plan.”

6. Trying to have serious and deep conversations all at once and face-to-face. These are awkward and unlikely to meet their desired goals. Talk about the issues in small chunks. Use the car ride or some physical activity time (playing catch).

7. Dominating conversations. Say anything that smells of “I-told-you-so” or involves a long drawn out lecture, and you’re actually doing more to push your child away.

8. Not recognizing warning signs that it’s more than just standard teenager stuff. Unfortunately, teens and pre-teens do get depressed, and significantly withdrawing can be a sign. Look for the following:

• Significant abrupt changes in interaction.
• Severe withdrawal (not coming out from arriving at home until school the next day).
• Moving away from activities that they used to enjoy.
• Loss or gain of appetite/sleep.

Growing up can be difficult. Don't forget that. We've all been there before. But normally, things will get better and they will come back to you soon enough.

The CDC found:

• That suicides increased by 56% during the 10-year span among people ages 10 to 24 years old.
• Suicide attempts among African-American teens increased by 73%.
• Suicide is the second-leading cause of death for teens from all demographics and the third-leading cause of death among black youths between the ages of 15 to 19 in 2017.
• In 2017, 2,200 teens between 15 to 19 years died by suicide.
• 1 in 5 high school students admitted to experiencing suicidal thoughts and 1 in 10 said they devised a plan to carry it out.
• The increase in the rate of suicides among 10- to 14-year old children have almost tripled between 2007 and 2017.

The CDC collected data from nearly 199,000 high school students by the CDC and Prevention’s Youth Risk Behavior Study.

Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s, realizes suicide in children and adolescents is a difficult topic for most parents. But she stresses it’s one that can’t be ignored.

“As a mental health professional, my worst fear is a child prematurely ending his or her own life,” Dr. Pyrc said. “As a mother, it is hard to comprehend the profound grief families must feel in the wake of a suicide.”

The American Academy of Pediatrics has updated its guidelines to recommend pediatricians routinely check for signs of depression in their young patients. The focus is to carefully screen patients ages 12 and over during annual checkups.

“I have found it is a good way to signal to kids and parents that we are open to talk about this and want them to ask us about it,” said Vanessa Charette, M.D., a pediatrician at Cook Children’s Magnolia office in Fort Worth. “Even if nothing comes up, often a parent will return with the teen later wanting to talk about anxiety and depression.”

While researchers say they aren’t sure of the exact causes for the rising suicide rates, experts point to a rise in depression among adolescents, drug use, stress and access to firearms might all be contributing factors.

Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Cook Children’s Behavioral Health Clinic in Denton, is simply fed up. She’s seen too many kids come into her office depressed, frightened or even suicidal because they can’t get away from their bully or bullies.

“I think that bullying is worse than ever before because of cyberbullying,” Elliott said. “Kids can’t get a break.”

No child is bully-proof. Elliott offers parents the following talking points when speaking to their child about bullying:

• Even people who say they're your friends can bully you.
• You should confront your friends when they're being hurtful to you or others.
• Retaliating may feel good temporarily, but refusing to stoop to the bully's level will win you more popularity in the long run.
• When you hear a false rumor, just ignore it and be yourself.
• You're most likable when you respect yourself and others.
• Bullies usually have their own insecurities. Returning meanness with kindness is the best way to break down their defense.

Elliott advises parents to monitor their child’s computer and cell phone, and encourage them to spend less time on social media. If bullying expands onto social media, then parents should talk to their child’s teacher, coach or another school official.

“Parents should watch for any change in a mood like sadness, depression, hopelessness, irritability, anger, and hostility,” Elliott said. “You may see more tearfulness and changes in activity level. Watch for more withdrawal from friends and family, change in friends and loss of interest in activities once enjoyed.”

Elliott says warning signs of teen suicide include:

1. Alcohol/Drug Use
2. Preoccupied with death (writing, drawings)
3. Talking about feelings of hopelessness
4. Talking about being a burden to others
5. Telling loved one's goodbye
6. Decline in performance
7. Giving prized possessions away
8. Isolating and withdrawing
9. Acting highly anxious or agitated
10. Acting reckless and taking risks
11. Rages
12. Changes in sleeping and/or eating
13. Dramatic changes in personality and/or appearance

If you would like to schedule an appointment, refer a patient or speak to our staff, please call 682-885-3917. 

Sources for this Topic:

• Cook Children's Behavioral Health Center
• Youth Risk Behavior Surveillance System (CDC)
• Report: Suicide Attempts Among Black Teens Increased by 73 Percent (The Root)
• Suicide attmepts increasing among black children and teens, study finds
• Youth Suicide Rate Increased 56% In Decade, CDC Says
• Suicides and homicides on the rise in young people (NBC News)

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.

1. The pain is "crushing" or pressing down.
2. There are other symptoms like passing out, nausea or skipping/racing heartbeats.
3. The pain is brought on by exercise.
4. There is a medical history that would worry you (examples are a history of heart disease, Kawasaki disease or Marfan syndrome).
5. There is a history of a murmur. 

And here are 5 other common causes of chest pain:

1. Muscular or chest wall pain. The pain comes back when you touch their ribs or chest.
2. Reflux. The pain is after meals or described as burning.
3. Anxiety. The pain is associated with stressful situations.
4. Lungs. The pain is associated with a deep breath or there is a history of asthma.
5. Who knows? It's fairly common that we can't figure out where it came from but this should only be said after everything else has been considered or checked for.

And only time will tell for sure, but some indicators lean toward a potentially severe influenza season.

Clinical experts in the U.S. watch the Southern Hemisphere of the world for signs of what might be in store for us in the north.

In Australia, where winter recently ended, the Department of Health reported the flu season arrived earlier than normal. Of special concern to the experts is the type of flu season seen in Australia – Influenza A (H3N2). H3N2 is a more dominant strain of the flu and causes more illnesses.

How effective the flu vaccine is depends on how well experts predict what strains of the flu will be circulating the globe that year.

“The vaccine strains are chosen about nine months before flu season, based on circulating strains from around the world by epidemiologists who are geniuses and do this for a living,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases.

Locally, the first case of flu (Flu B) was reported at Cook Children’s Medical Center two weeks ago. Last week, no one tested positive for either strain.

NBC News reports that one pediatric flu death has already been recorded in the U.S. – a 4 year old in California who had underlying health problems.

Jason Terk, M.D., a Cook Children’s pediatrician and a national expert on immunizations, adds his voice to other pediatricians and global health experts who say the flu vaccine remains the best way to prevent influenza.

“The great news about the vaccine is that even when it’s not always a perfect match for prevention, the flu vaccine can reduce the severity of the illness, even if you do catch the flu that season,” Dr. Terk said.

To make an appointment for your child’s flu shot, contact your Cook Children’s pediatrician. The vaccine is currently available in many offices and a second shipment will be delivered next week.

“It takes two weeks for the shot to become most effective. Because flu can hit as early as late October or early November, we recommend getting the flu shot as soon as possible and definitely before the end of October,” said Justin Smith, M.D., a Cook Children’s pediatrician.

