Growing up, Rebecca Brovina always wanted to be a nurse, just like her grandma. “I have always dreamed of being as successful and cool as she was,” Brovina said. Now, many would say, she is living up to that.

Rebecca Brovina, BSN, RN, CPN, Research Nurse Coordinator at Cook Children’s Pulmonology - Prosper, was just recently awarded the Great 100 Nurses for 2025, highlighting her outstanding contributions in her field.

Nurses are nominated for this award by family members, patients, peers, former teachers, physicians, and administrators. Over the past 34 years, this award has become recognized throughout the nursing community in the Dallas/Fort Worth metroplex as an esteemed honor and prestigious accomplishment.

Rebecca's journey began in the Pediatric Intensive Care Unit (PICU), where she worked closely with John Robertson, M.D. Dr. Robertson was starting research focused on understanding and treating exercise-induced respiratory disorders, and when Rebecca heard about it, her interest was immediately piqued. She almost instantly became a vital part of this dedicated research team.

“Rebecca’s superpowers are intelligence, creativity, empathy, and humor, in equal overflowing measure,” Dr. Robertson said. 

These disorders often lead young athletes to quit sports, which can significantly impact their self-confidence. Rebecca vividly recalls a patient who had to quit all her sports due to an undiagnosed condition and suffered a massive blow to her self-confidence. She found no answers until she visited the Cook Children's Exercise Respiratory Center in Prosper. Rebecca remembers witnessing the relief they experienced when they finally felt heard. As the patient's parent put it, "We finally feel like someone listened to us.”

In February 2025, Rebecca received first place in the 2025 Research Poster Presentation Master's Level at the Texas Chapter of the American College of Sports Medicine. The presentation, Estimating Minute Ventilation and Inspiratory Flow to Trigger Exercise Induced Laryngeal Obstruction (EILO) in Pediatric Patients, also led to the team's first published abstract.

At the exercise respiratory center in Prosper, no two days are exactly the same for Rebecca; there is always a unique blend of patient interaction, education and research. One of her primary roles is educating patients prior to their appointments and administering research surveys. Her work often involves looking for a connection between respiration disorders and other neurological conditions. Rebecca is also heavily involved in writing protocols, giving presentations, and videoing the end of procedures.

The respiratory clinic also uses a method that is only employed in three places in the country. In this method, a scope is inserted through the nose and down into the back of the throat while the patient is running on the treadmill. This novel approach helps discover dynamic changes in the airway that occur during exercise. This cutting-edge and unique approach is something Rebecca loves about her job.

“My favorite part of research is being able to develop things and actually be able to help people,” Rebecca said.

Rebecca’s motivation and her “why” stems from a deeply personal place. Having experienced health challenges herself, including worsening asthma and a spinal cord injury, she understands firsthand how not being able to do the one thing you love can impact a child. Rebecca is so passionate about her job because, as she said, she understands "how mentally and physically damaging it is to not be able to do the one thing that keeps you sane.”

Throughout her career as a nurse, she has also witnessed firsthand, patients not receiving the care they deserve, often due to insurance problems. This fueled her desire to change how people are cared for, develop new solutions, and truly help. Rebecca’s passion can be seen in every interaction and shows her commitment to getting patients back to doing what they love.

“I wrote my thesis on discharge delays," Rebecca said. "I would see kids who would have extended hospital stays simply trying to get the gear and medicine they need.”

Rebecca has truly loved her experience at Prosper. She has relished the opportunity to be a part of opening a brand-new hospital. She contributed to the organization of hospital departments and helped figure out staffing and roles. She says that being part of some of the first research initiatives at Prosper and building something from the ground has been incredibly cool and rewarding, even throughout all of the roadblocks.

Rebecca is driven by her patients, a fact evident in each of her interactions. She is dedicated and passionate about what she does. Congratulations on this very well-deserved award!

Last week, Cook Children’s saw 1,342 positive Influenza A cases at its medical centers in Fort Worth and Prosper. Across Cook Children’s seven urgent care centers (UCCs), 60% of the flu tests performed were positive for Flu A.

The influx is leading to over-crowded waiting rooms and long wait times across the board.

On Tuesday, Feb. 4, the emergency department in Fort Worth saw 534 patients, while 995 patients were seen at the UCCs. 

“This year is by far worse than previous years in regard to the flu,” said Stephanie Felton, D.O., associate medical director of the Cook Children’s Emergency Department. “Last year, we peaked at 800 positive patients in the month of January. This January we saw 1,200 positive patients. Please keep in mind how contagious the flu is.”

The flu is an infection of the respiratory tract (nose, throat, and lungs) that is caused by a virus. It can spread easily from person to person. Roxana Narat, M.D., a hospitalist at Cook Children’s Medical Center – Prosper, says flu symptoms include fever, cough, congestion, fatigue and body aches.

Kara Starnes, D.O., medical director of Urgent Care at Cook Children’s, encourages parents to practice prevention when it comes to flu and other respiratory illness:

• Keep your children at home and away from public areas if they are not feeling well
• Wash your hands
• Cover your nose and mouth when sneezing and coughing
• Avoid touching your nose, mouth and eyes
• Avoid close contact with people who are sick
• Get a flu shot

“The flu vaccine provides the best chance at preventing the more serious complications of the flu,” said Dr. Starnes. “While a flu vaccine may not always completely prevent the flu, it typically makes the illness much less severe and of a shorter duration. It is not too late to get a flu shot, even if you or your child has had the flu.”

Managing Symptoms

If your child is sick, call your pediatrician first. They can help you decide if your child needs to visit their office or go to an urgent care or emergency room. 

For many children, viral illnesses like the flu, RSV, and COVID-19 can be managed at home with supportive care. Over-the-counter medications like acetaminophen or ibuprofen can help reduce fever and discomfort. Avoid ibuprofen in infants younger than 6 months.

Maintaining hydration is crucial. Encourage your child to drink fluids and consider giving them electrolyte drinks or popsicles. Saline nasal drops and cool-mist humidifiers can help alleviate congestion.

A fever is defined as a temperature of 100.4 or above. A temperature above 100.4 in babies less than 2 months old is a medical emergency and needs to be evaluated in the emergency room. Any fever lasting longer than four to five days, or one that continues to climb and does not break with fever reducers, should be evaluated by a physician.

When to Seek Medical Attention

While most cases can be managed at home, it's essential to recognize the signs of respiratory distress or dehydration, which require immediate medical attention.

Signs of respiratory distress:

• Increased number of breaths per minute
• Increased heart rate
• Bluish color around the mouth, on the lips, or on the fingernails
• Pale or grayish skin  
• Grunting sound during exhale
• Nose flaring
• Chest appears to sink in with each breath
• Head bobbing when breathing in
• Change in alertness  

Signs of dehydration:

• Urine output significantly below the child’s normal (at least once every 8 hours)
• Not producing tears when crying and eyes appear sunken
• In infants, the soft spot on top of their heads looks sunken
• Dried mucus membranes (lining within the nostrils, mouth, throat)
• Sleepy and unresponsive  

If your child exhibits any of these signs, seek immediate care at an urgent care facility or the emergency department. Reserving visits to urgent care or the emergency department for truly urgent needs helps ensure timely care for those who need it most, reduces wait times for everyone, conserves resources, and limits your child’s exposure to other viruses.

