Holidays often mean more car trips as families drive to visit relatives. Sharon Evans, trauma injury prevention manager for Cook Children’s Health Care System, explains that during the holidays, there is an increase in motor vehicle collisions and related injuries.

Texas law requires children under the age of 8 and those under 4 feet 9 inches to be in a child safety seat. Failure to properly restrain a child can result in a ticket of up to $250.  Despite these laws, NHTSA data shows that 46% of car seats are installed incorrectly.

“There are more kids in the car than there are seatbelts and/or car seats, or the car is loaded with gifts and food,” said Evans. “So parents don’t make the child sit in their car seat, booster seat or wear their seat belt.”

Unfortunately, that leaves children unprotected in a crash and often results in severe injuries or death. 

“Don’t skip on safety over this holiday season,” said Evans, “make sure you and your children are buckled up correctly on every ride, no exceptions.”

A Child Passenger Safety Technician (CPST) can help ensure a child is safely and correctly secured in their car seat. Cook Children’s Health Care System has 66 CPSTs across North Texas.  

The Injury Prevention Collaborative offers free car seat checks with a CPST. Additionally, assistance is available to families who may need a car seat. To schedule an appointment, please call 682-885-2634 or click the link. You must have your child with you, unless you are an expectant parent.

Know the Four Stages of Car Seats

1. Rear-facing

Rear-facing car seats are the first stage of restraint for children ranging from newborns to preschoolers. This stage supports their head, neck, and back while riding in a vehicle until they meet the maximum weight OR height of their car seat. Experts highly recommend keeping your child in a rear-facing car seat for as long as possible, as it is the safest option available.

2. Forward-facing

Forward-facing is the second stage of car seats for preschoolers through school-age kids. Children should remain in a forward-facing car seat with a five-point harness until they meet the maximum weight OR height, then move into a booster seat.

3. Booster

Children must be at least four years old before transitioning into a booster seat. The booster seat stage is crucial for children who have outgrown a harnessed car seat, but do not yet fit safely behind a lap-shoulder belt. Still, booster seats are skipped over all too often. 

4. Seat Belt

A seat belt is the final stage of restraint. The safest time to transition to a seat belt is when your child is at least 4’ 9”, or 57 inches tall. Although the law states that children can transition to seatbelts at eight years old, Evans cautions that many children won’t reach 57 inches in height and should therefore remain in a booster seat until closer to 10 or 12 years old.

Firearm Safety

According to the 2024 Community Health Needs Assessment of households with guns in our eight-county service area, approximately 1 in 5 children live in a home with guns that are not always safely locked away.

Between 2022 and 2024, Cook Children's Health Care System in Fort Worth treated 179 individuals for firearm-related injuries. 10 were fatal and 169 were non-fatal. The majority of fatalities were from handguns and 136 were unintentional firearm injuries.  

The Aim For Safety program focuses on educating about firearm safety to decrease the number of youth injured or killed by a firearm.

The program shares these safety tips:

• Safe Storage
  • Store firearms unloaded and in locked locations, out of reach of children.
  • Use cable locks and gun boxes.
  • Secure ammunition separately.
• If You See a Gun
  • Stop.
  • Don't touch.
  • Run away.
  • Tell a grown-up.
• Safe Play
  • Ask the parents of your child's friends if they have guns in their homes and how they are being stored.
  • If you are asked about your guns, don't be offended.
  • Never aim BB guns or pellet guns at another person.

Poison Prevention

More than 800 children are treated at Cook Children's Health Care System every year due to accidental poisoning, and 65% of those poisonings are medication-related. According to the 2024 Community Health Needs Assessment, 1 in 2 children live in homes where medications are not always locked up and 4 in 7 children live in homes where cleaning products are not always stored in a locked area.

Tips for Poison Prevention

• Safe Medication Dosing
  • Follow the dosing directions listed on the medication by using the appropriate measuring items, such as a medicine cup or oral syringe.
  • Double dosing is NOT twice as effective, and in many instances can cause internal damage.
  • Adult medications may be too strong for children and should not be given in half doses. Only give medicine to your child that is intended for children.
  • Print the medication schedule to keep the right dosage for your family.
• Safe Storage
  • Many people leave medications on bathroom and kitchen counters as well as bedroom nightstands as a visual reminder to take them. Avoid unintentional injury and store medication up high, locked, and out of reach.
  • Hang purses and personal bags up high so children cannot reach prescriptions, vitamins, or other regularly used medications.
  • Remember, when visiting friends and family, it is ok to have an open discussion about safe storage.
• Safe Disposal
  • Visit a medication drop box at a local pharmacy. For more information on poison prevention, visit www.meddropbox.org.
  • The best disposal option is to find a drug take-back location, which may be found in retail, hospital, pharmacies, and/or law enforcement facilities.
  • Removing any unused or expired medication in the home can reduce the risk of access.

Safe Sleep

Each year in the United States, 3,500 babies die unexpectedly during sleep, according to the Centers for Disease Control and Prevention (CDC).  In Tarrant County, between 2018 and 2022, there were 124 deaths due to Sudden Unexpected Infant Death (SUID).

Sudden Unexpected Infant Death (SUID) can happen in any sleep environment, but it is less likely to happen if the baby is in their own crib, bassinet, or portable crib," explained Samantha St. John, safe sleep program coordinator at Cook Children's Center for Community Health.

Caregivers should remember the ABC's of Safe Sleep:

• Alone: The sleep space should be clear of any soft items, such as blankets, stuffed animals, pillows, and bumper pads, leaving only a mattress with a tight-fitted sheet.
• Back: Babies should always be placed flat on their back for every nap and every night.
• Crib: A crib, bassinet, or portable play yard with a firm, flat mattress and a fitted sheet is the safest sleep surface. 

The Texas Poison Control Network received 192 reports of kratom and other 7-OH products in 2025 alone, compared with 229 exposures combined in 2023 and 2024.

The agency reported 19 cases this year. Eleven of those cases required treatment at a health care facility due to significant health risks.

Written by Samantha Youngblood

The Texas Poison Center has reported 192 exposures involving kratom or 7-hydroxymitragynine (7-OH) this year. 7-OH is a chemical compound found in small traces in kratom, a tropical tree native to Southeast Asia. Kratom is known for its stimulant and opioid-like effects. Both 7-OH and kratom are often marketed as remedies for pain, anxiety or opioid withdrawal.

The U.S. Food and Drug Administration recommends “consumers avoid 7-OH products, including conventional foods, dietary supplements, and those claiming to treat an ailment or disorder.” Neither 7-OH nor kratom is FDA-approved for medicinal use, and has not been proven safe or effective.

The Texas Department of State Health Services issued a public health alert on the use of 7-OH, on Sept. 2. DSHS has found 7-OH in low levels of kratom products sold as liquid extracts, powders and gummies across the state.  

Klaressa Broughton, poison prevention program coordinator for Cook Children’s Center for Community Health, explains that the public health alert is intended to raise awareness of the dangers posed by 7-OH products due to the rise in cases and increased access to these products.

Broughton shares what parents should know about this public health alert and offers guidance on how to talk to their children.

How should parents talk to kids about 7-OH?

Create an open, honest and judgment-free environment. Parents should provide accurate information, encourage questions and reassure children that they have a trusted support system.

It is important for children to feel as though they have a support team and/or trusted adults they can go to for questions they may have. If needed, seek professional guidance to assist.

What does exposure look like?

According to the Centers for Disease Control and Prevention (CDC) and DSHS, Symptoms reported after harmful 7-OH exposure include:

• Nausea and vomiting
• Agitation or confusion
• Sweating
• Rapid heart rate
• High blood pressure
• Trouble breathing
• Drowsiness or loss of consciousness
• Seizures

What if a child consumes a 7-OH or kratom product?

Parents should seek medical attention immediately. If the child becomes unresponsive, parents are encouraged to administer naloxone, an over-the-counter medication that can temporarily reverse opioid-like effects. Naloxone is available at many pharmacies, including Cook Children’s Medical Center Pharmacy, and is often covered by insurance. Visit www.meddropbox.org for more poison prevention information.

Naloxone’s effects last 30 to 90 minutes, while 7-OH and kratom effects may last four to eight hours, making medical care essential.

Who can I talk to about 7-OH?

Consult a doctor or pharmacist before using any supplement, especially those marketed for pain, energy or mood.

• Talk to a health care provider about treatment for opioid addiction, anxiety, mood disorders or pain.
• Call the Poison Help Line at 800-222-1222 with concerns about 7-OH.
• Dial 911 immediately if someone is unresponsive or needs urgent medical attention.

How can I dispose of these products?

Visit a medication drop box at a local pharmacy. You can also participate in National Prescription Drug Take Back Day, organized by the U.S. Drug Enforcement Administration, on Oct. 25. Police departments across Texas will accept unwanted, unused or expired medications that day. This is a great opportunity to safely dispose of all unused or expired medications in your home, too.

Texans are encouraged to stay informed, talk with their health care providers, and take advantage of safe disposal options to reduce risks tied to 7-OH products.

Toys gifted during the holidays are meant to bring joy and adventure. But toys can also pose risks for choking, head injury and other dangers.

A curious toddler might swallow a Barbie shoe or stick a craft bead up their nose. Older children might crowd onto the trampoline or shoot a Nerf gun at someone’s face. Teens might want to ride their bicycles and scooters without a helmet.

That’s why the safety experts at Cook Children’s urge parents to implement the best practices to help keep kids of all ages from getting hurt with toys. January is the time to set intentions for the new year … a fresh start for rules when it comes to how your family members use toys and put them away. 

“Injuries prevent fun. We want to be able to have fun with our toys, and in order to do that, we have to be safe with them,” said Ashley Pagenkopf, MS, CCLS, Child Life Specialist at Cook Children's Emergency Department (ED). “Safety produces fun.”

National statistics from the U.S. Consumer Product Safety Commission show an estimated 209,500 toy-related injuries were treated in hospital EDs across the country in 2022. Cuts and abrasions accounted for 41% of those ED visits. Almost half were injuries to the patient’s head and face.

At Cook Children’s in the year between October 2022 and September 2023, our ED saw patients with injuries stemming from: 

• 15 in bicycle collisions with automobiles
• 52 on bicycles
• 27 on scooters
• 25 on skateboard or hoverboard
• 20 on skates or rollerblades
• 106 on trampolines

The data from the Cook Children’s ED also included 93 injured ATV riders, including five fatalities. Additionally, the ED treated 29 patients hurt on go-karts and golf carts in the 2022-2023 year.  

Sharon Evans, trauma injury prevention coordinator at Cook Children’s, said parents need to understand the risks and be vigilant about teaching and enforcing rules for safe use of toys. She especially emphasizes the need to wear a helmet on any toy with wheels.

“Kids need to be taught the importance of using a helmet on EVERY ride, how to look for cars pulling in and out of driveways and on the street, crossing only at intersections,” Evans said. “They don’t learn all this by one parent lecture. You have to be with them and model this behavior until they are able to reproduce it on every ride.”