More On This Topic:

• Flu Shot Appointments
• Influenza/Flu Information
• Let's Learn About ... The Flu
• How To Tell If It's Strep, Flu, Rotavirus Or Norovirus
• Comfort Menu to Ease Pain, Anxiety for Children Getting a Shot
• Is It a Cold or The Flu?
• Pediatricians Say Kids with Egg Allergies Should Now Get The Flu Shot

Christian Englert was born with genetic hand tremors, like many of his family members. The tremors were never an issue, especially when he was drumming or doing school work … until he turned 15 when they helped diagnose a rare brain tumor.

At his annual physical, Christian mentioned his worsening tremors to his doctor and was quickly referred to a neurologist. As a family, they decided to go ahead with an MRI for peace of mind. Christian’s hand tremors had been the only noticeable change so there wasn’t an excessive cause for concern.

“I was with Christian at the very first MRI that we thought was just going to be routine,” Christian’s mother Shanna Englert said. “They had told us they weren’t going to be using contrast, but they came in toward the end and said they wanted to just go ahead and do it. At that point, my mommy alarm was already going off because it wasn’t what we were told originally.”

Within a few minutes, the MRI started again but Shanna was called out of the room. Christian’s neurologist was on the phone. He explained he wouldn’t normally give this news over a phone call, but the urgency was critical. There was a mass on Christian’s brain.

“There was a six week period between the MRI and Christian’s original physical,” Christian’s father Martin Englert said. “At one point we were just about to cancel the MRI because no one thought it would show anything serious. What if we hadn’t done the MRI? We could have lost him.”

The following hours after that phone call became a blur, according to Shanna. They immediately went to Cook Children’s for severe hydrocephalus, a condition caused by the tumor and resulted in too much fluid and pressure on the brain.

“When we got to the hospital everyone was confused because he didn’t have any symptoms. He wasn’t tripping, no headaches and no nausea. There was nothing on our radar saying this MRI could show something so there was no preparation on our end,” Shanna said. “I went from picking him up at school at three o’clock to him being in brain surgery the next day. His surgeon called him a ticking time bomb.”

Christian went into surgery the following morning to relieve the fluid and pressure, and take a biopsy of the tumor. Ten days later, he was diagnosed with Pineal Parenchymal Tumor with Intermediate Differentiation (PPTID), a rare form of cancer with both malignant and benign cells with only five prior diagnosed cases in the U.S. since 2000.

“The list of possibilities was so long. As a mom, that list overwhelmed me more than the actual cancer diagnosis because you have all these dreams and plans for your child,” Shanna said. “What is life going to look like after treatment? There were just so many unknowns, and as a parent to hear all of this, it was just like all these dreams came crashing down.”

With so few cases to study, Jeffrey Murray, M.D., medical director of Neuro-Oncology at Cook Children's, and John Honeycutt, M.D., Cook Children's medical director of Neurosurgery, had to research the production of a plan to safely shrink and remove Christian's tumor.

“We began creating a treatment protocol after review of the medical literature and discussions with colleagues across the country,” Dr. Murray said.

Dr. Honeycutt performed Christian’s initial surgery to relieve the pressure on his brain, as well as the tumor removal surgery three months later.

"A tumor in the pineal gland is an unusual area in the brain because it’s in the center. It’s more difficult to get to and it has a lot of important structures,” Dr. Honeycutt said. “We went in with an endoscope and navigated down to the bottom where there’s a membrane and poked a hole in it. It created a detour for the spinal fluid called an ETV.”

Christian later underwent additional surgeries to remove the tumor, insert and remove his port for chemotherapy and realign his right eye, which occurred as a result of his prior brain surgeries.

Six months later, after four total surgeries, two rounds of chemo and 30 treatments of radiation, Christian was deemed to have no evidence of disease. To this day, the tremors aren’t related to his tumor but acted as a signal that something had changed.

“Even though we’re now a part of a group that we didn’t want to be in, it’s turned out to be more of a joyful mission. Cook Children’s has become a part of our family. Dr. Murray, Dr. Honeycutt, nurses and staff that support them are people that are a part of our lives,” Martin said. “When we walk in there it does feel like a triumph, but it also feels like we have an opportunity to bring hope to the folks there. We know there are some stories that don’t end as ours did. We want to continue to be a light for others.”

Christian has now been in remission for four years. He still loves to play the drums in his spare time and has just started his sophomore year at a local university. He remains an advocate for childhood cancer awareness and the Make-A-Wish Foundation.

Even as the summer was winding down, every member of the Emergency Department knew a fatal drowning could still happen at any moment. Tragically, that moment came over the weekend when two sisters were found unresponsive in a Haltom City apartment swimming pool. News agencies report the girls were taken to Cook Children’s where they both died.

“Drownings occur year-round and there is no ‘drowning season,’ especially in Texas,” said Corwin Warmink, M.D., medical director of Emergency Services at Cook Children’s. “You can’t get comfortable and complacent with children and water, no matter the time of year.”

Before this weekend’s pool drownings, three children had died from drowning at Cook Children’s in 2019 – two separate incidents in bathtubs in March and one child in open water in May.

Even in the month of September, the warm Texas weather means kids are getting in the pool. From 2014 to 2018, there have been a total of  16 drownings (13 in a pool and 3 in open water) during the month of September, with two being fatal.

“I worry that with the end of the summer and kids being back in school that people will relax a bit,” said Dana Walraven, community health outreach manager for Cook Children’s. “But we can’t let our guard down even for a little bit. The temperatures are still warm and there’s plenty of time left for kids to be in the water. All the same rules apply to keep our kids safe.”

It's hard to turn on the news and not see a story about the dangers of e-cigarettes or vaping. 

As of Aug. 28, 2019, there have been nearly 200 reported incidents of vaping-related illness in 22 states, resulting in at least one death. 

Earlier this summer, 17-year-old Tryston spent 18 days in Cook Children's ICU, needing machines to keep him alive. He lost 30 pounds, and had to re-learn to walk normally again because he had no muscle mass in his legs anymore from being bedridden for almost three weeks. He is still coughing at times and feels tired. A clear answer for why his lungs failed him was never found, but doctors believe it was because of his vaping.  

“We don't know for sure. But there are literature reports of hypersensitivity pneumonitis from vaping. I told him no inhaling anything again, ever. We still don't know for sure what the trigger was. But it is very plausible that it could be due to his vaping,” Suzanne Whitworth, M.D., medical director of Infectious Disease at Cook Children's said.

Tryston was one of a growing number of teens who are vaping. Statistics show 45% of U.S. teens have tried it. 

While the Centers for Disease Control and Prevention (CDC) says E-Cigarettes may have the potential to benefit adult smokers if used as a complete substitute for regular cigarettes and other smokeless tobacco products, they are not safe for youth, young adults, pregnant women or adults who are currently using tobacco products. 

The CDC adds there is "a lot to learn about whether e-cigarettes are effective for quiting smoking" and "if you've never smoked or used other tobacco products or e-cigarettes, don't start."

Diane Arnaout, M.D., a Cook Children's pediatrician in Fort Worth, wrote the first story about Tryston. He was her patient and he asked Dr. Arnaout to get the word out about the potential dangers of vaping. 

"And though they claim to be a “healthier option” to regular cigarettes, I beg to differ. Inhaling chemicals is inhaling chemicals. There are over 40 different chemicals in vaping liquids. And they can cause some major damage," Dr. Arnaout wrote. "They can hurt delicate lung tissue. We are seeing more and more reports of teenagers and young adults suffering severe lung injuries and seizures coming out in the news lately.