This week, the Prosper emergency department has seen a record number of patients. Most patients are being admitted for either RSV, pneumonia or asthma.

The surge in hospital visits is due to a sharp spread of RSV and Mycoplasma pneumoniae (walking pneumonia) cases in the Dallas-Fort Worth area. While the rise of respiratory cases happens each year around this time, RSV cases spiked more quickly than usual this year, said Medical Director for Emergency Services Taylor Louden, M.D. Across the system, 23% of patients tested for RSV last week tested positive. 

“You know, we've seen over 1,100 patients in the last two days and through the ER, so it's been very difficult for us to manage this volume all at once,” Dr. Louden said. 

Of the 972 patients tested at Cook Children’s Medical Center-Fort Worth from Nov. 10 to Nov. 16, 224 tested positive for RSV. Out of 624 patients tested for walking pneumonia at Cook Children’s Medical Center - Fort Worth, 99 tested positive. 

What is RSV and when should I seek emergency care? 

RSV typically impacts kids under the age of two most and can cause a build-up of mucus and congestion that makes it difficult for kids to breathe. Parents should take precautions to limit further spread of the virus. Stay home if you are sick and keep kids home if they are showing symptoms. RSV vaccines are available for pregnant women, babies and elderly people. 

If your child is sick, parents and caregivers can help reduce stress on the emergency services system by knowing when to bring a child into the emergency room and when to schedule an appointment. Limiting emergency room traffic to true emergencies helps keep the hospital system from being too overwhelmed. 

If your child is sick but not experiencing severe issues such as trouble breathing or obvious dehydration, consult with your pediatrician and, if possible, schedule an urgent care appointment for your child instead of visiting the emergency room. 

If your child is in respiratory distress, you should call 911. In respiratory distress, a child might turn blue around the nose and mouth, have labored and rapid breathing, have severe shortness of breath or have a rapid heart rate.

RSV is treated by monitoring and treating symptoms; there is no cure for the virus. Many viral respiratory illnesses can be treated at home through rest, plenty of hydration and electrolytes. For congestion, parents and caregivers can use nasal saline to thin the mucus and suction it out with a bulb syringe. 

What is walking pneumonia? 

Walking pneumonia cases have been consistently high since this summer, Louden said. From Nov. 10 to Nov. 16, 99 kids tested positive for the illness. Last year at this time, Cook Children’s reported less than 10 cases of walking pneumonia between August and December. 

Walking pneumonia typically impacts school-age children. Some of the symptoms include: low-grade fever, fatigue and cough. Most atypical pneumonia cases can be treated with antibiotics, but if your child has pneumonia and has had a fever for more than five days and/or having difficulty breathing, seek emergency care. 

Pneumonia, RSV, the flu and COVID-19 can all have similar symptoms. Flu and COVID-19 may also include sore throat, headaches, body aches, chills and change/loss of taste and smell. Parents should not go to urgent care or the emergency department for an RSV, flu or COVID test. Your pediatrician can test for all of these. 

In many cases, physicians can assess and treat a patient via a virtual health appointment. Download the MyCookChildrens app to schedule a virtual health/telemedicine appointment. 

When to Seek Immediate Care: 

• Any temperature greater than 100.4 in an infant under two months of age is considered a medical emergency. If your child has a fever for more than three days, contact your pediatrician or visit an urgent care center. 
• Concerns for dehydration. In dehydrated babies, parents will see fewer wet diapers or a lack of tears. Their flat spot can also appear more sunken. 
• Your child is breathing faster than usual or you can see the skin between the ribs being sucked in. 
• If your child is requiring frequent use of their albuterol rescue inhaler or is having worsening asthma symptoms. 

Signs and Symptoms

Symptoms of RSV in infants younger than 6 months may include:

• Irritability
• Poor feeding 
• Lethargy 
• Episodes where they stop breathing 
• Fever 

Infants and children over 6 months may experience: 

• Runny nose 
• Loss of appetite 
• Cough 
• Sneezing 
• Fever 
• Sometimes wheezing 

Practice Prevention

When it comes to respiratory illnesses, prevention is always the best medicine, especially as we approach the holidays and the many indoor gatherings they bring. Vaccines can help reduce the spread and severity of illness and prevent hospitalization. It’s not too late to get your child’s flu shot or COVID vaccine. Call your pediatrician to make an appointment. 

Remind your children to practice healthy habits such as washing their hands and coughing into a tissue or their elbow. If you or your child feels sick, stay home to prevent spreading illness, take time to rest and stay hydrated with lots of fluids.
 

Last year, Cook Children’s Medical Center experienced the worst respiratory syncytial virus (RSV) season since before 2017, with the peak hitting in October 2022 when hospital admissions for RSV rose above 300. At the same time, Cook Children’s Emergency Department and Urgent Care Centers were overwhelmed with RSV cases, seeing 500+ patients a day. Nationally, RSV sends anywhere from 58,000 to 80,000 children under 5 years old to the hospital each year, according to the Centers for Disease Control.

But future RSV seasons could look different, thanks to a new tool in fighting the virus.

In July, the U.S. Food and Drug Administration approved Beyfortus™ (nirsevimab-alip), a one-time monoclonal antibody injection for the prevention of severe RSV.

The injection is not technically a vaccine, as it does not provide lifetime immunity, nor is it a treatment. Beyfortus is a temporary antibody boost to a child’s immunity to get them through their highest RSV risk period, according to Nicholas Rister, M.D., an Infectious Diseases physician at Cook Children’s Medical Center. The American Academy of Pediatrics recommends Beyfortus for infants 8 months old and younger entering their first RSV season and children up to 19 months at increased risk for severe RSV and entering their second RSV season. In Texas, the RSV season typically begins in the fall and stretches through the winter months.

Cook Children’s doctors say the new RSV monoclonal antibody shot could be a game-changer when it comes to reducing severe infections and hospitalizations, and it's been a long time coming.

“The last time someone tried to develop an RSV treatment for infants that was preventative, I had not even started medical school,” Dr. Rister said. “So the fact that we now have a treatment option for infants for the first time in like 20 years for one of the most prominent diseases on the planet. That's so huge.”

While this particular use of monoclonal antibodies for the prevention of severe RSV is new, Dr. Rister says monoclonal antibodies have been used for hundreds, if not thousands, of indications for over a decade.

Clinical trials of Beyfortus show it reduces the risk of hospitalization for RSV by 75%, which could take a huge burden off of hospitals during peak respiratory virus season.

“We're talking about a disease that, during some respiratory seasons, is more than half of the admissions to the hospital,” Dr. Rister explained. “If you even drop that by half, which this is claiming to be able to do more than that, we're talking about massive reductions in the number of children getting sick enough to end up in the hospital, and massive reductions in the burden at the hospital during respiratory seasons, which hopefully will lead to even better care for the community at large.”