What’s most important for parents to remember? Here are key tips:

1. Get rid of the packaging right away when a new toy is unboxed. Plastic bags, bubble wrap and packing peanuts can be hazardous for a young child.  
2. Read the warning labels and instruction manuals. Show your child how to use the toy properly.
3. Follow the age range listed by the toy manufacturer. If it says 4+, then it’s not appropriate for a 3-year-old. And be mindful of your child’s maturity and any developmental delays that could affect their readiness for a particular item. Just because your child is 4 years old, they might not be suited quite yet for a toy labeled 4+. “As a parent you have the ability to say ‘We’re going to put this up for a while,’” Evans said.
4. If assembly is required, finish the job completely and correctly. A screw only partially screwed in can wind up in a child’s mouth.
5. Watch for magnets and batteries in toys. If swallowed, they can cause a fatal injury or serious harm to the throat, stomach and intestines.  
6. Be aware of recalls issued for toys identified as potential choking or fire hazards, containing unsafe amounts of lead, or other concerns.
7. Make sure older siblings keep things out of reach. That includes game pieces, mini LEGOs, makeup kits etc. Evans recommends finding a place and time when babies and toddlers aren’t nearby. “There may have to be rules where the older child can play with the small toys only when the younger child is asleep. Or put the toys up on a table or counter where they are out of the younger child’s reach,” Evans said.
8. Pick up after playtime. Plastic bins and secure lids from the dollar store are smart and affordable ways to contain your family’s toys.

Parents should set the expectations and then give their kids frequent reminders to help them stick to the family rules. Children might push back on the limit of two jumpers at a time on the trampoline or the requirement to wear a helmet on the scooter or bicycle. But it’s important to be consistent. And be ready to follow through with consequences if a child breaks the rules.

Pagenkopf said parents should reinforce again and again the conversations about putting away the toys that are risky for a little brother or sister. It’s also important to model the habits you want to instill, she said. For example: Parents should always wear a helmet when riding their bikes, so that kids understand that safety rules apply to everyone in the family.

Another tip is to praise your child for using and storing toys properly. “Say ‘Hey, thanks for having your helmet on.’ ‘Thanks for putting your toys away,’” Pagenkopf said. “Kids are so responsive to positive reinforcement.” They’ll repeat the praised behavior.  

Not all toy-related injuries can be prevented. But when a family makes safe habits the norm, they reduce the odds of a severe injury that requires a trip to the ED. It takes consistent practice by children and parents.

“There’s an intentionality and a mindfulness in it,” Pagenkopf said. “Not being safe is what steals fun away.”

RELATED STORIES:

• An ER Doctor's Warning About Water-Based Soft Gel Guns 
• Heads Up: Helmet Tips for Safer Bicycling 

A case of measles was confirmed in a pediatric patient last week in Texas, according to Texas Health and Human Services. The last confirmed measles case in Texas was in 2019. Cook Children’s is sharing what parents and caregivers should know.

Measles is highly contagious. It causes severe pneumonia and can cause a progressive form of encephalitis or inflammation of the brain.

Measles spreads through the air when an infected person coughs or sneezes. You can get measles by being in a room where a person with measles has been, even up to two hours after the person has left. An infected person can spread measles to others even before knowing he/she has the disease.

Some of the more common measles symptoms include:

• high fever (may spike to more than 104° F),
• cough
• runny nose
• red, watery eyes (conjunctivitis)
• rash (3-5 days after symptoms begin)

If you think you have measles or may have been exposed, isolate yourself and immediately call your health care provider and your county health department. It is recommended to wear a face mask.

Even children who recover from measles, especially those younger than 2 years old, are still at risk for developing SSPE – delayed brain inflammation – seven to 10 years later.

Two doses of MMR vaccine provide the best protection against measles for your child. The Centers for Disease Control and Prevention recommends that all children receive two doses of the measles-mumps-rubella (MMR) vaccine – one at 12 to 15 months old and another at 4 to 6 years old. One dose is 95% effective against measles and two doses are 97% effective.

People at high risk for severe illness and complications from measles include:

• Infants and children aged <5 years
• Adults aged >20 years
• Pregnant women
• People with compromised immune systems, such as from leukemia and HIV infection

According to the Centers for Disease Control and Prevention, 16 cases of measles have been reported this year as of June 8, 2023. The CDC warned in November 2022 that a record of nearly 40 million children missed a measles vaccine dose, leaving them susceptible to infection.

Protection

The best protection against measles is MMR vaccine. MMR vaccine provides long-lasting protection against all strains of measles.

Here at Cook Children's, we follow the same guidelines that we recommend to our patients and their families.

• Vaccines save lives
• Vaccines are safe
• Vaccines protect those that cannot be vaccinated
• We vaccinate our own children

Nicholas Rister, M.D., of the Cook Children's Infectious Disease team, answers questions about measles and shares what parents and caregivers need to know.

What should I do if my child has only received one dose of the MMR vaccine so far?

If your child has received only a single dose of the MMR vaccine and is >4 years of age, then they are due for a second dose which can help boost their immunity.

In the meantime, the single dose they have gotten should provide substantial protection from severe disease. This is great for their safety but can make how they may present more subtle. While they may still have a fever, cough, red eyes, and a rash, these may be much more subtle or absent. However, they will still be contagious and can infect other children and adults who are non-immune.

If your child is only partially immunized and has some of these symptoms, especially a red rash that starts on the head and spreads downwards, be sure to ask your pediatrician about measles to review if testing is indicated.

How do I know if my child has been exposed to measles?

In many cases, you will not unless you are contacted by the health department. Sometimes an outbreak will occur through schools or daycares, and you will be alerted through these contacts as well. However, if your child or close contacts develop the constellation of symptoms above, be sure to discuss with your physician about the need for monitoring and testing.

How does measles transmission occur?

Measles transmission occurs via person-to-person contact as well as airborne spread. Infectious droplets from the respiratory secretions of a patient with measles can remain airborne for up to two hours. Therefore, the illness may be transmitted in public spaces, even in the absence of person-to-person contact.

Additionally, if someone is exposed to measles and is not immunized, they have a 90% chance of contracting the disease. It is highly contagious without vaccination.

What are the physical signs of measles in children?

The classic findings of measles in addition to fever and rash are cough, pink eye, and a runny nose. These are often prominent. The rash is also unique in that it starts on the head and spreads downward over the body. While other viruses can cause some or all of these symptoms, the constellation should raise the question of measles if there has been a known exposure or if a patient is unimmunized.

Where do measles come from?

Humans are the only natural source of the measles virus. While it could be spread in a laboratory setting, virtually all disease we see is from natural infection between person-to-person and airborne contact.

Information from Cook Children’s and the Centers for Disease Control and Prevention:

• CDC: Top 4 Things Parents Need to Know About Measles
• CDC: Measles
• Go here to view photos of measles from the CDC.
• What to know about vaccines and immunizations | Vaccine fact and fiction | Cook Children’s

Related content on CheckupNewsroom.com:

• Infectious Diseases Doctor Shares Why Measles Vaccination is So Important (checkupnewsroom.com)
• Infant Immunization Week Encourages Babies' First Shots (checkupnewsroom.com)
• Get Immunized for a Healthy School Year (checkupnewsroom.com)

This is an alarming increase compared to January through May 1 in 2021, 2020, 2019, 2018 and 2017, according to Cook Children's data.

This year, 11 drownings have occurred in swimming pools, one occurred in a hot tub, and five drownings were in bathtubs. Children ranged in age from 11 months old to 9 years old.

While most patients survived these incidents, drowning injuries can result in severe effects.

Many of the drownings in 2022 happened during unplanned swim time. This is when parents didn’t expect their child to be in or around the water. 

Parents can put barriers in place to help prevent a child from accessing the water or make it more difficult to access when an adult is not present. Barriers – such as locks, alarms and fencing – can help keep unsupervised young children from getting into swimming pools.

In 2021, more than 60% of drownings treated at Cook Children's were during unplanned swimming time.

Lifeguard Your Child

Cook Children’s initiated a drowning prevention campaign called Lifeguard Your Child in 2015 in response to a high number of drowning injuries treated in the Emergency Department and medical center that year. The Lifeguard Your Child campaign is spread through the Safe Kids North Texas Coalition, which is based in Fort Worth and led by Cook Children’s.

The campaign’s strategies include Cook Children’s Loaner Life Jacket Stations at many lake entry points across the region. Families can go to the stations to find U.S. Coast Guard-approved life jackets in a variety of sizes with easy tips for a proper fit.

Safety tips for home swimming pools: 
• Restrict access by installing door locks high out of children’s reach. Door and window alarms can signal if someone leaves the house. 
• Install four-sided fencing around pools with a self-latching gate that only opens out. The fence should be at least 4 feet (preferably 5 feet) high. 
• Remove all toys and floats from the pool area so children are not tempted to get close to the water. 
• For above-ground pools, make sure the ladder is removed and not accessible when it’s not swimming time. 
• Consider a pool surface alarm to alert if anyone/anything falls into the water. 

Safety tips for the bathtub: 
• An adult must stay at the side of the tub in reach of the child. 
• Pay attention. This is not the time for multitasking. 
• Ignore distractions like the doorbell or phone calls. 
• Drain the tub after each use. 
For more information about drowning prevention, go to www.lifeguardyourchild.org. 

The Center for Children’s Health (C4CH), led by Cook Children’s, installed its first loaner life jacket station in the spring of 2020. The stations provide five different sizes of U.S. Coast Guard approved life jackets, ranging from infant to adult, that can be borrowed and returned. The goal is to make sure no child or adult drowns at a public lake because they didn’t have access to a life jacket.

“Texas has a lot of lakes and having a loaner station at entry points is a great reminder for families,” said Amy Johnson, program coordinator for the Center for Children’s Health. “The signage on the station not only explains how it works but also how to properly fit a life jacket.”

Sadly, the number of drowning patients seen at Cook Children’s this month has already surpassed the number of patients seen in the same time period of 2020. So far, 35 children have been admitted to Cook Children’s for drowning, with two deaths. Three of the drownings occurred at area lakes.

The loaner life jacket program has 12 stations at lakes across DFW, including:

• Cleburne
• Alvarado
• Flower Mound
• Grapevine
• Weatherford
• Lewisville

The stations are constructed by Lifeguard Your Child partner and Texas-based construction firm, Linbeck. C4CH plans to extend the stations to pools in neighborhoods and communities soon.

Cleburne resident Robin Kiel has lived across the street from Lake Pat Cleburne for more than 30 years. As a former pediatric intensive care (PICU) nurse, she has seen her fair share of drownings and fatalities.

Recently, the two new loaner life jacket stations at the lake caught her attention.

“I saw something out of the corner of my eye one day and went to check it out,” Kiel said. “Once I realized it was a loaner life jacket station from Cook Children’s, all I could think about was how many lives could be saved.”

Kiel and her family have seen several tragedies while living directly across from the lake. She recalls instances over the years when helicopters have landed in her yard to transport a child to the emergency room, or emergency personnel rushing past her house to save someone’s life. Kiel says these moments are hard to watch, but what’s even worse is watching the number of children who enter the lake without a life jacket.

“During my time as a nurse, I’ve seen tragedy after tragedy,” Robin explained. “The hardest part was the water fatalities that could have been avoided. There's a lot of children that swim without life jackets and it's dangerous in a lake. You can't see the bottom if they were to fall or get swept away. You can't find them once they're under the water.”

Kiel says with school out and summer in full swing, she expects to see thousands of people at the lake on the weekends and she is hopeful people will take advantage of the loaner life jacket stations.

“I think it's just really important to remind people that if you don't have a Coast Guard approved life jacket, there are some that are loaned here in two different places on our lake and they can just borrow them and put them back when they're finished for someone else.”

Tara Janszen is Kiel’s daughter and the president of the Cleburne Chamber of Commerce. She says she’s also thankful for the additional safety measure at the lake.