"I’m really worried about how addictive these things are. Kids who want to quit are finding it more difficult to do so than if they’d smoked a pack a day."

Don Wilson, M.D., an endocrinologist at Cook Children's, has been speaking out about the dangers of e-cigarettes for quite some time. Dr. Wilson, who is an an Endowed Chair of Cardiovascular Health and Risk Prevention, offers this basic information for parents:

More On This Topic:

• Why Doctors Believe Vaping Landed 17 Year Old In ICU
• Surgeon General’s Advisory on E-cigarette Use Among Youth
  • Download pdf icon[PDF–572 KB]external icon
• E-cigarettes Shaped Like Flash Drives: Information for Parents, Educators, and Health Care Providers
• Teachers and Parents: That USB Stick Might Be an E-cigarette
• E-cigarettes.surgeongeneral.govexternal icon
  • Information from the Surgeon General on the risks of e-cigarettes for young people, and includes free tools such as a parent tip sheet for talking to teens about e-cigarettespdf iconexternal icon [PDF – 5.2MB].
• Teen.smokefree.govexternal icon
  • Information for teens who use tobacco products, including tips on how to quit.
• Electronic Cigarettes
  • Basic information about e-cigarettes from CDC’s Office on Smoking and Health.

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

Earlier this summer, my 17-year-old patient Tryston just wasn’t feeling like himself.

“I was tired all the time. My energy was low. I was losing some weight.”

Then, things quickly turned downhill. He started having chills. He was feeling really exhausted all the time, was nauseous, and had some fevers.

When he started becoming short of breath and having some chest pain, he and his mother decided it was time to head to an urgent care clinic, where he was given antibiotics and flu medications.

In 24 hours, he felt worse. His breathing became more difficult. Something was definitely wrong.

He came to Cook Children’s, and the doctors and nurses quickly realized what poor shape he was in. X-rays showed something that looked like pneumonia on both sides of his chest. But the specialists were confused, because it just wasn’t obvious.

Within 48 hours however, what WAS obvious was that Tryston was getting worse.

As his Cook Children’s pediatrician, I was sent daily updates about him. I found myself holding my breath every time I opened the update – and audibly gasped the moment I realized that he was intubated.

This means a tube was stuck down into his windpipe to breathe for him.

And the tube stayed there for the next 10 days. Machines were keeping Tryston alive. He was in the ICU, where the sickest children in the hospital stay.

“I lost a lot of sleep over this kid,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. Dr. Whitworth wasn’t sure what was going on, and became very close with the family.

Was it an infection? No organism seemed to grow from cultures. Was it an autoimmune disease? The rheumatologists didn’t think so.

Even a lung biopsy – a piece of his lung which was cut out and examined under a microscope – didn’t seem to hold any clear and obvious clue as to why he was so sick. His lungs just failed, and he was in something called respiratory distress.

He was put on numerous antibiotics and antifungal medications to see if they’d help. He was needing more and more oxygen. He even needed special high-frequency ventilations (think little tiny rapid puffs of air) to keep his lungs open and working.

There’s one thing I haven’t mentioned yet. The one thing that was in the back of everyone’s minds.

One thing that Tryston mentioned to the staff of Cook Children’s before he got very ill is something I already knew, and had talked to him about the year prior.

Tryston liked to vape.

Most of you have heard about “vaping” in some way or another, but if you haven’t watched the news lately (or been in my office lately - because jeez, I am hearing more and more about it daily), “vaping” is when someone smokes an aerosolized chemical, usually from something called an e-cigarette.

Vaping is becoming VERY popular amongst teenagers. Statistics show 45% of U.S. teens have tried it. The Centers for Disease Control and Prevention is now investigating the "sudden emergence of severe lung disease linked to vaping in 14 states. Ninety-four possible cases of severe lung illness associated with vaping have been reported from the end of June to Aug. 15, the CDC reports.

Corwin Warmink, M.D., the medical director of Emergency Services at Cook Children’s, says he has seen multiple patients come through the ER and his team sees a child every week for vaping. But it’s not just teens, we are also seeing younger children, 5 and under, who have ingested vaping liquid. Scary stuff.

The most popular types look like USB devices. They’re super easy to hide. They have different “fun flavors” like mango, crème brulee and fruit medley. Some of the devices are even cute, with teddy bears on them.

They are more addictive than cigarettes. One Juul pod (currently the most popular brand) has the same amount of nicotine as an entire pack of cigarettes! “And I know lots of kids smoking 2 or 3 pods a week,” Tryston told me.

And though they claim to be a “healthier option” to regular cigarettes, I beg to differ. Inhaling chemicals is inhaling chemicals. There are over 40 different chemicals in vaping liquids. And they can cause some major damage.

They can hurt delicate lung tissue. We are seeing more and more reports of teenagers and young adults suffering severe lung injuries and seizures coming out in the news lately.

I’m really worried about how addictive these things are. Kids who want to quit are finding it more difficult to do so than if they’d smoked a pack a day.

Want to know why you should quit?

Tryston spent 18 days at Cook Children’s.

He lost almost 30 pounds. He is re-learning how to walk normally again. He has no muscle mass in his legs anymore from being bedridden for almost three weeks. He is still coughing at times. He feels very tired.

A clear answer for why his lungs failed him was never found.

“We don't know for sure. But there are literature reports of hypersensitivity pneumonitis from vaping. I told him no inhaling anything again, ever. We still don't know for sure what the trigger was. But it is very plausible that it could be due to his vaping,” Dr. Whitworth said.

The general consensus was that his lungs were severely injured, and I believe his vaping habits had a lot to do with it.

Two days after going home, he walked into my office for a follow-up visit. We had a very real, very brutal heart-to-heart.

I said, “Tryston, buddy…you know you could have died, right?” and he looked me in the eye and said “I’ll never touch the stuff again, Dr. Diane. And I want everyone to know that. I want to tell my story. And if I can just keep one kid from going through what I did, it’ll all be worth it.”

So here I am, telling you his story. Tryston is a great kid with a great heart. He made a mistake, one that LOTS of kids are making, because they assume e-cigarettes are “healthier” than regular cigarettes.

And Tryston wants us all to learn from it. Do me a favor and do what he has asked: print this out, and give it to your teenage son or daughter. Ask them to read it.

Let them know it’s just not worth it.

Learn More About This Topic:

• Vaping, Juuling, Dabbing (AAP Environmental Health) - Source for statistics in article
• New York Times: Dozens of Young People Hospitalized for Breathing and Lung Problems After Vaping
• Huffington Post: CDC Launches Probe Into Surge of Severe Lung Disease Cases Linked To Vaping
• Juul, Other E-Cigarettes Called an 'Epidemic' By FDA Chief
• E-Cigarettes Exposes Teens to Cancer-Causing Chemicals, Future Cigarette Smoking
• Adding flavors to e-cigarette liquids changes chemistry, creates irritants (Duke University)
• Tobacco Use Increases By More Than 38 Percent Among High School Students

It was also during this time that measles showed up in Texas and when I received my second MMR.