A welcome relief

It’s a welcome relief for Karen Schultz, M.D., medical director of Pulmonology at Cook Children’s. During peak RSV season, it’s not unusual for her to consult on five to 10 new babies with RSV each day in the Pediatric Intensive Care Unit (PICU). The new antibody shot could drop that number significantly.

“It’s good for our clinicians’ work-life balance during these very busy months, but it’s even better for these babies and families to not have to be in the PICU,” Dr. Schultz said.

As a neonatologist in Cook Children’s Neonatal Intensive Care Unit (NICU), Darryl Miao, M.D., cares for babies at particularly high risk for severe RSV due to their prematurity, underdeveloped lungs and other risk factors like congenital heart disease. He says the new antibody shot gives him more confidence that the babies discharged from the NICU won’t end up back in the hospital with RSV.

“I'm excited that all the data shows that there's less hospitalizations, less morbidity, and makes babies better able to fight off RSV in their first year of life.” Dr. Miao said. “I do expect to see less hospitalizations all across the board, including from our NICU population after discharge. That part is really exciting.”

When Vanessa Charette, M.D., a pediatrician at Cook Children’s Pediatrics Fort Worth – Magnolia, had her first child 17 years ago, RSV was one of her top concerns for her baby. As a physician, she knew all too well how sick the virus can make little ones.

“As much as I had the ability to control things, I tried to have him so he would not be a newborn in the winter during RSV season,” Dr. Charette said. “I was so concerned about him getting the virus in the first month of life that I tried to have a baby that would be delivered in the spring rather than later in the year.”

As both a mom and physician, Dr. Charette is thrilled that the new RSV monoclonal antibody can potentially release parents from this burden.

“We’ve been waiting on something, and I think many families have been waiting on something, like this,” she said. “Maybe they’ve had an older child who had RSV and now they’re having their third baby and maybe they’re worried about their new baby getting RSV. It can be the most severe respiratory illness that babies have in their first year of life, and to finally have a tool to prevent it, that’s exciting.”

What parents need to know

We asked each of these physicians to share with us the most important thing they want parents to know about the RSV monoclonal antibody injection when considering it for their child. Here’s what each of them had to say.

Dr. Miao: “I would say, first of all, that it's not a vaccine. It's actually an antibody, and a similar mode of protection against RSV as one that has been on the market and used for NICU babies for 10+ years. The difference between the two is Beyfortus is one injection that will last about five months, which is usually the entirety of the RSV season, as opposed to a monthly injection of the other throughout RSV season. Beyfortus is also recommended for healthy children, unlike the other which is reserved for our highest risk NICU babies.”

Dr. Schultz: “The safety profile of the new antibody shot, when they have done comparative studies with a similar drug we’ve used for a lot of years and has been very safe, is the same. I know that's a big concern for any parent with a new medicine. What are the side effects? But they were really few and far between. They were mainly really mild things like redness at the injection site. There weren't any significant deterrent symptoms or side effects.”

Dr. Charette: “The main thing we hope to see is that the youngest babies, especially our babies less than six months, won’t be as sick and, therefore, won’t be as at-risk for needing hospitalization should they get RSV. They can still get RSV despite having gotten this injection but with much less severity. That is important, not only for the baby's health, but it also obviously helps alleviate parents' fears when their child is diagnosed with RSV.”

Dr. Rister: “I think the most important thing parents need to know is that they need to talk to their pediatrician about it. There is some nuance with this, even though it's generally being recommended for all children, so everyone needs to talk to their pediatrician about their child specifically. Does their child have extra risks? I would just hate to think someone's not having this conversation because it has such a big role in the safety and health of children going forward, especially those young infants, for the first time in decades.”

RELATED STORIES:

• CDC Recommends RSV Shot for Infants. Infectious Diseases Doctor Shares What Parents Need to Know 
• Clinic Watches out for Respiratory Trouble After Prior RSV Care 
   

As cases of the flu and RSV decline at Cook Children’s, we are experiencing an increase in positive cases of COVID-19. Families are encouraged to remain vigilant against respiratory illnesses and make sure their children have the latest COVID booster vaccines, especially as a new dominant subvariant appears to be more contagious.

From Dec. 25 to Dec. 31, Cook Children’s saw a COVID positivity rate of 9.2%, which has been increasing since November. From Jan. 1 to Jan. 7, the positivity rate increased to 11.2%.

As children return to school from the holiday break, there could be an increase in respiratory viruses and illnesses over the next two weeks and beyond, so it’s important to remain watchful and proactive. If your child is feeling sick, keep them at home from daycare or school and wear a face mask when in public to stop the spread.

Influenza A and B cases have declined since November. From Jan. 1 to Jan. 7, we had a positivity rate of 9.9% for Influenza A. This doesn’t mean that the flu season is over, it’s possible to see another increase in cases, so be sure to get vaccinated against the flu. The flu vaccine works to prevent you from catching the flu – or, reduce the severity if you do come down with the illness.

“It is very encouraging to see cases decline,” said Laura Romano, D.O., hospitalist at Cook Children’s. “However, this does not mean that RSV and flu season is over. There is a very likely possibility of a second peak occurring later this winter.”

Respiratory syncytial virus (RSV) cases are declining compared to high cases in October and November. We currently have a RSV positivity rate of 7%. There are limited treatments for RSV. Right now, there is no vaccine available to prevent RSV. Synagis, a monoclonal antibody, can be given to prevent severe infections but this is reserved for premature infants, etc. We are also seeing positive cases of rhinovirus and adenovirus in our patients.

COVID-19 Subvariant

The World Health Organization said that it’s concerned with how quickly the XBB.1.5 subvariant of COVID is spreading in the northeast U.S. The subvariant makes up 40% of submitted specimens to the national SARS-CoV-2 surveillance system. There's still a lot that is unknown about this subvariant.

“This subvariant may be able to slip past our immune defenses and might be more contagious, but it is not clear yet if it causes more severe disease or if the vaccine can effectively prevent severe infections from this strain,” said Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children’s. “We do know that masking and good handwashing will still be helpful to avoid infection.”

The Centers for Disease Control and Prevention tracks the community spread of COVID-19. For the week of Jan. 1, Tarrant County is rated “high” transmission spread.

Prevention & Precautions

The biggest thing the community can do to help is to take precautions against COVID-19, including masking indoors if you or your child feel sick, frequent hand washing, and getting the COVID-19 vaccine and booster.

Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If you or your child is sick, wear a mask in public.
• If your child is sick, keep them home from daycare or school. Make sure your child drinks lots of liquids, gets plenty of sleep and takes over-the-counter meds to alleviate symptoms.

Flu vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

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

Flu immunizations, COVID-19 immunizations and other services are available at Cook Children’s neighborhood clinics and primary care sites across Fort Worth and beyond. Find a location near you: Primary Care Offices/Neighborhood Clinics (cookchildrens.org)

For COVID, at-home tests and community testing locations are also great options.