“The collaboration between Cook Children’s, Cleburne Fire Department, and the Cleburne Parks and Recreation department is something that will benefit our residents and visitors who come to Lake Pat Cleburne,” Janszen said.

Lake Pat Cleburne is also home to holiday celebrations, and more. Tara says the city is happy to have their Independence Day celebration back at the lake this year, and she is hopeful having the life jackets will be an added safety measure for families.

“We have thousands of people that come out to enjoy the lake for the day. We shoot fireworks off the dam that evening,” Janszen said. “We want people to have fun, but first and foremost, we want people to be safe. I think this new opportunity for kids to be able to loan or borrow a life jacket, and for families to utilize this program is going to make our event just even better this year.”

Johnson shares the same feelings. She wants people to get out and have a good time, without any tragedies. Thus far, the stations have been well-received at all six lakes.

“Our community partners and families are excited about having the stations and how easy they are to manage,” Johnson explained. “The feedback from lake-goers has been amazing, and they are using the life jackets, which is the goal.”

Kiel says she enjoys walking out of her front door and seeing neighbors and visitors enjoying the lake, and she is hopeful this summer will conclude with every family making it back home safely.

“I think the life jackets can help save lives,” Kiel said. “Drowning happens so quickly, and it’s such a tragedy for families. I think it could save a lot of children's lives and I believe that’s the goal for Cook Children’s and the City of Cleburne.”

Johnson understands families are excited to get together for the summer, but safety has to be the top priority for everyone to have a good time.

“We know everyone is eager to enjoy the summer, but along with that we know there are a lot of potential distractions,” Kiel expressed. “We want families to remember to have an emergency plan in place, always designate a pool and lake ‘water watcher’ for safety, and to remember to keep a child’s life jacket on until they are safely away from the water’s edge.”

Important to note:

If you live in a community with a lake or pool that could benefit from a loner life jacket station, send an email to Safe.kids@cookchildrens.org. To learn more about the loaner life jacket program and other safety measures, visit lifeguardyourchild.com

The videos, which are part of the Lifeguard Your Child initiative, feature simulations of some of the most common drowning scenarios we see, including children falling into swimming pools unnoticed and teens drowning in open water.

“Too often we see drowning patients who have fallen into water either at a pool party or after a swimming event when everyone is packing up to leave,” said Sharon Evans, trauma injury prevention coordinator at Cook Children’s. “We’re really hoping these videos illustrate the importance of 100% supervision and layers of protection, such as pool fences and locks.”

Cook Children’s launched Lifeguard Your Child in 2015 after a record number of child drownings. Sadly, 2021 is on track to surpass recent years. Already this year, 35 children have been admitted to our hospital for drowning injuries. Two have died – both in May.

Of the 35 drownings this year, 22 occurred this month making this the worst June on record since 2016. The majority of the drownings we see occur in swimming pools, including the two recent deaths. With the holiday weekend ahead of us, our experts urge everyone to practice vigilance around water.

“Everyone is so eager to get back into a normal routine and have those gatherings as COVID-19 decreases,” said Dana Walraven, manager of community health outreach for the Center for Children’s Health, led by Cook Children’s. “We’re just hoping for a heightened sense of awareness. When people are so happy to get back together, there may be distractions.”

Walraven and Evans encourage adults to take turns as designated watchers, fully attentive and within arm’s reach of kids in the pool. Designated watchers can spot trouble before it turns into tragedy.

“They don’t talk, they don’t drink, they don’t look at their phones,” Evans said. “You have to have that person in charge of watching. That is your job for 10-15 minutes, then you pass it off.”

Highlights for drowning prevention include:

• Young children should know to never get in the water unless an adult is within reach and watching. Learn to swim and swim with a buddy.
• Teens should be alert for hazards lurking in murky lake water. No horseplay or risky stunts. Wear U.S. Coast Guard approved life jackets.
• Caregivers should create barriers to the pool, such as four-sided fencing. Don’t lose track of the kids during the transition from swimming to the next activity (a trip inside to the bathroom, loading the car, etc.).

The Lifeguard Your Child initiative has distributed 1,296 life jackets this year in drive-through events and through six loaner stations at area lakes. The program recommends only those life jackets approved by the U.S. Coast Guard. Proper fit is essential too.

For more information about steps to prevent drowning, go to www.lifeguardyourchild.org.

Water safety advocates urge parents to stay vigilant to protect their children over Memorial Day Weekend and throughout the summer as backyard pool parties start happening again.

People are excited to socialize in person as coronavirus restrictions ease up -- but they must still keep close watch on the kids in the swimming pool. Drownings can occur even with many adults present.

“Everyone is so eager to get back into a normal routine and have those gatherings as COVID-19 decreases,” said Dana Walraven, manager of community health outreach for the Center for Children’s Health, led by Cook Children’s. “We’re just hoping for a heightened sense of awareness. When people are so happy to get back together, there may be distractions.”

In 2019, prior to the pandemic, the number of drowning admissions at Cook Children’s hit 71. Seven of those patients died. By comparison in 2020, there were 48 drownings seen at the medical center, three fatal. Those statics include drownings in bathtubs and open water, such as lakes; the majority, however, occurred in swimming pools.

2020’s decline in drownings came as a happy surprise to those who work to prevent injuries and deaths due to accidents in the water. One possible explanation? Last summer’s social distancing kept many families and friends from meeting up in big groups. Those big gatherings tend to be occasions when everyone assumes someone else is supervising the swimmers.

Sharon Evans, trauma injury prevention coordinator at Cook Children’s, encourages adults to take turns as designated watchers, fully attentive and within arm’s reach of kids in the pool. Designated watchers can spot trouble before it turns into tragedy.

“They don’t talk, they don’t drink, they don’t look at their phones,” Evans said. “You have to have that person in charge of watching. That is your job for 10-15 minutes, then you pass it off.”

Evans said drowning cases typically ramp up starting on Memorial Day. The age group most susceptible to drowning in pools is 1- to 4-year-olds. Precautions should be taken as well for older kids, even if they’re strong swimmers.

Drownings can happen silently and swiftly. A submerged person might not attract attention or appear to be in danger.

“It’s not like it is in the movies where they’re thrashing around and yelling for help,” Evans said. “In real life it almost looks like they’re climbing a ladder underwater, and if they can get their head above water, they just get a breath.”

“Lifeguard Your Child,” a drowning prevention campaign created by Cook Children’s, aims to get the message out through a regional collaboration of partners from eight counties across North Texas. The coalition includes school districts, police and fire departments, pool builders and swim lesson providers such as the YMCA. “Lifeguard Your Child’ promotes safety strategies through its website, videos, online classes and social media.

“The biggest piece we’re trying to do is have parents think about water safety and drowning prevention all year long,’’ Walraven said.

Campaign partners came up with new methods to reach their audiences during the COVID lockdown. Those efforts included a shift to greater virtual education. And in spite of the pandemic, “Lifeguard Your Child” reached 6,950 adults and children with educational toolkits between October 2019 and September 2020.

Highlights for drowning prevention include:

• Young children should know to never get in the water unless an adult is within reach and watching. Learn to swim and swim with a buddy.
• Teens should be alert for hazards lurking in murky lake water. No horseplay or risky stunts. Wear U.S.C.G. approved life jackets.
• Caregivers should create barriers to the pool, such as four-sided fencing. Don’t lose track of the kids during the transition from swimming to the next activity (a trip inside to the bathroom, loading the car etc.). Hospital admissions data increasingly show that drownings tend to occur during these unplanned situations “when one child goes back for a toy, or a child wants to jump in one more time,” Walraven said.

In addition to the education component, “Lifeguard Your Child” has distributed 1,296 life jackets this year in drive-through events and through six loaner stations at area lakes. The program recommends only those life jackets approved by the U.S. Coast Guard. Proper fit is essential too.

For more information about steps to prevent drowning, go to www.lifeguardyourchild.org.

Sometimes the first step toward saving the world begins in your own backyard.

That’s the hope for Frances Wampler and Blair Williams, two staffers at the Center for Children’s Health led by Cook Children’s, who are part of a team exploring how communities might target youth suicide as a standalone issue.

There are several “ifs” to contend with, but the two women believe it’s worth exploring the steady climb of youth suicide cases in the nation and determine what’s happening on the local and state levels.

“We see it in the headlines, see it on social media—even clinicians are expressing concern over it,” said Williams, who is a community health analyst and member of the community health needs evaluation team at the Center. “So, we’re seeing this as a rising need.”

Wampler and William’s decision to pursue the issue resulted from a culmination of events. In September, Wampler’s nephew, 19, died by suicide, leaving her family reeling from his death. And years earlier, Williams suffered the loss of a close family friend, a 15-year-old who took her own life. Their shared experiences, along with other data—including the Center for Disease Control’s report marking suicide as the nation’s second-leading cause of death among ages 10 to 24 in 2018 and a reported increase of self-harm cases seen at Cook Children’s last year—propelled the two women to pitch the idea of collaborating on exploring whether area communities needed help with this complicated issue.

“I know how hard it was for me and my family to experience the things we did,” said Wampler, program coordinator at the Center who focuses on child abuse. “He was my nephew, but he felt like one of my bonus kids. I felt like I lost one of my children, and I would take that heartache away from any person I could. I don’t want that to be the end of his story. He was not the last decision he made in his life...he was so much more than that.”

“I just want to do something with that—and I don’t know­­—try to save the world,” she said.

While discussing Wampler’s nephew’s death, she and Williams made note of how often youth suicide overlaps with other issues, such as firearm and poison injuries, child abuse and neglect, Adverse Childhood Experiences (ACEs), mental health and so on.

“These are things that the Center already has programming around,” Wampler said. “I was like, ‘We have to do something.’”

The two decided to take it to Center leadership and were given the green light to pursue it and “do some digging on the data,” Williams said.

“They’ve been really supportive of this,” she said. “That, to me, is really powerful because our leaders heard our concerns and supported us in our efforts to keep every child safe from injury.”

Wampler and Williams’s preliminary research efforts could potentially support the 2021 Community Health Needs Assessment. The Community Health Needs Assessment is conducted by Cook Children’s every three years to assess children’s health needs and the board uses the information to develop implementation strategies for addressing these needs.

They’re not sure how COVID-19 may affect this issue, let alone community health needs across the board, but youth suicide was on the rise well before the virus hit, Williams said. In 2012, the number of suicide deaths surpassed the number of cancer and heart disease deaths - causing suicide to be the 2^nd leading cause of all deaths in Americans ages 1-44 every year since.

“Part of it is recognizing there are several community partners and agencies that are well-equipped to handle this,” Williams said. “Part of the assessment is not only looking at the data, but it’s also looking at what resources are in the community that can be used to help.”

As it stands, the Center is in the data collection phase of the 2021 Community Health Needs Assessment process. They’ll sift through all sorts of data, such as what local health departments are seeing, what the CDC says, what the national and statewide numbers on children’s health needs show, and what’s happening inside and outside Cook Children’s walls. They’re currently conducting focus groups, a parent survey, a community leader survey, and key informant interviews, among other things. When finished, the data will be synthesized and a report published as the 2021 Community Health Needs Assessment.

Wampler and Williams are proud that the question they raised about what the Center can do to support youth suicide prevention has been met with a team approach to investigate this important topic further. They acknowledge this task is a huge undertaking. But both are passionate about getting help to children and families who need it.

Recognizing that this is becoming more of a trend is an important step, Williams said.