My sister had been in San Antonio with my mother for two months receiving care at a Bone Marrow Transplant center. While she had no memory of her twenty-third birthday, I saw pictures of the nurses and doctors surrounding her with a cake.

Later when she returned home, she commented on this nice shirt she had found in her suitcase as she had not seen it previously. I did not have the heart to tell her that it had been a gift from me for her birthday, she just had been so ill she did not remember.

As the number of measles cases in Texas were climbing, her doctors became fairly insistent that I receive a second MMR. They really didn’t want me to be around her without being protected.

Some may feel that wasn’t their decision to make. However, those doctors were not only scientifically correct but they cared deeply for my family. They knew me well enough to know that if I gave anything to my sister that would have hurt her, I likely would have never recovered from that guilt.

While measles can harm anyone, it likely would have been a death sentence for my sister. Initially, my mother was concerned about any possibility of me developing measles after the vaccine and giving it to my sister. The doctors reassured her and said the only way to protect her was to protect me. My mom had to make so many difficult decisions that year. Sometimes she did what the physicians recommended and sometimes not. Her goal everyday was to advocate and protect her daughter. So I was vaccinated based on the new two dose MMR policy.

Then I was able to be with my sister. I was with her when they told her that cancer returned. I was there to watch my platelets infuse into her weak body. I was there on the morning she died. Holding her hand. It would have been too risky during the measles outbreak for me to be around her that summer if I had not received that vaccine. While I grieve the loss of her beautiful mind and spirit still after almost 30 years, I realize that experience inspired me to enter medicine and advocate for children.

It is so unfortunate that the discussion around vaccination has become so volatile. Like my mom, parents are just trying to make the best and safest decisions for their children. They have to navigate a much more complex world of information available to them. At my clinic, we spend a good amount of time discussing questions and concerns regarding vaccines. While I try to work with families and guide them, in the final discussion, vaccinating children is the healthiest choice for them. Not just for their own disease prevention but for all of those who cannot receive certain vaccines through age or medical condition.

Honestly, I was a bit nervous writing this realizing potential backlash from those not agreeing with vaccinations. Yet as I was looking through my closet the other day, I saw that shirt I gave my sister. It made me smile remembering her wearing it and it reminded me of how all of us had to be brave in different ways that year. In her memory, I will continue to try and be brave.

Vaccinate. It saves lives.

Recently, Dr. Justin Smith talked about things to remember before your child heads back to school. He specifically mentioned you and your child’s anxiety as back to school approaches. It is true that pediatricians experience first-hand the anxiety that the transition back to school can create. Working in the emergency room as a child life specialist, offers a front row seat to the same pressures and stress. We often see a wave of kids struggling with anxiety and having a difficult time coping as they go back to school. As parents, we are often struggling too. Getting back in the swing of things and managing our kids’ emotions can feel overwhelming and often disheartening.

I want to challenge you, though, as parents and caregivers to enter into this time of transition with some tools in your back pocket ready to combat the stress and anxiety that back to school can bring. As a child life specialist, we are on the hospital side offering kids normalcy in the midst of a stressful situation. We are creating space for kids to learn to cope and develop tools that they can use throughout their lifetime – not just during hospitalization. As parents we need to create this same space in our homes. Here’s a few tips for creating space to cope during this transition. Remember that not every family and schedule can look the same. As you read, think of ideas that fit into these tips but also fit into your family’s culture.

1. Celebrate!!! Instead of back to school being a bummer, make it a celebration. Have traditions around the first day of school. We always have cinnamon rolls on special days so the first day of school is no different in our family. I usually write my girls a special note to commemorate the day and have a Dollar Store goody sitting at their spot for breakfast. I have all girls, so we have a tradition of getting nails done before school starts. School supply shopping day usually includes a lunch or dinner out to eat at a favorite place. You could go to their favorite restaurant or make a special date for a fun activity. These are just a few ways we celebrate, but there are LOTS of ways to celebrate a new school year, the end of the school year and all the things inbetween!
2. Create a routine. Often during the summer, our routine is gone or at best inconsistent. Going to school can provide the opportunity to revamp your routines and boundaries. In our home, there is no screen time before school, no matter how early you get up. There is an order to our mornings that include breakfast, getting dressed, brushing teeth, packing backpacks - all while music is playing in the background. My kids know what to expect each day when they wake up. We also have afternoon routines- a few minutes for a show when they get home, quiet/homework time before dinner and always set aside time for reading. While routines need to include the mundane things, it’s also good to include FUN in your routines. We have fun weekly routines and traditions. We get ice cream after school every Wednesday. We often have movie/pizza nights on Fridays or Saturdays. This year we will be adding a weekly job for our girls to accomplish also. Setting expectations and boundaries for kids sets them up for success. My kids know when to expect screen time, ice cream and family activities, and they can look forward to it without always asking for the next thing.
3. Be nosy! What does that mean? Well, you are the parent. You get to know ALL the things simply because you are the parent. Just because your kiddo is away from you for 7 hours a day or more, you still get to know what is happening in those hours. Ask your kids about their day with open-ended questions - stay away from yes or no questions. Get to know the people at school…your kids’ teachers, principal, even cafeteria workers. Take time to honor them so that they can know and respect you. Get to know your child’s friends and ask who they are eating with, playing with, etc.? Know the other parents in your kids’ class so when the stories don’t quite line up, you can get some more details. Know your kids’ teacher. While you want to be respectful of their time, it is important to address things that come up for your kids during the year. Don’t be afraid to ask questions to know more. Send the email to clear up confusion. Make the phone call when you see a red flag. The more you know, the more you can engage your child. Plan to eat lunch with your child regularly. That might be once a month, but your presence in that space matters…mostly to your child. Volunteer in your child’s classroom or at the school or offer to do things from home. This allows you to know what to ask and to advocate when and where there is a need. You don’t have to be an infamous “helicopter parent,” but being present (and a little nosy) creates space for your kids to trust you and know that you are with them and for them no matter what.
4. Focus on character. So often much of school feels centered around grades, testing, and measured successes. Often those are measured against other kids and expectations are high. While it is incredibly important for kids to master subjects and advance academically, their character will take them through all of life ~ all the challenges that they will face. And while math facts are super important, they won’t teach them how to be a good friend or show respect. I try to assess what character quality my kids need encouragement in and spend time fostering it. Whether it be self-control, patience, humility or the many others, we take time as a family to talk about these things. One thing I do for my kids is start a notebook at the beginning of the year that goes in their lunch box. I focus on character and encouragement in that notebook. I write a note or draw a picture each day that hopefully reminds and encourages them in that character trait. I also always let them know they are loved. I remind them at the beginning of each day, usually on the way to school, to choose others before themselves and treat others as they would like to be treated. We encourage trying over perfection, kindness over being right, and gratefulness when things aren’t going your way. The work will always be there, the vocabulary and math facts, but I don’t want my kids to get so lost in those facts that they forget about being human.

We want our kids to feel prepared and ready for this next year. Preparation alleviates some anxiety while creating space to teach them how to cope with the inevitable stress that comes with this transition. Celebrating, establishing routine, being present (aka a little nosy) and focusing on their character are all ways that you can help your children cope and combat the stress and anxiety of going back to school.