“These are a couple of toys for our PICU and TCU families,” she says, donning a plaid scarf and a Cook Children’s mask.

Coffee mug in hand, she speed walks to the door – partly to get out of the cold and partly to check in with the charge nurse as soon as possible before the COVID-19 Command Center call in 30 minutes. By her side is Lori Parrott, a pediatric intensive care unit (PICU) nurse manager, who’s helping carry in Christmas presents for patients.

“It sounds like we may have gotten two more overnight,” Melodie tells her as they briskly cross the sky bridge linking the garage and medical center.

As the director of the PICU and the Transitional Care Unit (TCU) at Cook Children’s Medical Center, Melodie wears a lot of hats. She’s a decision maker. A trusted leader. A master juggler. And she oversees a special wing dedicated to critically-ill COVID-19 patients known as 2North.

She quickly sets the bags down in her small, windowless office and heads to the nurses’ station without pause. Sitting next to a small Christmas tree, the charge nurse fills Melodie in on what happened overnight. A med alert, or medical emergency on the 3P, the stepdown COVID-19 unit, and a DKA, otherwise known as diabetic ketoacidosis. But the big news is the latest patient admitted to 2North. It’s a teenager transported in from another hospital. This patient makes eight on the unit, which has a total of 10 beds. This admission means her team will soon have to find more space to house the patients that are increasingly filling up the COVID-19 unit.

Back in her office, Melodie awaits her turn to speak on the Command Center call, a tri-weekly meeting for leaders entrenched in COVID-19 planning and processes. While sipping coffee, she listens as the director of infectious diseases rattles off the latest number of children who’ve tested positive for the virus. Today, it’s 112 in 24 hours, with 25 currently in the hospital.

Soon, it’s Melodie’s turn to share bad news.

“We may need to think about moving kids over to ‘A’ depending on what the continued census is, and especially if we get down to one bed,” she says as clearly and concisely as possible. “These kids continue to be quite ill and I don’t think any will go out today.”

Moving patients to ‘A’ means opening up a new COVID-19 ICU wing. The hospital is being stretched, but you wouldn’t know it by the positive tone of the call. People are optimistic; there’s hope on the way. They’re waiting on notification from Pfizer that the hospital’s allotment of the COVID-19 vaccine has shipped, which could happen at any moment.

We’re with Melodie this Wednesday morning, the week before Christmas, because she’s offered to show us something we have not seen before. She’s volunteered to take us inside 2North.

Inside the COVID-19 ICU

After the call, we follow Melodie down the hallway, her heeled-boots clicking on the confetti-laden floors. Big, purple double doors are ahead of us with 8-by-11, paper signs. They read, “Doors Must Remain Closed,” and “Isolation Garb for COVID (+) rooms,” with a long list of recommended attire: N95 or PAPR, surgical mask, gown, goggles or face shield, gloves, hair covering, and booties. Immediately upon entering, we see all of this gear in action. To the right, there’s a doctor towering over two nurses. All three are concealed inside in personal protective equipment (PPE) – yellow gowns, white masks and blue headcovers. The physician’s goggles resemble something you’d see on the ski slopes, but he’s not on vacation. He’s just left the room of a child who’s suffering a heart arrhythmia due to the virus.

It feels like we’ve just stepped inside a beehive or an ant bed. Every worker has a job and they’re busy doing it. The energy is fast-paced, but controlled. We watch as a respiratory therapist just a few feet in front of us straps on a PAPR, a small backpack that pumps air through a hose into a sealed helmet. Her speed and skill reveal that she’s done this many times.

To the right, a gloved nurse gives us a thumbs up through a window in a patient’s room. She’s talking to her colleague, who’s sitting at a computer on the other side of the wall. The two are communicating through a mini walkie-talkie type device called a ‘Vocera’ that’s clipped onto their scrubs.

“Can I bring you anything,” said the one sitting near us.

The nurse inside the room can’t leave. She’s halfway through a 12-hour shift, meticulously monitoring the many machines keeping her patient, a 12-year-old girl, alive. This is not a job for the weary. She’s an ECMO specialist, meaning she is precisely trained to take care of children who need extracorporeal membrane oxygenation (ECMO). This treatment is a last resort in which blood is pumped to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back into the body.

When a child is on ECMO, two of these specialized nurses or respiratory therapists remain at the bedside at all times. Breaks for food and the restroom are limited. Layers of PPE keep them safe from the virus, but not comfortable. They wear two masks, a surgical mask on top of an N95, plus a face shield, gown, gloves and headcover. If they were soldiers, they’d be ready for war. Their enemy, though, can’t been seen – only the ravages it’s left on their young patient.

Melodie has asked if the girl’s mother would be willing to speak to us. She’s just woken up from the small couch/bed in the room and agrees to step into the hallway. Obviously exhausted, she tells us her name is Florence and that her daughter was diagnosed with COVID 11 days prior.

“She was having a mild temperature, so I brought her to the emergency room just so they could check her out, and we ended up here,” she said in a low, hushed tone. A steady beeping flows in the background.

“That visit was the best decision I made,” she said.

Due to the virus, Florence is the only person allowed to be in the hospital with her daughter. And she can’t leave the room, unless she is leaving the property. All meals are delivered. Anything she needs will be brought to the room for her.

We asked about her time at Cook Children’s, and how things have been.

“I love this place, and I love the staff,” she said.

Florence breaks down. She says everyone she has encountered at the hospital has treated her as if they were the only family there.

“That matters a lot,” she said with tears soaking into her mask.

Ready to return to her room, she shares one last thought: “The ECMO machine is a lifesaver.”

As she walks away, Melodie asks ECMO Manager Jill Pittman to suit up and join the two nurses inside the girl’s room. Shanna Senay and Sara Morgan are the ECMO specialists on duty today. They show us the machine that’s taken the place of the child’s lungs and heart. It’s a bulky contraption with multiple screens, tanks, and tubes, which are red with blood pumping through them.

“ECMO is allowing her lungs to rest and heal from the pneumonia, while we oxygenate her blood and circulate it throughout her body,” Shanna says.

She’s the nurse who gave us the thumbs up from behind the window.

“ECMO is the highest form of medical care that we offer at Cook Children’s, and it requires a lot of training,” said Jill, who’s been a nurse at the hospital for 23 years and now leads the ECMO program. “To be able to facilitate that and have an active role is very meaningful to me.”

ECMO patients are often on the machine for weeks, not just a few days. Because of that, ECMO specialists have to have endurance and the mental fortitude to keep going, even when there is no end in sight.

We’re curious and ask ‘Why do you do this?’

“There’s something special about being able to take care of these kids when they’re so sick and their parents can no longer give them the care they need. Then, it’s up to us,” Sara said with clean air being pumped inside her PAPR helmet. “It’s the last chance these kids have, so we fight every day, every night until they get to the point where they can get better on their own.”

Shanna nods in agreement.