“There are so many great resources in our community, so many great partners. We have a wonderful health care system, a great employer who recognizes this issue. So, what can we do with these great assets and protective factors to keep kids safe from all types of harm, including harming themselves?”

Regardless of their findings and the various factors that come into play, Wampler and Williams believe ramping up awareness surrounding self-harm and suicide is key to preventing it among young people. But awareness doesn’t equate applying stereotypes, they said.

Even if children do “check off those boxes” for suicide risk factors, it doesn’t mean they’ll try suicide, Williams said. She encouraged all families to have a mental health plan to address any crisis that may arise.

“There are people who have multiple adversities and risk factors who lead very successful, healthy lives, and probably go on to help many other people, too,” she said. “It’s just recognizing that it needs more awareness. It can happen to anyone and to be prepared. If you’re in crisis, it’s going to be harder to seek out help. So, have that help lined up for you.”

Wampler agreed.

Normalizing conversations about thoughts of suicide, even if it’s uncomfortable for families, she said, also might help with prevention. Her nephew had supportive friends and family, played football in high school and had joined the military, she said, adding the family “had no idea he was feeling that way.” No one saw his suicide coming.

“I don’t think it’s talked about enough,” she said. “I don’t know how hard that would be to say, ‘I want to hurt myself.’ But you don’t have to suffer in silence. You can tell somebody that you’re struggling and get help.”

There may not be a simple answer to preventing youth self-harm and suicide, Wampler and Williams said. What leads to it and how to prevent it is often muddied by a multitude of factors, some controllable and others not.

But one aspect of it is clear to both women.

“For me,” Williams said, “if we can save one child, well, that is (saving) the world.”

“Yes. That’s right,” Wampler quickly agreed. “That one child is somebody’s whole world.”

Statistics, no matter how alarming, sometimes blur into faceless numbers when parents hear them on TV or read them in a news story.

That’s until it’s your child in the emergency room, hooked to an IV while receiving treatment for ingesting too many pills—in this case, over-the-counter pain meds often used to relieve menstrual cramps—with the intent of harming herself.

And then suddenly, those numbers have a face. For Betty, a Tarrant County mom who asked not to be identified to protect her 14-year-old from any stigma attached to her attempted suicide, the face that came fully into focus was her own teenage daughter’s.

Betty’s daughter is among the many children and young adults across the country who’ve used excessive doses of common drugs, like pain relievers or allergy medications, with the intent of harming themselves. National studies have shown OTC meds as the No. 1 means used by youths in suicide attempts and the third-leading cause of youth suicide deaths.

“I really didn’t put those in the category of prescription medications, so I never put them away,” Betty said of the handful of OTC meds—a combination of Motrin and Midol—her daughter swallowed earlier this year. (Motrin contains ibuprofen, and Midol is a mixture of acetaminophen, caffeine and pyrilamine maleate, an antihistamine.) “I want other people to know, and to even have lockboxes for their medications, so that someone else doesn’t have to go through what we went through.”

Her daughter, who went to school but said it wasn’t the same because of COVID restrictions, had felt isolated and been sad because she missed her friends, she said. She faced the typical teenage stuff like low self-esteem, Betty said, but she had no idea her daughter was considering suicide.

“She’s seeking treatment now, but I want to be really clear, ‘Put all your medications away, not just your prescription medications,’” she said.

Betty is far from alone in facing this issue. Other parents across the nation also are grappling with children and teens who are intentionally overdosing with easily accessible OTC meds.

In a study published by The Journal of Pediatrics in May 2019, Nationwide Children’s Hospital and the Central Ohio Poison Center found that suspected suicide attempts by self-poisoning in children and young adults had doubled in the past decade. The research, which targeted ages 10 to 24 during 2000 to 2018, also showed suicide attempts using OTC meds had tripled among girls and young women.

The same researchers later expounded on the initial report, pointing out that the two most commonly used substances among all age groups were OTC pain relievers—such as acetaminophen, ibuprofen and aspirin—followed by antidepressants.

Last year, a study conducted by the Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Children’s Hospital focused specifically on the use of OTC pain relievers in suicide attempts, showing a 57-percent hike in overall cases from 2000 to 2018. Children and young adults between 6 to 19-year-old made up half of the cases, and of those, 73 percent were female, the study showed.

Researchers analyzed 549,807 suicide-related calls made to poison control centers across the United States that involved OTC medications. The study, published in Pharmacoepidemiology and Drug Safety journal, also determined a 34-percent rise in the frequency of those cases during that time period, caused primarily by a jump among calls involving 6- to 19-year-old females, researchers said.

The results from the study showed the breakdown of OTC substances involved in the calls: 48 percent, acetaminophen alone; 33 percent, ibuprofen; and 19 percent, aspirin. Acetaminophen and aspirin accounted for 65 percent and 33 percent of deaths, respectively. Aspirin created the most serious medical outcomes for 36 percent of the cases and 68 percent of the cases with aspirin were admitted into a health care facility compared with other OTC pain relievers. Overall, while suicide-related cases using acetaminophen and ibuprofen climbed, the number involving aspirin decreased, researchers found.

Although local numbers on these types of cases are not yet readily available, physicians at Cook Children’s Medical Center are noticing a similar increase in intentional OTC medication overdoses.

Stacey Vanvliet, M.D., an inpatient pediatric hospitalist at Cook Children’s, said suicide attempts “have become part of my daily practice” and most are overdoses on a substance that’s “convenient for the children and teens to grab.” While it’s mostly older ones, children as young as 8 or 9 come in for attempting suicide, she said.

“Commonly, we see Tylenol, Motrin, aspirin, Benadryl—things that people just stock in their cabinets to have on hand,” she said. “We see teenagers take huge handfuls of them.”

Many people have a misconception of how dangerous these drugs can be when ingested over the recommended dosage, Dr. Vanvliet said. For example, high levels of acetaminophen (as in Tylenol) can cause liver damage or acute liver failure as well as other serious health issues.

“I think another misperception is that there’s a certain type of patient or type of teen that might try to overdose. Or that there’s a certain stressor or pattern, so to speak, that this happens and then the teen goes for pills or whatever it may be,” she said. “But in my experience, that’s not the case. We certainly have children who have undergone significant trauma and have mental health issues…but we also have children who haven’t shown a whole lot of warning signs and are very high achievers.”

When a child or teen attempts suicide, it’s usually an impulsive decision, Dr. Vanvliet said, which makes the accessibility to OTC meds more dangerous.

“You’d be amazed at some of the things that trigger them to make a serious attempt. It can be something as small as, ‘My mom took my phone away because I got a bad grade,’ or ‘My best friend is mad at me,’” she said. “It’s not necessarily anything that’s huge…but they make these snap decisions, and they go take a handful of pills, and it could be really damaging. It happens over and over, unfortunately.”

So, what can be done to keep children safe? Many health experts and researchers propose restricting the amount of OTC meds that can be purchased at one time and suggest unit-dose packaging, such as blister packs, as well as promoting safe storage for OTC and other medications.

Responding to that call, The Jordan Elizabeth Harris Foundation, a Fort Worth-based nonprofit group that targets suicide prevention, plans to launch Keep All Meds Secure (KAMS) public awareness initiative this summer. Christina Judge, the foundation’s executive director, said the initiative includes educating families and caregivers on the dangers of various medications, providing lockboxes for safe storage and advocating safe disposal of old medications. The foundation also offers free suicide prevention training to help parents to know what to look and listen for with a child who might be considering suicide.

The initiative began with a phone call that Judge received. A frantic mother, whose daughter had taken a handful of Tylenol and a handful of Advil, called the foundation seeking help in finding a bed at a mental health facility for her daughter.

“The pivotal moment was just hearing the anguish in the mother’s voice,” Judge said. “I asked her, ‘Did you know that these drugs in the hands of a suicidal child could be lethal?’ She said, ‘No. We just keep them in the cabinet above the sink.’”

“Well, that was enough for me,” Judge said, who researched the topic, presented a case for it and sought funding for the initiative.

Vanvliet believes programs such as KAMS will help with suicide prevention among children and teens.

“Education for parents and keeping those substances safe, I think, is a big part of preventing this from happening,” she said.

For Betty, what happened to her daughter has made her even more vigilant. She has always paid close attention to safety in her house. The family’s guns are always locked away in a safe, along with prescription medication. Now, she secures her OTC meds, too, she said.

She’s thankful her daughter, who’s getting ongoing treatment, didn’t suffer any long-term health effects from the incident. But Betty is highly aware that it all could have ended much differently that day her daughter tried to overdose.

“I think she got scared and came to me and told me. I’m so glad she did,” Betty said. “And I have to say if there were more pills in the bottles, we would have had a much different situation…it could have been much more harmful.”

“Like I said, we’d locked up everything else except for that. And if we had locked that up, maybe we would have avoided this,” she said.

“Just because it says crash tested doesn’t mean it’s been reviewed or approved by any regulatory agency,” said Sharon Evans, RN, trauma injury prevention coordinator at Cook Children’s.

Previously, non-regulated car seats were seen most in areas like California and New York. But according to Evans, these products are now showing up in North Texas.

Here’s what you need to know:

• To be approved by the National Highway Traffic Safety Administration (NHTSA), car seats must meet all the criteria to be able to state they meet or exceed FMVSS 213.
• Unregulated products may be found at well-known stores and online, so it is important for parents to check if the product is approved by the car seat manufacturer to be used with your specific car seat.

“The problem occurs when a parent buys a car seat that meets FMVSS 213, but adds accessories, which are not regulated. These products can alter the way the car seat works in a crash, or the accessory can become a flying missile, like a snap-on mirror,” explains Sharon Evans, trauma injury prevention coordinator at Cook Children’s. “I think parents feel that if it’s being sold by a big name retailer, it has to be safe, but often it isn’t.”

Evans big concern is that many car seat accessories claim to be “crash tested,” even though they are not regulated and do not meet the criteria by NHTSA.

The car seat manufacturers realize this is a problem and many now make non-regulated products such as seat protectors, water-resistant pads or covers for their specific car seats. If parents are going to add something to the car seat, it is important to verify the car seat manufacturer states the accessory is safe to use with the specific brand and model of the car seat.

“Accessories and non-regulated products are designed, made and sold by car seat manufacturers and anyone else who wants to,” Evans explained. “Even though the product may say ‘crash tested’ or meets NHTSA standards or FMVSS 213, however, there are no standards for these products. The product may be crash tested but we don’t know how and we don’t know if the product was tested in specific car seats and/or what car seats.”

What to look for:

• Make sure car seats are labeled with FMVSS 213. This means the product is approved by the NHTSA.
• Non-regulated products often have a similar label of FMVSV 213. These products are not federally registered, and cannot claim to effectively restrain the child or claim to prevent injury.
• Regulated products and accessories will state: Meets or exceeds all federal standards for car seat safety (FMVSS 213 Federal Motor Safety Standard for USA).

“Parents need to be really careful with car seat accessories, because you run the risk of your child being injured due to something like a footrest or head strap,” Evans said. “Unfortunately, some companies are intentionally using confusing labels to sell their products, so it’s really important that parents know what to look out for.”

The National Highway Traffic Safety Administration provides child passenger safety that can be found here. 

The ACEs Task Force, chaired by Cook Children’s, aims to reduce adversities for children starting before they are even born. Their work is based on a study conducted between 1995 and 1997 by Kaiser Permanente and the CDC. The study, which involves 10 questions about what a person experienced before the age of 18, shows ACEs are associated with high risk behaviors, chronic disease and reduced quality of life in adulthood. The task force is focusing their efforts on the signs of stress or difficulties that show up in early childhood.