For most of us, a snake bite of any type would send us directly into a panic. However, when Ray was bitten while working in his lawn, he was hesitant to go to the doctor. He didn’t want to overreact. He wasn’t even sure he’d been bitten because of the heavy gloves he wore outside.

“Initially I knew it wasn’t good, the numbness and tingling. I told my wife that I thought I got bit by a snake but I never saw it because I was trimming the shrubs,” Ray said. “I actually called the Emergency Department at Cook Children’s and talked to one of the physicians I work with, and he advised that I go into my local ER to get some labs.”

While Ray was on the phone with the doctor, his wife went to the front yard where he was bit, found the snake and killed it. Later, poison control confirmed the snake hiding in their shrubs was, in fact, a venomous copperhead.

Ray went to Texas Health Resources for testing and bloodwork, and eventually started Crofab (an anti-venom) in the following hours. He spent the next four days in the hospital, receiving additional doses of antivenom while waiting to regain use of his left hand.

Providers aren’t immune to the fear of the unknown that patients often experience. It was in that same unease that he began to sympathize with his own patients.

“Going from a caregiver and being placed into the role of a patient is something I’m going to take away from this,” Ray said. ”I was really anxious in the waiting room because of the swelling, I even knew the science behind it all, but it was still a source of anxiety for me so for children to be a patient, it’s even harder on them.”

Now fully recovered, Ray’s experience has given him a deeper level of empathy for his patients and has made him a better provider for children with anxiety.

“Seeing the compassion of the other physicians and the nurses is something that is going to make me a better provider going forward,” Ray said. “This experience is going to make me more compassionate. I think whenever a provider is forced into the role of a patient it can create more empathy for their future patients.”

Related Topic:

• After the Bite: When and Why Antivenom is Used at Cook Children's
• 1 Year Old Bitten By Rattlesnake Recovering At Cook Children's
• Patients Bitten By Snakes
• What Are The 4 Venomous Snakes Found in Texas?

Sadly, these heartbreaking occurrences no longer shock us. But that doesn’t make these events any easier to talk about with our children, especially as they occur more and more often.

So, where do we go from here and how do we make sense of any of this?

Lena Zettler, director of Psychology at Cook Children’s, says parents should spend time listening and watching their kids after tragedies such as what took place over the weekend. When talking to your children, Zettler encourages parents to focus on what makes their kids safe.

“I know it seems more difficult to do, especially when something like a shooting is close to home or in our same state, but our job as parents is to reassure our kids about the ways they are safe,” Zettler said. “Sadly in this day and age, that means talking about the drills our children perform in school to protect themselves. Maybe, as a family, you have your own safety plan. Remind your children of the safe people in the world who are looking out for them, such as their parents, grandparents, teachers, police or other relatives or close family friends. A good idea, may be to sit with your child and make a list of all the safe people they know in the world.”

When talking to your children, Zettler encourages parents to focus on what makes them safe, based on their child’s specific fears. She suggest parents ask opened ended questions before providing information. For instance, with the El Paso shooting, we are hearing that racism and targeting immigrants played a role. However, don’t assume that kids have made the connection between race and this incident. Find out what they know and what scares them and address those specific issues.

“Focus on what things make your children safe, based on their fears,” Zettler said. “Respond with your eyes, body language and words when kids express their fears. Anytime we are scared, our brains read body language and facial expressions more than words. Kids may express these fears verbally or behaviorally. Pay attention and provide reassurance when you see they need it.”

Lisa Elliott, a licensed psychologist and clinic manager of Cook Children’s Psychology Clinic, said the events of the weekend came up during most of her sessions on Monday. She reminded the children to focus what Mr. Rogers’ mother taught him, “To this day, especially in times of 'disaster,' I remember my mother's words and I am always comforted by realizing that there are still so many helpers ― so many caring people in this world.”

“There are always helpers in crisis and there are more helpers than there are people who do hurtful things,” Elliott said. “Today, this was once again helpful for each one of the kiddos who brought this up. We actually did an exercise where the kids looked up all the stories of those who helped people.”

Joy Crabtree, Psy.D, a licensed psychologist for Cook Children’s Behavioral Health in Southlake, said parents must set the example for their children to follow. Crabtree encourages a discussion of the events, but only if your youngest children have learned about the incident elsewhere. If they haven’t heard about it, don’t share information with them. If they already know about it, answer their questions and most importantly, reassure them as best you can.

For example, talk about the good people like the first responders who took care of the people who were hurt and everyone who worked together to make sure people were safe.

“Parents have to stay calm and cannot be glued to the TV,” Crabtree said. “If you have an elementary-aged child, and they haven’t learned the news, there’s certainly no reason to sit down with them and show them the story. There’s no need to cause fear in your children. By the time children are 7 or 8 years old, they can distinguish fact from fiction and will understand the consequences of what they are watching. If they have heard about it, take as much time as needed to sit down with them and have a discussion/answer session, providing reassurance and support. Answer their questions, but only their questions. There’s no need to add more information that may scare them even more.”

For older children, such as those in middle school and high school, Crabtree encourages parents to again determine if their child is mature enough to handle the information. If parents feel they can handle it, use the DVR as your friend during the news. Watch it with your child and pause the TV to answer questions. Gauge your child’s emotions and turn the TV off if your child becomes too emotional or the news is too intense.

The psychologists we talked to agree the recent tragedies may also be a good time to promote speaking up when your kids see a peer who is in distress. “They are not tattling. If they see a peer who is acting out things or talking about violence, speak up to a trusted adult,” Zettler said.

“It is definitely important for children and teens to speak up and say something if they have a concern, or feel someone may be making a threat, either toward themselves or someone else,” Crabtree added. “And sadly in the times we live in now, it’s also important to have general situational awareness, no matter where you are.”

For a great resource on how to speak up, visit sandyhookpromise.org.

Kids, even teens, look to parents for reassurance. Parents can express their feelings about these events, but do not make this about your feelings. Model resiliency and good coping (calming, grounded practices that could include praying, meditating, deep breathing, laughing, yoga, and exercise for instance).

After listening, ask the child what they need: it may just be a hug for now. Reach out to professionals for help if fears persist more than a few weeks.

Crabtree advises parents to watch and see if their children restrict activity. For instance, they may not want to go to school or to the playground because it is too far away from home, or simply because they are afraid. Also, notice if your child becomes withdrawn or more clingy than usual, and constantly wants to sleep in your bed. For older kids, if you see them avoiding social events or larger gatherings, that might be something to discuss.

“It is common for children to have a mild fear, but if you see an overwhelming fear, it’s important to start by talking to their pediatrician,” Crabtree said. “If it continues to be a concern, then it may be time to get professional help.”

For more on this topic:

• Sandy Hook Promise
• Cook Children's Behavioral Health
• Cook Children's Psychology
• Individual and family therapy
• Parent Education and Support
• Diagnostic Testing

"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."

It was reported by the American Academy of Pediatric Dentistry that sports accidents account for 10-39 percent of all dental injuries in children! These injuries can happen to a child’s face and teeth from falls, collisions, contact with hard surfaces and sports equipment. Activities such as riding a bike, skateboarding, hover boarding and jumping on a trampoline can result in injuries that affect the teeth and the face. The upper lip, gums and front teeth are more prone to injury. These teeth are subject to fracture, nerve damage, becoming loose and even falling out.