“These kids are warriors. They’re why we push through and why we come out of here sweating bullets and having held our bladders for hours,” she says. “If it were my kid, I would want somebody doing the same thing.”

Back in the hallway, another group of 2North staff members gather to talk to us. One is a young nurse named MyKayla. She has bandages across the ridge of her nose and both ears to protect herself from her N95, which cuts into her skin and leaves sores. Five bandages total, but she’s not complaining. She says she loves taking care of children. It’s her calling.

A respiratory therapist named Joanna is with her, along with another nurse named Megan. They both echo MyKayla, saying they love what they do. We ask if they’ve ever felt scared. There’s a pause.

“Yes, I’ll say it. Especially with it affecting the Hispanic population, it worries me for my family,” says Joanna, who is Hispanic. “But, if God forbid, any of my family members get it and had to be in the hospital, I feel completely comfortable with our doctors, nurses, and respiratory therapists taking care of them.”

Megan jumps in.

“I’m not scared, but I have a healthy respect for it,” she says point blank.

Megan, tall and blonde, moved to Fort Worth a couple of years ago when her husband was sent to work at the Naval Air Station Joint Reserve Base. She was accepted into the competitive nurse residency program at Cook Children’s, and after six months was selected to work full-time in the PICU. She had just a few months under her belt before the pandemic hit. Nearly 10 months on 2North, she now seems like a seasoned nurse.

“I came into this profession knowing anything is game,” she says. “Since COVID, our teamwork as a unit has exponentially increased. It’s been stressful, it’s been frustrating, things are constantly changing, but we keep plugging through, trying to keep our spirits up, and the kids’ spirits up too.”

Off to the side, Jennifer Hayes has just exited a patient’s room. She’s a chaplain on the floor and is accustomed to the tougher moments of an ICU setting.

“The PICU is a hard and heavy place to work, and then you add COVID on top of that, it’s tough,” Jennifer tells us, her appearance failing to match her words.

She’s wearing a bright red shirt with a snowman on it. Her hair is short and brown, pulled up into two spunky knots. She explains her role, how she helps patients and families deal with difficult situations both emotionally and spiritually. She provides the same support to the PICU staff.

“I’m trying to bring joy and fun into the unit,” she says while showing off her fanny pack, creatively decorated to look like a taco for a contest she spearheaded.

She also tells us about the ‘COVID Café,’ a space she established on the unit for worn-out frontline staff to retreat to during their shift. They can watch TV, enjoy the snacks or one of the many word searches, games, or funny memes she’s left at the half-dozen socially distanced tables.

Jennifer is the caretaker of the caretakers, and one of the many moms on the unit. She, like everyone else on this floor, has had to change the way things are done at home. She explains how her 2 year old always wants to hug her as soon as she walks in the door, but can’t for fear that some microscopic particle of COVID-19 has made the trip home with her.

“It has been a big change and has created a delicate balance where we are trying to keep normalcy for our kids, but also we have to be mindful keeping them safe,” she says.

Ashley Miller, the charge nurse we saw filling Melodie in early this morning, agrees. She is also a mom and shares how her 14-year-old son watches the news and worries. She oversees the entire 43-bed PICU and is in charge of admitting each patient. She says the now is by far the worst they’ve seen of the pandemic.

“It’s a reality that kids can get COVID and they can become very, very sick,” she says. “It’s definitely a change from March, we’re seeing many more now.”

While we’re talking, Melodie reminds us about an 11:30 a.m. meeting we’re due to attend. It’s with PICU leaders, and they have a lot to discuss.

Leading During a Pandemic

We make our way down to the basement of the hospital where five women have gathered in a classroom. More are on a conference line. Their top concern today is overflow for COVID-19 patients.

“It’s hard to put a target on when we should open a new wing, because we don’t want to turn around and close it if our census lowers,” Melodie tells the group, which is spaced out around the large room. “But once we get to nine patients, that’s it, and that can change in five minutes.”

Until recently, 2North only had two to three patients at one time. Now, it’s pushing capacity. Finding more space and beds is not an issue. The problem is staffing. With a new COVID-19 ICU unit, more staff will be pulled in to take care of the children in the beds. That’s worrisome because burnout is already top of mind for these leaders. They will do anything to prevent losing essential caretakers. That includes Linda Thompson, M.D., medical director of the PICU, who’s sitting in the corner of the room. She is so concerned about burnout, she offers up her vacation home on the Texas coast for fatigued staff to escape to with their families. Everyone here is willing to do whatever they can to prevent from losing people in the pandemic.

“Ding, ding, ding – Ashley Miller.”

This is the sound of a call coming into a Vocera. Ashley, the charge nurse, is alerting the leaders that another COVID-19 patient is being admitted as they speak. Their discussion about overflow may take shape sooner than expected. They hurry to get through their agenda, knowing there is work to be done on 2North.

After the meeting, we part ways with Melodie. She’s off to do what she does best, leading her team during a challenging situation. We’re gathering our cameras and equipment to capture another area we’ve never seen, the step-down COVID-19 unit known as 3Pavilion, or 3P. Until today, 2North and 3P had been restricted to ‘necessary’ personnel only. Somehow, we got lucky, and are being allowed inside both.

Inside 3P – the COVID-19 Step-Down Unit

We take the nearest elevator to the third floor. As soon as we step off, Valerie Badgett, the day nurse manager, is waiting for us. She’s worked on this unit for 17 years and recalls the day this past March when administrators gathered everyone into a break room and told them they were about to be taking care of COVID-19 patients.

“This was a specialty med surge unit prior to COVID. We treated patients with renal disease, from acute kidney failure to children who received kidney transplants, and GI patients,” she explained. “When they told us we were going to become a COVID unit, people were understandably nervous.”

The administrators explained that their floor has a unique airflow system, which allows air to vent directly outside. This prevents airborne viruses from circulating through the ventilation system.

Valerie tells us more about that day in March, and how they had to quickly move their patients to other floors. They thought they had days to prepare for their first suspected COVID-19 patients. In reality, they had just hours before seven children under investigation for COVID-19 were admitted to their floor.

“There were a lot of questions at first because we didn’t know enough about it,” Valerie said. “But Dr. Whitworth came over the very next day and eased a lot of people’s concerns. She has always been there to answer our questions.”

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s. Valerie credits her composed leadership for helping the staff on 3P not only accept the challenge ahead of them but take it on as a mission they were called to serve.

Unlike 2North, the atmosphere on 3P is calm. It’s quiet and much larger than the ICU. Patient room doors stretch down two long hallways lined with purple and blue carpet. The only thing that visually sets this floor apart from other non-critical areas of the hospital is the donning and doffing of PPE happening all around us. Doctors and nurses are suiting up in PAPRs, gowns, goggles, and gloves before entering rooms. Knowing this team didn’t necessarily sign up to take care of COVID-19 patients gives us a whole new respect for them.