Parents can help by making sure that children plan accordingly for testing days at school. Find out from your children and the school how they’re doing and the likelihood of not performing well on tests. This will help alleviate fears by pacing preparation for the tests, creating a plan to help kids succeed and encouraging them to problem-solve their worries.

Here are steps you can take to help your child during this stressful time:

1. Ask for help. If your child is especially anxious about test taking, set up a meeting with the teacher and school counselor to come up with a plan to ease fears on test day.
2. Go online and get sample items of practice tests from previous years and, if needed, practice with your children at home.
3. Practice deep breathing exercises at home. Then on test day, they will be able to put these practices into action.
4. Make sure your child gets plenty of rest. Studies have found that people who get eight hours of sleep before taking a math test are nearly three times more likely to figure out the problem than people who stay awake all night.
5. Control your children’s anxiety by making sure they are prepared. Focus on good study habits and the importance of not waiting until the last minute to cram before the test. There’s still time. Also, make sure your child has everything he or she needs going into the test. Even if it’s a new sharpened pencil. Make a check list the night before to avoid stress.
6. Stay away from entertainment as test time approaches. It’s not easy, but your child needs to study and not spend all night watching TV, looking at Facebook^® or being on the computer. You can wait on that until after the test.
7. Help your child keep mistakes in perspective. Everyone makes them and nobody is perfect. As you move closer to tests and studying, use wrong answers as a learning opportunity.
8. Eat right. Make sure your child has had enough sleep, exercise and healthy food. Avoid heavy food or desserts that may upset the stomach. Avoid  high sugar foods that may keep your child up all night and  make sure your child has a healthy breakfast (low-sugar cereal or oatmeal) the morning of the test.
9. Expect distractions. Let your child know someone in the class will have sniffles. Some kid will be banging his pencil on the desk. Someone may be humming. Those kids have their own stress. Just warn your child this is going to happen, but don’t let it be a bother.
10. After testing is completed, create ways to celebrate with your child. What you want to focus on in this celebration is the success of managing their stress, and not whether they passed or failed, which they won’t know for weeks.

Every year Cook Children’s treats more than 600 children due to poisonings. Seventy-five percent are medication related. Children can be accidentally poisoned by finding medication belonging to a friend or family member at their house or in their purse or bag; or by getting into a cabinet that contains household cleansers like bleach or window spray.

Nationally, nearly 60,000 young children end up in the ER every year because they got into medicine.

“Telling your child that medicine is candy or disguising it as candy in anyway is never a good idea,” said Corwin Warmink, M.D., medical director of Emergency Services at Cook Children’s. “Young children who can’t read labels may not know the difference between candy and pills or between juice and a cleaner. If you stack them side-by-side, you would have a hard time distinguishing between Sudafed tablets and candies like Red Hots, Tic Tacs or red M&Ms.”

So what do you do if you suspect your child has been poisoned?

Call the North Texas Poison Center help number at 1-800-222-1222 if someone in your family eats, drinks, breathes, touches poison or gets it in the eyes.

1. Program the Poison Center number into your cell phone today.

2. Don’t be afraid to call. Only the people who help you will know your name.

3. The phone line is available 24/7 and your call is free. More than 150 languages are spoken.

4. The Poison Center is staffed by nurses, pharmacists and doctors.

“Parents should call 9-11 immediately if a child, or anyone else in the family, won’t wake up or is having trouble breathing or is having seizures,” Dr. Warmink said.

Here are 5 other things you should know if you expect your child has been poisoned:

1. If your child has swallowed poison, have him or her spit out as much as possible.

2. Don’t make the child vomit, unless the label on the poison or local poison control center ask you to do so. “Vomiting can often times cause even more problems,” Dr. Warmink said. “First of all, it’s usually not very effective at removing the poison and the vomit can also go down the wrong way and find its way into the lungs. Another concern is that products such as cleaners and dishwasher powders can actually cause more burning.”

3. Don’t be alarmed if the child does vomit on his or own, but call for advice. “Sometimes it’s a natural reaction for a child to throw up,” Dr. Warmink said. “If that’s the case, it’s a good idea to give the child a few sips of water and then call the North Texas Poison Center.

4. Don’t use syrup or ipecac to induce vomiting. “This is not something that we recommend any longer as a routine treatment for poisoning,” Dr. Warmink said.

5. Don’t give your child milk without consulting a medical professional first. “First, consult with the professionals at the North Texas Poison Center,” Dr. Warmink said. “Milk can be helpful at times, but depending on what the child absorbed, the milk can increase the possibility of poisoning.” The same holds true for other fluids, such as juice or soda, consult with the Poison Center first.

Here are 5 other things you should know if you expect your child has been poisoned:

1. If your child has swallowed poison, have him or her spit out as much as possible.

2. Don’t make the child vomit, unless the label on the poison or local poison control center ask you to do so. “Vomiting can often times cause even more problems,” Dr. Warmink said. “First of all, it’s usually not very effective at removing the poison and the vomit can also go down the wrong way and find its way into the lungs. Another concern is that products such as cleaners and dishwasher powders can actually cause more burning.”

3. Don’t be alarmed if the child does vomit on his or own, but call for advice. “Sometimes it’s a natural reaction for a child to throw up,” Dr. Warmink said. “If that’s the case, it’s a good idea to give the child a few sips of water and then call the North Texas Poison Center.

4. Don’t use syrup or ipecac to induce vomiting. “This is not something that we recommend any longer as a routine treatment for poisoning,” Dr. Warmink said.

5. Don’t give your child milk without consulting a medical professional first. “First, consult with the professionals at the North Texas Poison Center,” Dr. Warmink said. “Milk can be helpful at times, but depending on what the child absorbed, the milk can increase the possibility of poisoning.” The same holds true for other fluids, such as juice or soda, consult with the Poison Center first.

About the Source

Corwin Warmink, M.D., is medical director of Cook Children's Emergency Services are available 24 hours a day, seven days a week. Cook Children's Emergency Department (ED) treats more than 105,000 patients every year. Our ED is the only EMS-designated pediatric trauma center in Tarrant County. Now, thanks to years of dedication and hard work, Cook Children'sMedical Center has reached Level II Trauma Designation from the American College of Surgeons and the Department of State Health Services. Cook Children's Medical Center is one of nine such facilities in the state of Texas. Click to learn more.

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February isn’t over and already four children have been treated for near-drowning accidents at Cook Children’s Emergency Department. All of these incidents occured in swimming pools.

“So often we think of the summer months as the time when we see drownings,” said Sharon Evans, Trauma Injury Prevention coordinator at Cook Children’s. “But as long as a child is around water, the threat is real for a child to drown. In Texas, we have 70 or 80 degree days during the winter and kids are outside playing around pools. If you have a pool, parents should be outside with their child. If not, the results can be tragic.”

The threat of drowning is a continuing concern well before summer begins. By the end of April 2016, 12 children were admitted for drowning injuries (9 in a pool) at Cook Children's, including two that were fatal (one pool death, one pond).

Even non-fatal, or near, drownings can be devastating for a child. Corwin Warmink, M.D., medical director of the Cook Children’s Emergency Department, says there’s a large amount of children who survive a drowning, but end up with catastrophic outcomes. The most effected parts of a near-drowning victim are the brain, lungs and kidneys. “The one that is most catastrophic and the one that will kill you is the brain,” Dr. Warmink said.

As a parent, Dr. Warmink stresses supervision of his own children in the pool. He calls it a hallmark of making sure children are safe. Half of all drownings occur within 25 feet of an adult.

“Children should never be in water without adults watching them,” he said. “If you have a toddler, that child shouldn't be in water without what we call touch supervision. You need to be in hand's length and it's not just pools. That includes bathtubs or any other container with water. I've seen kids drown in buckets. A child can drown in any water, even a few inches deep.”

The most important step a parent can make in making sure their child is safe around water is simply being present without distractions. Drowning is silent and quick, so a grownup should be watching children near water at all times and never leave, even for a brief moment.

“Active adult supervision and layers of protection such as door alarms and a fence can lower the risk for your child,” Dana Walraven, Community Outreach manager said. “The majority of these water-related incidents happen in the child’s own backyard pools and to children 4 years old and younger. Preventing pool drownings begins with adult supervision.”

Children are protected by layers of protection by using these safety techniques whenever children are around the pool:

• Always have adult supervision present when children are swimming or around pools.
• A fence with a locking gate should surround the pool.
• Install door alarms to alert adults when a child is entering the pool area.
• Require life jacket use for non-swimmers.
• Enroll children in swimming lessons.
• Parents and caregivers should undergo CPR training.

Other Resources:

• NRH Water Safety 365 Drowning Prevention Coalition
• Grownups be smart: Put down the phone at the pool
• 9 Ways to Protect Children From Drowning
• What Your Children Should Do If They See Someone Drowning
• Is Your Baby Ready For Swim Lessons?

The physicians, nurse practitioners, and staff at Cook Children's Willow Park Pediatrics have all fully vaccinated their children. Every single child. Every single vaccine.

August is National Immunization Awareness Month.

Vaccines save lives. It is a thankless accomplishment.. We can't know the good they have done, as they are arguably the greatest preventative invention in the history of modern medicine.

The vaccines you've received may have saved your life. You will never know. Think about that - a shot you got on a random day, in a random year of your life, may be the reason you're still alive.

We've watched children die of vaccine-preventable illness. We've watched parents cope with the horrific loss of a child, knowing that what happened was preventable. We never want you or your children to go through that.

Let's learn about them. Tune in this month as we teach about the diseases we vaccinate against. Sometimes knowing the other side helps us remember why they're so important.

‪#‎savinglivessilently‬

Hugs,Dr. Diane

And yet, one in three parents surveyed has left their child at pool for two to three minutes without supervision.

You may have seen movies of someone drowning and splashing in the water and making a big, dramatic scene. But that’s only in the movies.

Drowning is a silent killer. In reality there’s very little splashing, waving or screaming. You likely won’t hear your child drowning until it’s too late.

“Parents should stay in the water and within arms-reach of their child,” said Sharon Evans, Trauma Injury Prevention/Outreach coordinator for Cook Children’s Medical Center. “Don’t rely on a lifeguard, or an older child, to save your child. Be in the water. A drowning can happen too quickly not to be in with a child.”

Watching your children in the pool isn’t a job for kids, even older children.

"Teens can be easily distracted and they may not have the judgement skills to handle the job," said Dana Walraven, Community Health Outreach manager at Cook Children’s. "If there's a problem in the pool, a child may have trouble getting another child out of the pool. And this is not a responsibility for a young person. A drowning, even if not fatal, can scar a child for life if something happened if he or she were in charge. This is definitely a job for a grownup."

Evans said she was alarmed at a recent event she was at when she asked children what they should do if they saw a friend drowning or struggling in the pool. Too many said they would jump in and save the child.

“That’s the last thing we want to happen,” Evans said. “The child may not be strong enough to support the other child or a strong enough swimmer to support both kids. If a kid jumps in to rescue a friend, you can easily have two victims.”

Evans said to make sure your children know the best way they can help if they see someone in trouble in the water is to run and get help. Notify a lifeguard at a pool if one is on duty or find the nearest adult. Have someone get help and call 911 immediately.

So what should you tell your child to do if they see someone drowning?