Not all sports-related injuries can be avoided, but most of them can be prevented! Wearing helmets, facemasks and mouthguards have been shown to greatly reduce the severity of dental and facial trauma. The National Federation of State and High School Associations only mandate mouthguard use for certain sports such as football, ice/field hockey, lacrosse and wrestlers wearing braces. But it is very important that proper protective equipment and mouthguards be worn for all sports that have the risk of injury (baseball, softball, basketball, soccer, volleyball, gymnastics to name just a few).

A mouthguard is made to protect the lips, gums and teeth from damage. They work by absorbing the energy from an impact and dissipating the remaining energy. There are many different types of mouthguards and if you are thinking of getting a mouthguard for your child, it is important that you visit your dentist. The best mouthguards are the ones that are custom made at the dental office. A mold is taken of the teeth and a mouthguard is made that is the right fit and comfortable for your child. If a custom mouthguard is not feasible for you, then there are many other mouthguards that are available over the counter. Even though they may not be a perfect fit, they will still provide offer some protection.

Bottom line, please protect your child’s face and teeth with the proper protective equipment while they are playing sports and having fun!

Life as a parent with a child who has Sickle Cell Disease (SCD) is already frightening enough, but could you imagine this diagnosis with two of your kids?

Mykhia and Malik, now 11 and 12 years old, were diagnosed with SCD within the first two years of their lives. When the family first learned of the diagnoses, they were referred to the Hematology and Oncology department at Cook Children’s.

Their mother, Monique Hammon, was familiar with the disease as it already ran in her family. She knew Malik and Mykhia would eventually need the cure of a bone marrow transplant.

“On my dad’s side, I grew up watching my family deal with sickle cell and a majority of them died from it,” Monique said. “My sister’s son went through the same thing that Malik and Mykhia went through, except he didn’t have a sibling that could donate bone marrow.”

Malik began to have more and more SCD crises, an acute pain episode that occurs when the sickle-shaped blood cells start to clump in the blood stream, and was frequently hospitalized at Cook Children’s.

Monique watched her children struggle to act like kids. They couldn’t play sports or swim due to the frequent crises and health problems, such as signs of stroke and organ failure.

“Mykhiah never had an episode. Her eyes would stay yellow, but one day her spleen swelled up and she had to have it removed,” Monique said.

Siblings typically have the highest chances of becoming potential bone marrow donors, but only 30 percent of families can find a match. Malik and Mykhia’s oldest brother was eventually tested to determine if he could be their cure, and he was.

“They [Malik and Mykhia] had a donor match,” Monique said. “I just thank God that my oldest son was a match for both of them instead of them waiting for a donor to come.”

Mykhia received her transplant first in 2015, due to signs of stroke on her MRI test results while Malik received his in 2016. The siblings can now swim and play soccer without fear of potential crisis.

“While Stem cell transplant can provide a cure for Sickle Cell Disease, it is not an easy cure. There can be many complications. Some patients may not engraft, meaning the donor cells may not grow, and the patient’s own cell grow back instead or a second transplant is needed," said Clarissa Johnson, M.D., medical director of the Sickle Cell Programt at Cook Children's. "There can also be challenges with finding a donor. So unfortunately we cannot consider stem cell transplant to be a universal cure that is available to all with the disease. More research for a universal cure is needed. There are small trials with gene therapy being done currently which I hope will prove successful to offer the chance of cure to even more people with Sickle Cell Disease.”

SCD is the abnormal shaping of red blood cells. The red blood cells are shaped like crescents instead of circles. They don’t last long and they can get stuck in the blood vessels, which blocks the blood flow, often resulting in pain and organ damage.

Approximately 100,000 Americans have Sickle Cell and an estimated 3 million Americans carry the trait, which can be passed onto their children.

Among the many misconceptions of SCD, African Americans are not the only race affected by the disease. While the African American race makes up a reported 60 to 80 percent of Americans diagnosed, people of Indian, Middle Eastern, Hispanic and Mediterranean descent may also be affected.

The cure for SCD lies in bone marrow transplants, and while siblings typically are the best matches for this disease, anyone willing to donate can be tested.

An estimated 3,000 people die each year in the United States from waiting for a donor for a bone marrow transplant because of the lack of donors on the registry.

Donating bone marrow requires less than five percent of bone marrow cells and is typically taken from the hip of the donor or through a non-surgical procedure in which it is collected through an IV.

Believe it or not, summer’s almost over and the new school year will begin before you know it.

Are you ready? Or are you like a certain dad I know who usually waits until the last minute? Last year, this dad forgot:

• To book his child's physicals so he had to scramble to get checkups before flu shots.
• His daughter has some pretty significant fears about going into school the first day and he didn’t take the time to properly prepare her.
• To get his son's asthma inhalers refilled and the forms on file so that he could have it at school (until April when he was having a flare).

Don't be like me…here are 10 steps you can take to make sure you and your child are ready for back to school.

1. Vaccines - Make sure that your child is up to date on vaccines. As your kids get older, your school might prevent them from enrolling in classes or other benefits, which might make it difficult to get their classes scheduled, etc. Vaccines are routinely scheduled at 4 years old (measles, whooping cough and polio among others), 11-12 (whooping cough and meningitis) and 16 (meningitis). At Cook Children's, we also recommend the HPV vaccination starting at age 11.
2. Physicals - If your child plans to participate in a sport or marching band they may need a sports physical form to be completed by your child's doctor. This requirement is required by the UIL before junior high, ninth and eleventh grade but many schools ask for it each year. The marching band requirement is new so not as many parents are aware. I expect we'll be doing a lot of those in the first few weeks of August. Students who are attending private schools or participating in sports that aren’t governed by the UIL may have other physical exam requirements. Many of these kids are already out in the heat working hard preparing for their upcoming season, so I recommend getting these as soon as possible.
3. Forms - Don't be that parent who realized in April that their child doesn't have his inhaler or the form required to take it at school (ahem ... me). Here are some common medications your child might take which might need to be administered at school: inhalers/nebulizers for asthma, insulin, ADHD medications and pain reducers.
4. Sleep - Transitioning back to a sleep schedule that works for school might be the most difficult transition in prepping for back to school. The older your child, the more likely they are to be going to bed too late and sleeping in. Start making subtle changes in their bedtime over the next few weeks. Rolling bedtime back 30 minutes at a time can make the transition to early morning easier.
5. Screen time - Just like sleep, screen time can get away from us a bit over the summer (Fortnite! I’m looking at you). An immediate drop off in daily screen time can be a struggle so starting to make changes now can help your screen junkies detox a bit before they go back to school.
6. Your child’s back to school fear or anxiety - Many children deal with some fears about going back to school. These fears can be mild or they can be more severe, almost debilitating. Helping your child prepare for the transition by talking them through their day, setting up a play date with classmates ahead of time or taking a tour of the school can orient (or re-orient them) back to school in a way that can be helpful. If the anxiety is more severe, consider talking with your pediatrician or a play therapist in advance to help them and you prepare.
7. Your back to school fear or anxiety - Getting yourself prepared for back to school is almost as important as preparing your child. Some parents will kick their kids out the door and drive off to their gym class without a second thought. For others, the transition can be just as hard on the parent as the child. Begin now to prepare yourself for what it will feel like those first few days at drop off. Showing emotions with your child is certainly OK, but a prolonged, tearful drop off can make things harder on your child.
8. Supplies - Get your child ready for back to school by buying their school supplies in advance whenever possible. Whether you buy the prepared packet from school or enjoy the process of shopping for individual supplies doesn't matter, just make sure your child is well prepared with what they need to start the year off right. Buy some extra tissues or hand sanitizer to help the teacher out.
9. Set goals - My favorite part of a new school year is the fresh start that kids can get. Whether last year was amazing or a huge struggle, it's a great opportunity to help our kids realize that they can always work on something to make themselves better. Using last year as a guide, help them set some goals that focus both on their strengths and challenges.
10. Attend meet the teacher night - Sometimes these events occur before school and sometimes they occur a little after school starts. Use meet the teacher night strategically to help frame your child in a positive light. This can go a long way to helping your child accomplish their goals for the year.