“It has brought a lot of new diagnoses that we didn’t take care of before, chemo patients, newly diagnosed diabetes, a lot of patients that we’ve gotten have come in the emergency department because they’re sick from something else, and then coincidentally they test positive for COVID,” Valerie said. “Many of our nurses have become certified in chemotherapy so they can take care of the patients we’re now seeing.”

Hearing how this unit has stayed together the past 10 months, even when they had opportunities to abandon ship to work in other areas, is inspiring. They’ve overcome fear, learned how to care for an array of injuries and illnesses, and built an unbreakable bond. They’ve proven resilient, and their strength is needed now more than ever.

“We have 20 beds on this floor, and today we have 17 patients,” says Ashley Kovacev, the night nurse manager who’s volunteered to give us a tour.

She walks us down the hallway, pointing out the negative pressure rooms they never had to use for isolation purposes until this year. We round a corner and an alarm is dinging. A light overhead flashes. Ashely peeks into the room.

“Are you ok?” she asks.

Inside, a mother needs help getting her child to the restroom. Ashley calls for a nurse.

Families on 3P rely on the staff for everything, including food and water. Like 2North, only one parent at a time is allowed per patient and they can’t leave the room unless they are leaving the hospital. Because of COVID-19, the floor’s family lounge and playroom are closed. Patients and parents are stuck in their rooms, but everyone tries to make the best of it.

One small glimmer of hope is the child life specialists and music therapists who don and doff PPE to deliver activities to the children’s rooms. We spot one, a young woman with long blonde hair, sitting alone in the closed playroom. She’s teaching a patient how to play guitar via Zoom, just one of the many creative ways the child life team is engaging isolated patients.

To the left, down a short hallway, a woman in a blue scrub top and black pants is pushing a large cart.

“That’s Rebecca. She’s been absolutely phenomenal since day one,” Ashley says. “We tease her because she literally wipes down the walls non-stop.”

Rebecca is an environmental services worker. She looks uncomfortable as Ashley gushes about how she has kept the team safe throughout the pandemic.

“Not a single person here has contracted COVID from our unit,” says Ashley, crediting Rebecca for their protection.

Reluctant to accept the praise, Rebecca says simply through her mask, “We have to take care of each other.”

As we near the end of the tour, a food services employee in a mask and goggles delivers a plastic bag full of Styrofoam containers to the nurses’ station. It’s just one of the many trips he will make to 3P today, delivering three meals to each of the 17 families on the unit. He, like everyone else we’ve met, smiles as he drops off the food.

It’s no small feat for any of these people – the changes they’ve adapted to. The anxiety of the unknown. The courage they’ve displayed. After spending eight hours behind-the-scenes of Cook Children’s COVID-19 units, we can attest to the following statement:

“Our staff truly honor our ‘Promise’ every single day,” Ashley says holding back tears. “It makes me emotional. These people are so resilient. They care for these kids like they’re their own. It’s truly amazing.”

Last week, eight children tested positive the flu at the medical center, according to Laboratory results from Cook Children’s. What’s interesting is that seven children tested positive for influenza B and only one for the A strain.

Morgan Pence, Ph.D., a clinical microbiologist at Cook Children’s, says this occurrence is a bit odd because the A strain usually precedes B. Pence adds that the majority of flu cases reported nationwide have been influenza B.

Since Sept. 29, 2019, the Centers for Disease Control and Prevention (CDC), found that 68.1% (289) of positive tests gathered from clinical laboratories nationwide were for influenza B.

The good news is Flu B is usually less severe than Flu A. The bad news is the flu season is just beginning. And while it remains to be seen what the flu season holds in store for the area, one thing is for sure: it’s time to get your flu shot.

“It’s important for people to take care of themselves and others to prevent the spread of the flu as much as possible,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases. “The flu vaccine continues to be recommended for everyone 6 months of age and older. Make sure to practice washing your hands and please keep your children home if they are sick.”

Speaking about the early flu season, the CDC reports:

• Nationally, flu activity is low and similar to what has been observed during recent previous seasons at the same time, but Louisiana and Puerto Rico are experiencing high levels of influenza-like-illness.
• Severe flu outcomes have been reported, including the first two pediatric deaths of the 2019-2020 season.
• Flu vaccination is always the best way to prevent flu and its potentially serious complications. Most flu vaccines protect against 4 different flu viruses. Get vaccinated now.

Other flu prevention tips include:

• Try to avoid close contact with sick people.
• While sick, limit contact with others as much as possible to keep from infecting them.
• If you are sick with flu-like illness, the CDC recommends staying home for at least 24 hours after your fever is gone except to get medical care for other necessities. Your fever should be gone for 24 hours without the use of fever-reducing medicine.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands with soap and water. If soap and water aren’t available, use an alcohol-based hand rub.
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

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

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

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

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

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

Safety

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

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

1.The oil itself did not hurt the child.

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

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

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

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

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

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

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

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

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

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

Q: Have you seen allergic reactions?

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

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

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

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

We know that these oils can affect the liver and cause the liver to metabolize other medications faster or slower. This could lead to medications not being as effective or potentially be more toxic. Some information is being gathered in adults to try to figure this out but kids are not “little adults” and we’ll likely need research in children before we can answer this for sure.

More from Doc Smitty on this topic:

New York Times Report: Are Essential Oils Safe For Kids?

Essential oils and their use on children

Essential oils and children - more questions answered

Wheezing, coughing and the struggle to catch a single breath.

Sounds like asthma, right?

But there may be another cause for respiratory distress in your child: vocal cord dysfunction.

Asthma and vocal cord dysfunction (VCD) seemingly show the same symptoms, especially in adolescents. But what’s the difference between them?

Cook Children’s Emergency Department sees an average of 13,000 children each year exhibiting wheezing and difficulty breathing. The similarity of symptoms between asthma and vocal cord dysfunction may be difficult to differentiate to the eye so it’s important to note the small distinctions.

“Asthma and VCD are quite different even though some of the symptoms can overlap,” Corwin Warmink, M.D., medical director of Emergency Services at Cook Children’s said. “VCD causes difficulty breathing in compared to asthma, which makes it more difficult to breathe out. They also sound different when using a stethoscope to examine a patient.”

Unlike vocal cord dysfunction, asthma is an immune response when the body is exposed to various “triggers,” such as air pollutants, physical activity and airborne particles like pollen and pet dander. When triggered, the bronchial muscles in the airways constrict and the sudden obstruction causes the reaction of an asthma attack.

You may be experiencing an asthma attack if your symptoms include:

• Tightness in the chest

• Difficulty breathing

• Shortness of breath

• Coughing and wheezing

• Excess mucus

Vocal cord dysfunction is the abnormal closing-together of the vocal cords, resulting in the loss of airflow. Unlike asthma, VCD does not involve an immune response or a reaction from the airways. Vocal cord dysfunction makes it more difficult to breathe in than breathe out when symptoms occur.

Children who are active, vocal and use their vocal cords more than usual may have higher tendencies to experience VCD.