First, know the signs. The American Red Cross says to watch for these signs a person may be drowning:

• The person is upright (vertical) in the water.
• The person is unable to move forward or tread water.
• The drowning person is pressing his or her arms down at the sides, trying to keep the head above water to breathe.
• The person spends energy just trying to keep his or her head above water.

If a child sees someone showing signs of trouble, he or she should stay out of the water and look for something to grab a hold of to help the person in trouble:

• A pool noodle
• Any flotation device by the pool
• Fishing pole
• Rake
• Canoe paddle
• Boat oar
• Stick
• Tree branch
• Baseball bat

Children who are too small to pull someone in or the person in the water is out of reach, should find objects to throw in to the water including:

• Kickboard
• Empty picnic cooler
• Life jacket
• Ring buoy
• Water jug
• Basketball
• Inner tube

Drowning is the leading cause of unintentional injury-related death in children ages 1 to 4 years old and the second leading cause of unintentional injury-related death for ages 1 to 14.

SafeKids Tarrant County, led by Cook Children’s, offers other sobering facts for parents leading into this swimming season:

• Drowning can still occur even if you know how to swim.
• No one is “drown proof” – no matter their level of swimming ability.
• Falls, entrapments and injuries lead to drowning regardless of swimming level.
• A majority of people overestimate their own and their child’s ability to swim, especially in a panic.
• Drowning is quick and silent.
• Drowning occurs in as little as 2 minutes.
• Irreversible brain damage occurs in as little as 4 minutes.
• Most children who drown are out of sight or missing for less than 5 minutes and usually in the presence of 1 or both parents.
• Most children die who are submerged for as little as 6-10 minutes.
• Children who drown do not scream splash or struggle. They silently slip beneath the water, even with adults and lifeguards present.

That’s scary information, but there are steps you can take to help protect your child and have a safe summer while in the water:

1. Constant visual supervision

• Assign an adult water guardian whose only responsibility is to watch children who are in the water.
• Teach children who can’t swim to stay away from water unless they are with an adult who is within arm’s reach and has eye-to-eye contact on them.

2. Learn to swim

• Studies show that formal swim lessons for children under age 4 reduce drowning by 88 percent.
• Take swim lessons with your child if you don’t know how to swim yourself. Even adults who are strong swimmers should never swim alone.

3. Keep backyards and bathrooms safe

• Dump all water buckets and empty kiddie pools when they are not in use.
• Install safety latches on toilets
• Never leave children unattended in the bathtub

4. Multiple barriers on all pools and spas

• Install pool fences, self-closing, self-latching gates and door alarms in areas leading to pools and spas.
• Keep a phone by the pool and call 911 in an emergency
• Keep pool area picked up and clear of toys and other items which might attract an unsupervised child.

5. Always check pool/spa first for missing child

• Make sure to look at the bottom of the pool or spa.
• Do not quickly scan the top and move on – children who drown often sink to the bottom and appear as shadows that easily be overlooked.
• Every second counts.

6. Wear life jackets

• Children who cannot swim should always wear a properly sized Coast Guard approved life jacket.
• Do not rely on water wings, floats or other toys to keep children safe.

7. Learn CPR

• Studies show CPR doubles the victim’s chance of survival.
• Use hard/fast compressions in the center of the chest until help arrives.
• Refresh CPR skills yearly, certifications every two years.
• Post CPR guidelines near the pool.

Related Links

• Cookchildrens.org/safety
• Safe Kids’ Water Safety Tips
• Play it Safe on the Water - Texas Parks and Wildlife
• Backyard and Pool: Household Safety Checklist
• Household Safety: Preventing Drowning

1. Get in the water. Be in arms reach of your child. Don't let your child out of your sight and be there to grab your children out of the water at any sign of trouble.

2. 100 percent adult supervision at all times. Be active in the pool with the children or watch like a lifeguard. Don't take your eyes off of your child. If you aren't in the water, be sure to watch your kids at all times. Don't spend time on your smartphone, talking to friends or walking away for even a moment. Do have a phone nearby in case of an emergency. But that's the only time anyone should be using one.

3. Watch them until they are safe and inside. Monitoring your kids includes accounting for everyone who had been in the water all the way to the house or apartment. Once you are inside, count again and make sure all the kids are safe and inside.

4. Be a water watcher. If you are at a party with a group of children, take 15-minute shifts watching the kids. Count heads above water and look for any that are motionless on the bottom of the pool. Give your undivided while you are the water watcher. Stay sober and be alert. You can't have a more important responsibility.

5. Life jackets. Not just any flotation device will do. Make sure your life jacket is U.S. Coast Guard approved. Check the tag to say so.

6. Swim lessons. Mom and dad, you need to know how to swim. If you don't know, take lessons with your child. Make sure your child knows how to swim too. If they are in the pool, they need to know how to get to safety. But this is only a layer of protection and doesn't take away from the fact that you need to be in arm's reach.

7. Know CPR. Local CPR lessons are given in your area. A quick Google search should help you find a class.

8. Use pool and child alarms to alert you if your child gets in the water without you.

9. Isolate your pool from the rest of your backyard with a permanent, four-sided fence with self-latching gates to prevent kids from accessing the pool area without an adult.

Cheerleading has changed in the past 30 years from yells and claps to routines with high level gymnastic tumbling runs and stunts. It has also become a year-round sport with summer camps and cheerleading competitions. This has increased the number of injuries, especially in females. Most common injuries are fractures, strains, sprains, and concussions. Due to this change in the demands of cheerleading, it is important for coaches and cheerleaders to understand proper techniques during stunts and tumbling, strengthening, leg and arm alignment, core activation and different risks related to floor surface and practice time.

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

Loading, body mechanics and alignment

The way in which a cheerleader lands when tumbling is also very important in preventing injuries. Soft landings are the way to go. A soft landing is best with knees slightly bent and weight more on the toes rather than heels. Do not allow the knees to go in or forward over the toes; instead, keep toes and knees pointing forward with upright chest and tightened core. Tumbling and stunting on a softer surface is always preferred rather than a hard or wet surface.

Injuries have been related to improper loading due to decreased strength, body awareness and lack of proper alignment with body mechanics.  Loading refers to the pressure or weight a cheerleader has through their arms, legs, and spine while holding a stunt and landing a tumbling pass.

Cheerleaders need  to be aware of their body mechanics. Body mechanics is proper body movements to prevent or correct posture problems, reduce stress on the body, and enhance physical capabilities.   Strengthening cheerleaders’ cores, legs and arms will improve body mechanics and decrease injuries.

Here are some proper basing and spotting techniques from the bottom up, to address proper alignment for good loading and body mechanics: 

• Keep feet shoulder width apart with toes forward or slightly out; heels on the ground.
• Knees should never go forward past the toes or inward.
• Hips should stay over feet with equal weight.
• Trunk stays upright- do not bend or arch the back/spine when spotting a stunt.  
• Arms directly above shoulders; not behind your head when spotting a stunt.

Cheerleaders can be strong too

As cheerleading has become more about stunts and tumbling, it requires strength, balance and stability.  Coaches should be focused on strength-building conditioning, which includes core stability and proper lifting techniques. It is also beneficial for coaches to attend safety certification classes, such as those offered by the American Association of Cheerleading Coaches and Administrators (AACCA). Prior to any cheerleading event, a proper warm up with aerobic activity and dynamic stretching is necessary to prevent injuries. Stretching after cheerleading is just as important to decrease injuries. The longer the practice, the higher the risk for injury is. Most injuries happen between 61 and 90 minutes of practice.

Increasing awareness of concussions 

Cheerleaders are at high risk for sustaining concussions, which is a head injury/trauma to the head when hit.  Cheerleaders sustain concussions with a fall from high heights, being hit in the head when basing, or landing on their head during tumbling.  It is important to stop cheerleading if there is a possibility of a concussion. Signs to watch for include: headaches, dizziness, visual blurriness/double vision, memory issues, decreased coordination and balance problems. If these symptoms are present, the cheerleader should seek medical attention immediately.

Most concussions heal in about a month, however if cheerleaders continue to have the symptoms, they may need active rehabilitation. It is never good to return to cheerleading too early; it may make their full recovery longer.  If a cheerleader has any signs or symptoms of a concussion, they should not be allowed to return to cheerleading until cleared by a physician.  Cheerleaders are 3-6 times more likely to have a second impact concussion after having their first concussion;  the second impact concussion can have more severe complications.

American Academy of Pediatrics recommendations for preventing injuries:                                              

• Cheerleading should be designated as a sport in all states, allowing for benefits such as qualified coaches, better access to medical care and injury surveillance.
• All cheerleaders should have a pre-season physical, and access to qualified strength and conditioning coaches.
• Cheerleaders should be trained in all spotting techniques and only attempt stunts after demonstrating appropriate skill progression. 
• Pyramid and partner stunts should be performed only on a spring/foam floor or grass/turf. Never perform stunts on a hard, wet or uneven surface. Pyramids should not be more than 2 people high.
• Coaches, parents and athletes should have access to a written emergency plan.
• Any cheerleader suspected of having a head injury should be removed from event and not allowed to return until cleared by a health care professional.

Related links

• The Cook Children's SPORTS program
• Cheerleading Injury Prevention
• Top 10 questions parents have about sports injuries

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

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

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

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

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

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

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

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

That was the overall message from Fort Worth, Texas Mayor Betsy Price and representatives from the city of Fort Worth, including Cook Children's, at a press conference to address city-wide support of drowning prevention measures.

Mayor Price said that the message of the day was that tragedy in the water only takes seconds and that drowning is a silent killer. "Children drown without a sound," she said.

The press conference called for awareness and a city-wide call-to-action to protect our children through education, prevention and response. Along with the Mayor and Cook Children's, representatives from the Fort Worth Drowning Prevention Coalition, the Fort Worth YMCA, the Fort Worth Firefighter Charities, the Fort Worth Fire Department and MedStar were all in attendance.

The event included a poignant speech from Denise Doherty, an RN and director of Emergency Services at Cook Children's. Doherty said her staff is "drained and heart broken" from the number of children and patients affected by this "very preventable tragedy."

In the past two months, Cook Children's has seen nearly a child a day for drownings. The month of July began with two drowning deaths and Cook Children's Trauma Department seeing 19 total drownings from July 1 to July 22, compared to 11 drownings and two fatalities last year for the entire month of July. June saw more than double the amount of non-fatal drownings from a year ago with 26. 

Parents have been urged to watch their kids. Now the message has a new sense of urgency - you must protect your children. 

"We've seen more than enough children die this year," Doherty said. "It has to stop. Can you imagine being a parent, sitting in the ED waiting room, praying that the life of someone you love so dearly is spared, especially since it was something that didn't have to happen? No parent wants to be saddled with that guilt. I think it's also appropriate for me to say that no one is immune, and yes, it can happen to you. Cook Children's has witnessed this in a very intimate way, even our own medical community has experienced this heartbreak."

Doherty added," Today, we're making a plea. It's not only time to watch your kids near the water, but it's time to protect them."

So what does it mean to truly protect your kids? Help us spread the word with these tips:

1. Get in the water. Be in arms reach of your child. Don't let your child out of your sight and be there to grab your children out of the water at any sign of trouble.

2. 100 percent adult supervision at all times. Be active in the pool with the children or watch like a lifeguard. Don't take your eyes off of your child. If you aren't in the water, be sure to watch your kids at all times. Don't spend time on your smartphone, talking to friends or walking away for even a moment. Do have a phone nearby in case of an emergency. But that's the only time anyone should be using one.