Whether you're counting the hours until you can send the kids back or dreading the return of early mornings, hopefully, these tips will help you think through some of the things you need to consider. I know it did for me.

What topics did we miss?

Related To This Topic:

• Vaccines and Immunizations
• Immunization Schedule
• Common Questions About Immunizations
• Knowing Your Child's Medical History
• Sleep Center
• Your Kids Are Ready For School. But Are You?
• 5 Questions Every Parent Should Ask Their Child's Teacher
• 6 Ways You Can Help The Teacher Understand Your Child

That’s a question we hear quite a bit, especially during the summer months. So we thought we'd ask one of our experts.

In general, swimming with a middle ear infection (while under treatment) is not a problem, according to Natalie Roberge, M.D., an Ear, Nose and Throat (ENT) specialist at Cook Children’s.

However, a child should stay out of the water for some time while experiencing swimmer’s ear, also known as otitis externa.

Unlike the common middle ear  infection, swimmer’s ear is inflammation and/or infection of the ear canal.

Symptoms

The symptoms of swimmer’s ear usually start as itching of the ear, and quickly progresses to ear pain (especially if you pull on the earlobe). You may even notice a discharge or foul smelling odor from the ear. Swimmer’s ear is predominately seen in the summer months, mostly in children older than 2 years and often only affects just one ear.

“Swimming with an otitis externa is discouraged until three days after the pain and drainage have stopped,” Dr. Roberge said.

How do you get swimmer's ear?

There's a reason why your mother used to make you dry your ears when you got out of the pool or shower. Water sitting in your ears is the perfect environment to allow bacteria and fungus to grow. Wax prevents water from pooling in our ears and changes the acidity of our ear canals to stop microbial growth. Therefore children with little to no ear wax are at risk of developing swimmer’s ear. Conditions that trap water in the ear, such as excessive amounts of ear wax or foreign objects in the ear, may cause troubles. Swimmer’s ear also is seen in children with diabetes, chronic immunodeficiencies, or certain skin conditions (such as severe eczema, or psoriasis).

Prevention

As with many diseases an ounce of prevention is worth a pound of cure. Drying your child’s ears thoroughly by tilting the head and place a towel in the ear can significantly decrease the chance of infection. If your child is prone to swimmer’s ears the use of waterproof earplugs or a few drops of over-the-counter swimmers ears drops can help prevent. You can make your own swimmer’s ear prevention drops with equal parts of rubbing alcohol (isopropyl alcohol) and white vinegar (5 percent acetic acid). At the end of swimming dry your ears and place a few drops in both ears.

What about swimming with tubes?

In general, kids with tubes do not need ear plugs while swimming, unless it seems to bother the child or with lake swimming or deep diving. The exception to this: Swimming with draining ears in children with tubes should be discouraged until the drainage has stopped.

Both the American Academy of Pediatrics (AAP) and the Academy of Otolaryngology – Head and Neck Surgery Foundation published the following:

“Evidence from clinical trials shows no benefit or trivial clinical benefit from routine water precautions. Some children with tubes may benefit from water precautions in specific situations (lake swimming, deep diving, history of recurrent otorrhea, head dunking during bathing, or otalgia with water entry into the ear canal).”

We hope this answers a few of your questions and you have a safe and happy swimming season. #Lifeguardyourchild

Related Articles:

• Another ear ache. Is it time to see an ENT?
• Let's learn something: Ear infections and tubes
• 7 ear infection myths every parent should know

While this is the plot of a new movie, it’s based on  fact.  Sudden Cardiac Arrest (SCA) is the leading cause of death in young athletes. The Fort Worth based movie, The Last Whistle, takes a look at what happens when no one knows what to do after a high school football star collapses and dies at practice from sudden cardiac arrest.

Sarah Thieroff, Project ADAM Texas Coordinator at Cook Children’s, hopes The Last Whistle brings awareness to not only SCA, but also how to be prepared for such an event.

“Every school does a fire drill, but the last time a student died in a school fire was 1950. On the other hand, a young competitive athlete dies suddenly every three days. This is something we need to make people aware of and I hope The Last Whistle will do that,” Thieroff said.

Thieroff says that 20% of our population goes to school each day, and parents assume they’re healthy and safe, but there is always the chance for sudden cardiac arrest, which is why Project ADAM is so important.

The reality is that parents and staff often don’t realize their school keeps an AED on site for situations like the one portrayed in The Last Whistle, or with the Cook Children’s programs namesake, Adam Lemel. In 1999, Adam, who was 17 years old at the time, collapsed during a basketball game and died from sudden cardiac arrest. Like in The Last Whistle, knowing where there is an AED on site and how to use it could have saved his life. 

There are now 20 Project ADAM programs in 16 states, and 150 lives have been saved to date nationwide. These 150 lives saved are because students and staff were properly trained on how to react to sudden cardiac arrest, Thieroff says.

Currently in the Texas Project ADAM program there are 414 Heart Safe Schools and 14 Heart Safe School districts. In 2018 eight lives were saved in Project ADAM Texas schools. It is the hope that through movies like The Last Whistle and stories like Adam’s that people will be encouraged to learn what to do in the case a sudden cardiac arrest occurs.

Prevention

Pre-screening is an essential component of prevention. In Texas, the University Interscholastic League (UIL) requires a Pre-participation Physical Evaluation prior to student involvement in sports for grades (7-12). The physical may help determine whether a student athlete is physically capable of certain exercise, and may determine the need for further evaluation should warning signs be present.

However, athletes are not the only ones at risk, and not all children are athletes, many are active and some may have underlying heart conditions. 

Sign and symptoms

Pediatric heart disease has warning signs and symptoms that can go unnoticed. It is important to recognize the following:

• Fainting or near-fainting during or after exercise, emotion or surprise
• Dizziness or lightheadedness
• Extreme fatigue associated with exercise
• Extreme shortness of breath associated with exercise
• Discomfort, pain or pressure in chest during or after exercise
• Skipping or racing heartbeats
• High blood pressure
• Congenital heart abnormality
• Family history of sudden death prior to age 50 or known heart abnormalities

Not all episodes of sudden cardiac arrest are preventable because many of the kids do not have symptoms until they have the episode. For this reason, secondary prevention strategies are important.