“We see VCD most common in female teenage athletes although it does occur in males,” Karen Schultz, M.D., pulmonologist at Cook Children’s said. “Type “A” personalities are at higher risk.”

You may be experiencing vocal cord dysfunction if your symptoms include:

• Tightness in the throat

• Difficulty breathing

• Coughing and wheezing

• Hoarse voice

Asthma and VCD are regularly confused as the symptoms and triggers are similar. Many patients with VCD are originally treated for asthma.

“Patients are diagnosed by history, exam and lung function testing,” Dr. Schultz said. “Lung function testing can be completely normal in both conditions when no symptoms are present. Frequently history alone can differentiate the two. Occasionally lung function testing after exercise can be diagnostic or laryngoscopy after exercise”

Signs you may be experiencing VCD instead of asthma:

• It is more difficult to breathe in than it is to breathe out

• Asthma medications and inhalers do not ease symptoms

The diagnoses for VCD and asthma are different. Asthma requires pulmonary function tests, such as a peak flow and a spirometry test. While a diagnosis for vocal cord dysfunction typically entails results from other pulmonary function tests, such as a laryngoscopy or a spirometry test.

Many children who are diagnosed with vocal cord dysfunction are referred to see a speech pathologist who can assess the degree of dysfunction, and begin a plan of action with different types of breathing and stretching exercises for the vocal cords.

“There are a number of ways we treat different diagnoses, but we will usually start with breathing exercises to make sure air flow is unhindered and the vocal cords can be well supported,” Melanie Van Noy, speech pathologist at Cook Children’s said. “Then we may do simple exercises to lengthen and stretch the vocal cords or exercises to reduce pressure. It depends on the diagnosis and the dysfunction.”

While VCD does not have specific medications to ease symptoms, speech therapy is tailored to allow children and their families learn triggers and how to cope when an attack does occur.

“For kiddos, a large part of our job is helping our young patients to become more aware of their vocal habits and educating not only them but their parents and siblings on how they can help change those habits, Van Noy said. “We also have some sophisticated software programs that help give our kiddos the feedback they need so they can not only hear the difference, but see the difference and the changes they are making as well.”

Speech therapy typically teaches and treats children for three to five sessions. If the child is still showing symptoms, a team of Cook Children’s doctors will begin to assess all the different aspects to their case.

“Our ENTs and pulmonologists work closely together to ensure that if our treatment plateaus or the patient is still showing symptoms despite treatment, we can collaborate on what to do next,” Van Noy said. “That may look like a discussion with the physician regarding compliance and progress of treatment, what other medical intervention strategies are available or maybe just another episode of care, which is what we refer to as our plans of care.”

Cases of RSV (respiratory syncytial virus) infections in North Texas commonly increase in the winter. But this year, it's arrived earlier than usual. During the week of Nov. 20, 2016, 47 Cook Children’s patients tested positive for RSV. During this same time frame in 2015, only 9 kids had tested postive and the number was 18 in 2014.

A simple cold can quickly progress to bronchiolitis caused by the RSV virus, especially in kids under 2 years old. As a parent, here are a few things you need to know about RSV.

1. What is RSV?

RSV is a virus that impacts the respiratory tract, including both the upper and lower airways. It usually starts with cold-like symptoms, such as a stuffy nose and sneezing, but could progress to include a cough, fever or wheezing.

2. How does my child get RSV? Is it contagious?

The virus is spread through droplets caused by coughing and sneezing that linger in the air or land on surfaces. This virus can live on surfaces for about six hours and survive in the air for about 30 minutes.

3. How long does the illness last?

Illness can begin between four and six days after exposure to the virus, and can last for a week or two. Symptoms may continue longer in infants or patients with weakened immune systems.

4. How is it treated?

In most cases, supportive care is all that is necessary. This includes elevating the head of the bed, running a cool mist humidifier and using a nasal bulb for suctioning to clear secretions. Some children develop wheezing, in which case treatment with prescription albuterol through a nebulizer may be helpful. In more severe cases, deep suctioning, supplemental oxygen and hospitalization may be necessary.

5. When should I be concerned?

If your child is having difficult or labored breathing, as evidenced by retractions (tugging of the muscles around the ribs and abdomen), nasal flaring or shallow breaths, they need to be evaluated by your pediatrician.

6. How do I prevent it?

As with any other airborne disease, it is important to cover coughs and sneezes to prevent spread of the virus. Kids should avoid touching faces with unwashed hands, practice good hand-washing techniques and avoid contact with sick individuals. Parents should keep surfaces, like crib railings and toys, sanitized regularly and use disinfectant sprays. There is a vaccine available for certain premature babies or babies with underlying diseases. Talk to your pediatrician to see if your child qualifies for the vaccine.

In the absence of complications, RSV can usually be handled at home with supportive care and kids will feel better fairly quickly. If your child’s symptoms concern you or they show signs of difficulty breathing or dehydration, see your pediatrician right away.

Ailments run the gamut from respiratory and fever issues (RSV and influenza) to gastroenteritis with vomiting, diarrhea and severe dehydration. And while there’s not one illness that stands out, one thing is for sure – children in the ED are sicker than they’ve ever been.

“Our ED is running beyond full capacity and has been since December. But in the last few weeks we’re seeing a larger number of very ill children than even during flu season.” said Corwin Warmink, M.D., assistant medical director of the Emergency Department at Cook Children’s. “The sicker the child, the longer it takes to diagnose, treat and properly care for them.”

In December, 20 to 30 kids were admitted for treatment per day from the Emergency Department, but by February, those numbers jumped to about 40 to 50 children a day.

The Emergency Department is averaging nearly 400 patients per day, and during its busiest times a patient will check in every two minutes.

Overall, children appear to be sicker this year. Compared to this time last year, Cook Children’s has seen a 60 percent increase in the percentage of children who need critical care.

As the number of patients admitted and treated in the ED increases, so does the time physicians spend with each child, which contributes to the much longer waiting times.

Depending on the severity of the illness or injury, it could take 4 to 6 hours to care for a child. But it’s not just one physician treating that child. Nurses and health care providers may be brought in too.

“Many of the children we see are dealing with very serious emergencies and they receive immediate care,” Dr. Warmink said. “We use all necessary resources and manpower to care for those children. Unfortunately, that means longer wait times for the families in the waiting room.

“Families could spend anywhere from 5-10 hours or longer in our waiting room, depending on the day they visit. We are actively bringing in extra doctors, nurses and support staff to try and improve these times.”

Dr. Warmink advises parents that Sundays and Mondays are the busiest days of the week in the ED. Evenings after 5 p.m. seem to be popular too.

Families with sick kids who aren’t experiencing emergencies do have other options. The first line of defense is your child’s pediatrician. Making an appointment with a child’s doctor may help avoid a long wait at the ED. Cook Children’s also has several Urgent Care Clinics for non-emergent needs.

Previous articles on this topic:

• More flu, longer waits in the ED
• Emergency? 6 signs from an ER doc
• Cook Children's to build new South Tower on main campus
• Is it RSV?
• 8 flu myths I wish would go away

As someone who lives with asthma, I’m proof that the condition does not have to slow you down. It’s important for most children to know they can still partake in all of the fun activities of other kids, just as long as they properly take their medicine.