3. Watch them until they are safe and inside. Monitoring your kids includes accounting for everyone who had been in the water all the way to the house or apartment. Once you are inside, count again and make sure all the kids are safe and inside.

4. Be a water watcher. If you are at a party with a group of children, take 15-minute shifts watching the kids. Count heads above water and look for any that are motionless on the bottom of the pool. Give your undivided while you are the water watcher. Stay sober and be alert. You can't have a more important responsibility.

5. Life jackets. Not just any flotation device will do. Make sure your life jacket is U.S. Coast Guard approved. Check the tag to say so.

6. Swim lessons. Mom and dad, you need to know how to swim. If you don't know, take lessons with your child. Make sure your child knows how to swim too. If they are in the pool, they need to know how to get to safety. But this is only a layer of protection and doesn't take away from the fact that you need to be in arm's reach.

7. Know CPR. Local CPR lessons are given in your area. A quick Google search should help you find a class.

8. Use pool and child alarms to alert you if your child gets in the water without you.

9. Isolate your pool from the rest of your backyard with a permanent, four-sided fence with self-latching gates to prevent kids from accessing the pool area without an adult.

Previous articles on this topic:

• Drowning prevention - watch your kids
• Drownings double from a year ago 
• Be a water watcher. Adult supervisions saves lives.
• Is your baby ready for swim lessons?
• Drowning tragedy - 'I can't believe this happened to me.'
• Swimming with Type 1 diabetes
• Cook Children's drowning prevention page

For more information

Learn more about drowning prevention and water safety here. This page gives helpful information on keeping your kids safe during swim season, including proper fit for life jackets, pool safety videos and fences/alarms information.

• 2 deaths to begin the month of July
• 26 non-fatal drownings from June 1 to July 1, 2015
• 43 non-fatal drownings from Oct. 1, 2014 to July 1, 2015
• 4 fatal drownings during that same time frame

And now we head into the July 4^th weekend where people will be throwing pool parties at their house or apartment or going out to area lakes … and at many of those parties there will be drinking.

So what’s left to say? Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s, admits to being tired, frustrated, sad and even a little angry that no matter how much the message is delivered, kids drown.

“I feel like a broken recording at this point,” Evans said. “But I don’t know what else to do. We have to keep telling people. We have to keep getting the word out. Tell your friends. Tell your neighbors. Tell your other family members. Kids are dying.”

And then Evans collects herself to deliver the message again.

“I don’t think people know how quickly it happens,” Evans said. “It’s just seconds and it’s a silent killer. Kids died silently. You can’t just let your kids go. Water is dangerous. It scares me because now we are headed toward the July Fourth weekend.”

If nothing else, Evans wants to make sure everyone reading this gets this point.

“It can happen to you,” Evans said. “I can say it, but I don’t think people really realize it. It can happen to you. Don’t take your eyes off of your child. You have to hold on to his or her hand sometimes. The most important thing is to be there for your child. And my God, whatever you do, you can’t let your kid go swimming or to the water alone. You have to have adult supervision.”

Evans speaks strong, but you can hear the pain and heartbreak in her voice. She’s seen a lot of this in her career and twice the amount of drownings over the last month as she saw last year. And what troubles her the most is that she knows no matter how much she speaks about drowning prevention, she will see more again.

“I wish I had a better line, a better solution,” Evans said. “I don’t know what else to say. I just know it’s preventable, if we take the right precautions.”

Click to read the following information for those precautions:

• Drownings double from a year ago 
• Be a water watcher. Adult supervisions saves lives.
• Is your baby ready for swim lessons?
• Drowning tragedy - 'I can't believe this happened to me.'
• Cook Children's drowning prevention page

We cannot give into fear. We need to be prepared. Know the signs. Have a plan.

Before the storms even start it is important that you have a plan for your family’s safety.

You need to pick a safe room in your home where your family can gather. The safest place is a basement or storm cellar but these are pretty rare in North Texas so you need to pick an interior space in your house on the bottom floor like a closet, bathroom or hallway where there are no windows. You want to put as many walls between you and the storm. The biggest source of injury in a tornado occur from being struck with flying debris so if you can pull a mattress into your shelter space or cover with heavy blankets or sleeping bags you will increase your protection. Contrary to popular belief you do not have to pick an area in the southwest corner of your house. Just pick the safest area in your house. Also you do not have to open or crack windows to equalize the pressure in your house. You are just increasing your risk of getting hit by flying debris.

If you live in a mobile home get out! People are 15 times more likely to die in a mobile home than any other location. Try to take shelter in a permanent structure if you can. As a last resort if you cannot find a permanent structure for shelter then go to a low lying area like a ditch and cover your head.

If you are at work, take shelter in an interior room, stairwell, or bathroom on the first floor and away from windows. Your office should have an inclement weather plan and remind employees of it twice a year.

If your child is at school they will be instructed to follow the school’s tornado plan. Schools will go on lockdown mode and move the children to the safest area possible. Follow your school’s tornado and inclement weather plan. It is the best way to ensure your child’s safety as well as your own. Your child has gone through numerous safety drills at school and knows to follow the schools plan. Reassure them that this is the safest thing to do. Remind your children to follow what their teachers have taught them. The best way to reassure your child is to help them understand the importance of following the direction of the adults who are caring for them.

If you are outside, try to find shelter in a permanent location. If you cannot find structural shelter get in a low lying area and cover your head with your hands and arms. Try to pick a spot away from trees and other potential projectiles.

If you are in your car and cannot get to a structural shelter, the American Red Cross recommends staying in your car. They recommend pulling off the road. Leave your seat belt on and crouch down away from the windows. Try to cover your face and head with a coat or blanket is possible. They do not recommend trying to take shelter under an overpass or bridge. Do not try to flee a tornado that is moving toward you. They also note if your car is near a low-lying ditch or culvert it may be safer to leave your vehicle and get to the lowest point possible. Always remember to cover your head with your hands and arms.

It is important to know the difference between a TORNADO WATCH and a TORNADO WARNING.

TORNADO WATCHThis means that the conditions are present that make a tornado possible over the next several hours. This does not mean a tornado is about to occur. It is a caution to be vigilant as you go through your day.

TORNADO WARNING

This means an actual tornado has been spotted or that meteorologists have picked up rotation on their Doppler radar. Your city’s safety alert siren will sound if a tornado warning is occurring. This is a sign to go to your safe area.

I highly recommend you get the American Red Cross app for your phone. This is a free app that will alert you if a TORNADO WARNING is occurring in your area. It also has excellent tips about tornado preparedness and the ability to set up a blast message you can send to friends and family to let them know that you are safe. It will send the message via email, Message, Twitter, and Facebook.

It is a good idea to create an emergency- preparedness kit. The American Red Cross recommends you include the following basics:

• Water – at least a 3-day supply. One gallon per person per day.
• Food – at least a 3 day supply of nonperishable easy to prepare food
• Flashlight with batteries
• Battery powered or hand crank radio
• First aid kit
• 7 day supply of all necessary medications
• Copies of personal documents
• Family and emergency contact information
• Extra set of clothing and study shoes
• Sanitation and personal hygiene items

You have a Plan.You know the signs. Be safe. Have Faith.

Sandra C. Peak, M.D.

Learn what you shouldn't do during a tornado here.

Evans is concerned because at Cook Children’s:

• In 2013, there were three motor vehicle crash deaths (compared to 0 in 2012).
• There has been a 10 percent increase in injuries due to unrestrained kids and a 4 percent increase in ejections.

“This is the time of the summer when a lot of families will be traveling on the road,” Evans said. “I’m very concerned about the amount of unrestrained children we are seeing. I would ask all parents to make sure their children are buckled up correctly to prevent a tragedy to their family.”

Graco car seat recall, what you need to know

To see if your model may be covered, or for additional information, call Graco at 1-877-766-7470, or visit www.gracobucklerecall.com, or email consumerservices@gracobaby.com. Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s, stresses to parents to register car seats when purchasing them so they will be notified of recalls.

Marc Mazade, an Infectious Disease specialist at Cook Children’s, first heard about Middle East Respiratory Syndrome (MERS) at a presentation last year.

While Dr. Mazade says the attack rate of MERS seems low compared to other respiratory illnesses, he does advise certain precautions if traveling overseas.

“Returning travelers who develop signs of illness should discuss with their healthcare provider their full travel itinerary, exposures they may have noted during travel, and activities in which they participated while traveling,” Dr. Mazade said. “For a physician, the key to a prompt diagnosis of any potentially serious disease like MERS is making the connection that a patient or family has traveled recently to the Arabian Peninsula or other area where an outbreak has been documented.”

The CDC reports “most MERS-CoV cases have been reported in adults (median age approximately 50 years, male predominance), although children and adults of all ages have been infected.” Pediatric Infectious Disease Journal said that severe disease can occur in children with underlying conditions.

First, Dr. Mazade suggests those who are traveling from the U.S. to other countries to always check the CDC website for health-related travel advisories before making travel plans. Six to eight weeks before visiting overseas, Dr. Mazade advises people to receive a travel clinic consultation from their physicians.For more information, read the CDC's tips on traveling smart.

Dr Mazade said a travel clinic consultation will help determine if travel vaccines or malaria prophylaxis are necessary, as well as provide:

• An opportunity to receive counselling about other health risks a traveler might face.
• Whether to buy travel insurance or not.
• How to register a travel itinerary with the State Department to get a replacement passport in the event that one is lost or stolen.
• What items to take and what to avoid. 

“We consider fever in a returning traveler to be a serious concern and encourage travelers to stay in touch with their physician about any health problems occurring after traveling,” Dr.  Mazade said. “Visiting other countries can be exciting. Staying healthy and being aware of risks when traveling will keep the memories pleasant.”

The Centers for Disease Control and Prevention has reported the first case in the United States of MERS to be transmitted from one person to another.

The CDC states, the first U.S. Case of MERS was confirmed on May 2, 2014, after someone traveled from Saudia Arabia to the U.S. On May 11, 2014, a second U.S. “imported case” occurred, again from Saudia Arabia. The third case came as a direct result of an Illinois resident who had contact with the first case.

According to the CDC, Middle East Respiratory Syndrome (MERS) is a viral respiratory illness first reported in Saudi Arabia in 2012. It is caused by a coronavirus called MERS-CoV. 

The CDC says MERS “represents a very low risk to the general public in this country,” but will continue to monitor the situation and provide recommendations as necessary. At this time, no vaccine against MERS exists.

Safe Kids reports heatstroke deaths have occurred in 11 different months of the year and in nearly all 50 states.

Parents may mistakenly think they can safely leave a child in a vehicle for a “quick” errand, but that's not the case. Temperatures inside the car can be 20 or more degrees hotter than the temperature outside, rising to dangerous levels in minutes. So a nice 70 degrees outside can warm up to the 90s in minutes inside the car. It only takes a few minutes for tragedy to occur.

Heat is much more dangerous to children than it is to adults. When left in a hot vehicle, a young child’s core body temperature may increase 3 to 5 times faster than that of an adult. This could cause permanent injury or death.

Unfortunately, this is an all too common occurrence. Since 1998, at least 605 children across the United States have died from heatstroke when unattended in a vehicle. In Texas, 32 deaths have occurred since 2010, including five last year.

“We still have to get the word out that there’s never a safe time to leave your child in the car,” said Sharon Evans, Trauma/Injury Prevention coordinator at Cook Children’s, said. “We’ve seen children die in February. We hope people will take extra precaution in never leaving a child in the car.”