Alice Phillips, M.D., a Cook Children’s pediatrician in Fort Worth – Cityview, hears the worry in the voices of many of her patient families. They’re afraid their child may contract measles or some other contagious disease.

“I like to reassure them,” Dr. Phillips said. “And currently, I can say there is no indication of a major outbreak threatening the health of their children in our area. But I understand their apprehension and I admit I’m worried too.”

Measles cases have hit a 25-year high in the United States, and Texas already has reported 15 confirmed cases of measles in 2019, six more than in all of 2018.

And yet as the number of cases have gone up, Texas vaccine exemption rates have reached an all-time high. According to a report in the Texas Tribune, “the number of individuals who have had at least one vaccine exemption affidavit requested on their behalf has grown more than tenfold, to more than 70,000 in the 2018 fiscal year.”

Texas is one of 16 states to provide vaccine exemptions for conscientious, philosophical and/or religious beliefs. In our state, kindergartners must have 10 immunizations to be enrolled in school. The Tribune found that since 2006, when Texas first started reporting data, the exemption rate for kindergartners has risen from 0.3% for the 2005-2006 school year to 2.15% for the 2018-2019 year.

“I’m very concerned by these numbers,” Dr. Phillips said. “I truly believe vaccinations are the greatest public health advancement seen in my lifetime. This trend toward opting out of vaccines threatens the health of all of our children.”

The Texas Tribune article allows readers to type in their school district and see the vaccine exemption rates for kindergartners, those who aren’t receiving vaccines by claiming a conscientious exemption (along with citing medical or religious concerns). The story mentions that Alliance Christian Academy had the second highest vaccine exemption rate by percentage in the state last year with 40.6% of their students (13 of their 32 kids).

In Fort Worth ISD, 1.39% of kindergartners (84 of 6,031) received non-medical vaccine exemptions. Dr. Phillips knows that some will say that’s only 84 kids in Fort Worth or 13 at Alliance Christian, but those numbers add up.

“You may say only 2% of the population isn’t vaccinated, but that 2% is often times happening in clusters,” Dr. Phillips said. “We have seen those areas with clusters of a population are where we are especially primed and ready for an outbreak. That’s what we’ve seen recently in New York City. There was a cluster of people who didn’t vaccinate. I worry that’s what we are at risk for in Texas.”

Dr. Phillips hopes healthy people who can receive immunizations take that responsibility seriously. Community-wide protection depends upon a high percentage of the entire population receiving vaccines in order to protect children who are immune compromised and or can’t receive vaccines for health reasons.

“Those children rely on us to protect them,” she said. “They can’t have the vaccine, so they rely on the rest of us to stand up and protect them and keep these illnesses from them. That’s the herd immunity. That’s simply not happening as much as it should in this country. The measles cases in this country are startlingly high.”

With so much misinformation on the Internet or even among their friends, Dr. Phillips welcomes a conversation with her patient families. She said her job is to listen to concerned parents in a respectful way to try to provide facts and calm their fears.

“I try to answer them with what my experiences as a practitioner have been. I tell them not only what I’ve seen as a physician and explain all the science supporting immunization, but what I’ve done as a mom. My children are vaccinated. I believe in vaccines. Many times, a parent just needs kindness, compassion and assurance that they are making the right decision for their child. I truly want them to know that receiving a vaccine is the right decision for your child.”

For more on this topic:

• The Texas Tribune Story: Texas vaccine exemption rates have reached an all-time high. Did Texas make it too easy for parents to opt out?
• Vaccines and Immunizations
• Common Questions About Immunizations
• Measles
• Immunization Schedule
• From Vaccine Hesitant to Pro Vaccines. Why This Mom Changed Her Mind.
• Pediatricians Remember Experiences with Measles
• What The First Measles Case in Tarrant County Means for Your Child
• 'Vaccines Are Safe and Effective'
• When It Comes to Your Kids It's Never Just a Virus
• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles In the Classroom
• MMR/thimerosal/mercury: What you should know

I’ll be honest. I haven’t paid much attention to the NBA Finals this year. I’m much more impressed that the Rangers are over .500 at this point and in thick of playoff contention for a Wild Card spot…

Anyways, the NBA Finals are heading into Game 6, with the Toronto Raptors up 3-2 over the Golden State Warriors. When I heard on Monday afternoon that Kevin Durant was planning to play in Game 5, my stomach dropped. If you aren’t aware, Kevin Durant suffered what was called a “mild calf strain” on May 8, during a game against the Houston Rockets in the Western Conference semifinals. What was initially labeled as a “mild” injury, was later in the month described as worse than first thought by head coach Steve Kerr.

Even Durant said he originally thought the injury was worse than a strain. This past Sunday, the day before Game 5 of the finals, Durant practiced with his team for the first time since the injury. It was the perfect making of a sports fairytale – a team down 3-1 in the series desperately seeking a win to avoid losing the championship, the injured hero boldly rushing his return to save the team and hopefully deliver a championship… except the opposite happened.

In the second quarter, Durant pulled up suddenly on a crossover move and then dropped to the floor clearly in pain. Replay appeared to show his calf cramp and shrivel up. He had to be helped off the floor and ultimately left the arena on crutches and in a boot. On Wednesday, Durant confirmed what I feared: an Achilles tendon rupture.

Now that he's had surgery, you can likely rule him out for the entire 2019-2020 season. Recovery from an Achilles tendon rupture and returning to high level sport is roughly 12 months after surgery. So naturally, the questions begin. Who is to blame? Did he rush his recovery? Was he truly ready?

We will likely never know, but I do think this offers a great opportunity to talk about the importance of allowing adequate time for full recovery. In my role as a sports physical therapist at Cook Children’s, I have the pleasure of working with kids and young adults of all ages usually trying to return to some level of sport. My day is typically filled with cases such as the volleyball player with an ankle sprain, the baseball pitcher with elbow pain, the soccer player recovering from an ACL reconstruction, the basketball player with a hamstring strain or the football player who fractured his leg.

I love my job. I love helping these patients get back to doing what they love. But I also recognize that I have a great responsibility to make sure that each patient is genuinely ready to resume their chosen sport.

The physicians I work with depend on my feedback to determine readiness. I’ve been “the bad guy” on more than one occasion and told a patient that I didn’t think he or she was quite ready to play in the tournament that weekend. It’s a tough position to be in, and I recognize that sometimes it’s not received well by both the parents and child, but I always come back to the responsibility and trust instilled in me to make sure that their child is truly ready to play.

We have tests and measures in physical therapy that we use to assess readiness, and we also can simulate game time situations in a controlled environment. I can never 100% guarantee that reinjury will not occur, but I want to be as close as possible. I don’t want that basketball player with the history of a hamstring strain to fully tear his hamstring. I don’t want that volleyball player with an ankle sprain to not have full strength back, change the way she jumps, and then land awkwardly and tear her ACL. On the day of their last appointment with me, I always tell each patient that I genuinely hope they never see me again in the clinic.

My motivation and ultimate goal is that each and every patient has full strength, control, awareness and confidence upon finishing physical therapy. If your child has suffered an injury, we are here to help. Our physical therapy staff collaborate with your physician to create and customize our plan to get your child back in the game. We have their best interests at heart and want to do everything possible to avoid reinjury. The process may feel long, but patience and persistence will certainly pay off.

If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 866-205-7270.