I join about 10 percent of the general population who are asthmatics. Children have an even greater incidence of suffering from asthma, and the prevalence of asthma is increasing in both adults and children.

First let’s define asthma. Asthma is a condition caused by narrowing of the small air tubes in the lungs with inflammation and constriction of the smooth muscle surrounding the small air tubes.

There are many symptoms of asthma, including wheezing, shortness of breath and exercise intolerance. Some people complain of “tightness in their chest.” The symptoms do vary with the severity of the asthma and whether the person is having an asthma attack.

Anyone who has the condition knows about the triggers that can cause an asthma flare. The most important factor is the common cold; viral upper respiratory infections are the most common reason for an asthma attack in both adults and children. Allergies are the second most important trigger but other factors like, exercise and weather changes can cause trouble as well.

To measure whether your child’s asthma is under control, I use the “Rule of Twos.” Your asthma is not under control if:

• You have to use albuterol more than twice a week on average during the daytime, or twice a month on average at night.
• You have to use oral steroids more than twice a year.
• You go through two albuterol puffers a year.
• When your asthma is not under good control, I would either add an inhaled steroid or increase the dose of the inhaled steroid.

Discuss this with your pediatrician and make sure you have an asthma plan. Teach the plan to your children as they grow up to help prevent asthma attacks.

The most effective preventive medication is an inhaled steroid, which comes in both a puffer form and in the nebulizer. This medication needs to be taken on a daily basis to prevent inflammation, which narrows the small air tubes.

All of the research over the past 20-30 years has shown that if asthmatics take their preventive medication regularly their asthma improves. Another helpful measure is avoidance of allergy triggers such as, dust mites and cat dander, which are the two most common allergens in our society.

The mainstay of treatment for an asthma flare is a drug called albuterol. It comes in several forms, but it is mainly used in a “puffer” or metered dose inhaler, or in a solution that is used in a nebulizer.

This medication is a bronchodilator which opens up tight airways. The other commonly used medication is an oral steroid such as, prednisone which decreases inflammation in the small air tubes.

I wouldn’t describe living life with asthma as easy and it does come with challenges. But if you take care of yourself, follow your medication treatment prescribed by your Cook Children’s pediatrician and avoid triggers as best you can, children should be able to live normal and productive lives.

They may even become a pediatrician themselves someday and take care of other kids with asthma.

Her day begins bright and early around 7 a.m. with cuddles from Mommy and then it’s time for her bottle feeding at 8. Other activities for the morning include a visit from the respiratory therapist (RT) for her breathing treatment and morning “massage.” Her “massage” is part of her chest physiotherapy where they use an oxygen mask to firmly pat her on her chest and back to help expand her lungs and break up any mucus she may have. This is one of Avery’s favorite parts of the day. We love to watch her as she lies in her bed on her stomach and dozes off to sleep as the RTs work their magic.

She may also get a visit from occupational or physical therapy for a morning workout where they work on fun things like learning to put her feet in her mouth and building her core strength to help her learn to roll over and sit up. They also have taught us about infant massage and given us stretches we can do with Avery to help her with her flexibility.

After her morning workout, she has likely worked up an appetite so it’s time to eat again. This time, a speech pathologist may come to give Avery her bottle. Learning to eat after 6 months is tough, so a speech pathologist is working with us on what bottles and nipples to use, positions to try when feeding her and different combinations of breast milk and formula to use. All of these things play an important factor in helping Avery to swallow efficiently and effectively and not having her food go down the “wrong way” which can cause aspiration and an infection in her lungs. We are about to introduce her to solid foods which will be another fun adventure!

Once she’s done eating, it’s usually time for a visit from Daddy, where she likes to squeeze in her afternoon nap on his lap. All the activity from the morning often wears her out for a few hours. She is, after all, a baby who needs her rest so she can grow healthy, new lung tissue.

In the afternoon, she may get a visit from the Child Life specialist for some “smile therapy” where we work on coaxing a smile out of her or arts and crafts activities with her footprints. The music therapist may come by to sing and play music while Avery works on her babbling.

Interspersed throughout this busy day of therapy visits, eating, naps and playtime, she also receives countless visits from the NICU staff and our family, all stopping by to see her outfit of the day and get an update on how she’s doing.

The late afternoon and early evening is reserved for family time where she plays on her play mat, works on tummy time or hangs out in her Bumbo® or exersaucer. By the time Shawn and I are ready to go home and sleep, Avery is usually asleep, worn out from all of the day’s activities. After all, she has to get a good night sleep so she can wake up and do it all over again the next day.

Related links:

• Avery's story - part 1
• Avery's story - part 2
• Avery's story - part 3
• Avery's story - part 4
• Avery's story - part 5
• Avery's journey - part 6

Thus far, we have not seen the outbreak to be as severe as those seen in other regions. In my office, we are continuing to see the usual rise in respiratory illness as would be expected this time of year.

I want to take this opportunity to remind you that the severity of illness with EVD68 varies. Most children will have a common cold with runny nose and cough (most do not even have fever).

All of our Cook Children’s providers from the primary care offices to the hospital are aware of the situation so that we can continue to provide the best care for your children.

Here are some of the questions we have addressed in our previous coverage of this virus.

Does my child with runny nose and cough need to be seen by their doctor?

As with most viral infections, many of the children who get EVD68 will only have a runny nose and cough. There is no specific treatment for the virus and no way to predict who will become more ill once they have it. Because of this, there is no reason to rush in to be seen for mild symptoms. It is likely that the majority of children with these symptoms will get better on their own without treatment.

Watch your child for signs of wheezing or difficulty breathing, which would warrant a visit to your doctor or the emergency room. If you have any other concerns about your child, do not hesitate to contact your pediatrician for advice. Children with asthma need to be monitored especially closely. If your child has asthma, be sure that you have the prescribed nebulizer medication at your house should wheezing develop during the night.

How do we know if a child has EVD68?

Because there is no rapid test for the virus, your doctor or emergency room cannot determine if your child has it. That is why there is no need to be seen if your child’s symptoms are mild. At this point, testing is being recommended only for children hospitalized in an ICU setting.

How do we protect our children from EVD68?

As with all viruses, washing hands and keeping your child away from other sick children are important strategies. An important note: alcohol based hand sanitizers are not effective against EVD68, thus it is important to have your children wash their hands with soap and water before eating and periodically throughout the day.

My quick thoughts:

· Any new and emerging disease can be scary for parents.

· Media coverage increases the level of anxiety.

· Having a name for a virus increases the level of anxiety.

Fortunately, for most people, having information and being prepared help to decrease the anxiety. We see that as our job to you as your children’s hospital.

The good news is that there are many parts of the country that have already seen the peak of the illness and it is on the down swing. We have been able to monitor those outbreaks to be better prepared should we see an increase of cases in our area.

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.