Safe Kids Worldwide says that heatstroke is the leading cause of non-crash, vehicle related deaths for children and that young children are particularly at risk as their bodies heat up three to five times faster than an adults’.

“It’s difficult to think that we could forget our children, but it happens every year to people from all walks of life, regardless of their socioeconomic or education levels,” Evans said. “Often times, a change in routine, a distraction along the way, or a child falls quietly asleep, unseen, in the back seat, allows for a parent/caregiver to forget and leave a child in the car.”

According to news reports, a 1-year-old girl  in North Richland Hills, Texas,  may have died after being left in a car for too long .The high at Dallas/Fort Worth Airport on April 22 was 84.

Here are some important tips to help prevent unintentional injury to your child:

• Dial 911 if you see an unattended child in a car.
• Never leave your child alone in a vehicle, even for 1 minute, at any time. Even on cool days.
• Set safe habits: leave a cell phone, purse, briefcase, etc. in the back seat before driving, forcing you to always check the back seat and see a child is/is not back there.
• Program your cell phone and/or computer to remind you to drop off your child each day.
• Have a plan with your daycare provider to contact you within a few minutes of being late or absent, even if it’s only one day.
• Teach children not to play in any vehicle.
• Lock all car doors, even at home.
• If a child goes missing, always check the cars and trunks first.

Donald Murphey, M.D., medical director of Infectious Disease at Cook Children’s, worries over the fact that diseases like measles and pertussis are once again in the news.

“It’s alarming to see the rise in these diseases that were so common prior to the advent of effective vaccines, but largely disappeared with immunization,” Dr. Murphey said. “It’s frustrating too because we have safe vaccines that prevent these diseases. The solution is for kids, teens, and adults to get immunized.”

Measles is a highly, dangerous, but preventable disease with vaccinations.

The CDC report says that many of the cases are from people who visited other countries. Of the 129 cases reported by the CDC, 34 were “importations” from other countries. The Philippines has seen 20,000 confirmed or suspected cases of measles cases from Jan. 1 to Feb. 28 and 69 confirmed deaths.

But why is this happening? “The increase in importations from this outbreak and subsequent transmission in certain settings in the United States highlights the importance of ensuring age-appropriate vaccination for persons traveling to areas where measles is endemic and maintaining high vaccination coverage at the national and local level,” The CDC report states.

Parents can make an important step in preventing their children from catching measles through the use of two doses of the MMR vaccine.

“We thought we were on our way to eradicating these diseases,” Dr. Murphey said. “Our goal was that these diseases would be completely controlled by the year 2015. But misinformation and fear about immunization has prevented that from happening. It’s a very sad situation because children suffer, but it can be much worse if segments of the population refuse to receive their vaccines.

Measles is particularly contagious. Transmission is by coughing, sneezing or simply being next to someone laughing. It’s that easy.

Dr. Murphey said what’s particularly frustrating is that these diseases can be contained and even eliminated if we do our part. MMR vaccination remains the most effective way to prevent outbreaks. In children, the first MMR vaccine dose is usually administered at 12-15 months and the second at 4-6 years.  However, the MMR vaccine is recommended for children as young as 6 months old when they are traveling abroad. Children under 12 months of age and traveling internationally should receive 2 doses of MMR, separated by at least 28 days

All college students, international travelers, and health care personnel should receive two doses of MMR vaccine, unless they have other evidence of measles immunity.

“I can’t stress enough if you are traveling abroad, the importance of making sure you are updated on your immunization,” Dr. Murphey said. “This holds true for pregnant women, infants, kids, teens and adults. We all have to do our part and have our shots updated to keep each other healthy.”

1. Have you ever fainted, passed out, or had a seizure suddenly and without warning, especially during exercise?
2.  Have you ever had exercise-induced chest pain or shortness of breath?
3. Are you related to anyone with sudden, unexplained, and unexpected death before the age of 50?
4. Are you related to anyone who has been diagnosed with a sudden death-predisposing heart condition like Hypertrophic Cardiomyopathy and Long QT syndrome?

Early detection could save your child’s life. Cook Children’s will offer free EKGs during the month of February. An EKG is non-invasive and takes less than five minutes. The EKG shows how fast the heart is beating, the heart’s rhythm and the timing of the heart’s electrical signals. Any child can get one with a referral from a primary care doctor. Just ask your child’s pediatrician to order a “sports EKG.” Results are sent back to your pediatrician.

For more information, please call the Heart Center office at Cook Children’s at 682-885-2140.

Posture
Posture is often overlooked with athletes. Posture is the result of a balanced muscular system that can control various aspects of timing and force to generate power needed for throwing and hitting. Breakdowns in posture will lead to increases in injury. Good posture is the optimal position for your muscles to work effectively without creating a risk for injury.

It is common for athletes to concentrate on the muscles in their chest and arms, while forgetting about the muscles in their backs. Weakness in your mid and upper back and tightness in the chest leads to the shoulders rounding forward, which puts the rotator cuff muscles around your shoulders in an ineffective and dangerous position. The muscles in a baseball player’s back, along with the rotator cuff, are essential in maintaining control of the shoulder during throwing.  During off days it’s good for all baseball players to strengthen the mid and upper back muscles.

Strength
With throwers, it is important to remember that strength and control in your legs and core are just as important as in your shoulders. Most of the power for throwing begins in your legs and core. By improving your core strength and activation you can throw harder without your shoulder and arm working harder. Working on your strength in your core and legs on off days will help you with performance and lower the risk of injury.  Flexibility in your hips and legs allows them to use their available strength.

Warm-ups
Before games use active warm-ups to prepare the muscles in both your arms and legs for the stresses of a baseball game. After the game always stretch your calves, hamstrings, quadriceps, hips, shoulder internal rotation and shoulder cross body adduction to prevent loss of motion. Remember that post-game stretches should be held for 30 seconds and should be steady with no bouncing.

Pitch counts
Pitch counts are an important way to prevent injury in pitchers. It’s important to note that increased performance and speed of pitching, actually increases the stress put on the body of a pitcher. Every pitch puts small amounts of damage on the elbow and shoulder. The body needs time to be able to heal this damage. I am not advocating that pitchers should not throw to their full potential. However, they should not pitch too much during a game or too frequently without adequate rest days. The following pitch counts are recommended by the American Academy of Orthopedic Surgery:

• 8-10 year olds - 50 pitches/game, 75 pitches/week
• 11-12 year olds - 75 pitches/game, 100 pitches/week
• 13-14 year olds - 75 pitches/game, 125 pitches/week
• 15-16 year olds - 90 pitches/game, 150/160 pitches/week
• 17/18 year olds - 105 pitches/game, 150-160 pitchesweek

The more times a baseball player pitches in a single game, the longer the player should rest. While resting from pitching, baseball players should not play catcher. The two players that throw the most during a baseball game are pitchers and catchers, and for both positions, the most important component of healing is the rest time.

Throwing technique
Pitch counts are not the only reason that pitchers should stop pitching during a game. With youth pitchers, throwing form is a huge factor in preventing injuries. Throwing form should not suffer from fatigue. When pitchers start to sacrifice form, they should be taken out of the game and rested. Common issues that arise from fatigue are dropping the elbow, leaning away from the throwing arm and the elbow lagging behind the shoulder. Quality pitching coaches are important to establishing good throwing form. Safety should always be the number one priority, when deciding between keeping a player in the game and resting them.

Carbon monoxide is known as the ‘silent killer’ because it’s an odorless, colorless, tasteless gas. The Texas Department of State Health Services says, “Several household sources, such as gasoline-powered tools and generators, produce carbon monoxide. Anything that burns can produce carbon monoxide. The fumes are extremely hazardous and can cause sudden illness or death.

Carbon monoxide is especially dangerous to infants, women who are pregnant and their unborn children, the elderly and people with heart or breathing problems.

The Centers for Disease Control and Prevention (the CDC) recommends taking the following steps to preventcarbon monoxide exposure:

• Do have your heating system, water heater and any other gas, oil, or coal burning appliances serviced by a qualified technician every year.
• Do install a battery-operated or battery back-up CO detector in your home and check or replace the battery when you change the time on your clocks each spring and fall. If the detector sounds leave your home immediately and call 911.
• Do seek prompt medical attention if you suspect CO poisoning and are feeling dizzy, light-headed, or nauseous.
• Don’t use a generator, charcoal grill, camp stove, or other gasoline or charcoal-burning device inside your home, basement, or garage or near a window.
• Don’t run a car or truck inside a garage attached to your house, even if you leave the door open.
• Don’t burn anything in a stove or fireplace that isn’t vented.
• Don’t heat your house with a gas oven.

I, and I’m sure many others who care for children, were excited by the news. It was with great interest that I read the news article and began to examine the story more closely. The news while exciting deals with a relatively small number and specific population of children.

The study examined obesity rates in pre-school children, age 2-4 years old whose families received WIC assistance (The Special Supplemental Nutrition Program for Women, Infants, and Children). Not all of the states submitted information. Of the 41 participating states, 18 states showed modest declines in the number of obese preschoolers from information collected from 2008-2011. The remainder of the 41 states showed no change or even increases in obesity rates.

The challenge is understanding what this information means and placing it in the proper perspective. Experts in the field of childhood obesity believe the positive numbers reflect changes in the WIC program beginning in 2008. The program was changed in an effort to increase fresh fruits and vegetable purchases as well as other health options such as whole grains and low fat foods. Additionally, encouragement of breastfeeding is thought to help contribute the improvements.

The news validates the central importance of healthy eating in weight management. I believe that fresh ingredients and home preparation of meals is a major key in overall health and weight management. I have slowly continued reading the book, Salt, Sugar, and Fat, and am increasingly convinced of this belief.

As discussed in the article, challenges remain. One in eight pre-schoolers remain obese. And unfortunately, the likelihood is high for these children that obesity will persist into adulthood.

For more information:

• Cook Children’s Endocrinology and Diabetes Program
• Obesity where we live
• The Center For Children’s Health
• Checkup Kitchen
• Overweight and Obesity
• Keeping Portions Under Control
• How Can Families Be Healthier?

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices. He still loves to write, and he is a regular contributor to the Physician Perspective page on the Cook Children’s Web site.

I was immediatley interested when I chanced on a recent radio interview with the author, Michael Moss, who has written a new book about the inner workings of the processed food industry. The book deals specifically with the reasons that these companies use three key additives – salt, sugar and fat – in the processed food they create and market.

The term processed foods sounds somewhat sinister, but some of the ways that food is processed such as pasteurization or freezing are quite beneficial to people for both health reasons and convenience. The primary goal in most processing of foods is creation of a food product that is near ready to eat and is stable on the shelf or in our homes for a long period of time. This particular goal and the goal of making tasty processed foods according to Mr. Moss is where the problem begins.

In the book, Moss interviews food scientists in many of the large processed food companies. These scientists are tasked with making tasty food products that apeal to a large group of people. Moss describes the use of the three key additives to mask odd or bitter flavors that develop during manufacturing and to hook consumers on taste.

Moss argues that company pressures to create new appealing snacks, grow market share and improve profitability often result in unhealthy foods that contribute to the U.S. and global obesity epidemic.

The interview concluded with the debate about what steps can be taken to reduce these activities and make healthier foods. The debate no doubt will continue between different philosophies of strict government regulation and independence of consumer choice.

I’ve downloaded the eBook and look forward to learning more and examining different viewpoints. In the meantime, my family and I will continue to see fresh ingredients and discover new recipes.

More information is available if you are interested with links to the NPR interview and the book.