In Cook Children’s Emergency Department, treating gunshot victims requires all hands on deck. The moments are precious as staff work against the clock to save young lives. The goal? To rescue every child who comes through the sliding doors. The reality? Children with gunshot wounds are among those most likely to die from their injuries.

For emergency room physicians like Dan Guzman, M.D., caring for shooting victims is particularly bothersome because gunshot wounds are preventable. He fears he will see many shooting victims in the coming months as summer is typically a busy time for this type of injury.

“Kids are out of school, and parents are working,” he said. “Children will find a gun that’s not locked or hidden, and a matter of seconds can change a family’s life.”

As of May, 35 children have already been treated at Cook Children’s with gunshot wounds in 2021. Two died. Compare that to 2019 when 41 children were treated for gunshot wounds, including five deaths, and 2020, which totaled 47 patients and four deaths.

“We are five months into 2021 and are on track to exceed prior years,” Dr. Guzman said. “We haven’t reached the halfway point and we’ve already lost two patients.”

While most of the situations stemmed from unintentional gunshots, Dr. Guzman says all of the incidents could have been avoided.

“The vast majority of the kids that we see suffer from head and neck injuries. It's almost impossible to save a life because the damage has been done to the brain.” Dr. Guzman said.

Celeste Calhoun and Jill Plunkett are emergency room nurses with a combined 20+ years of experience. They both agree that seeing gunshot victims coming through the emergency department has happened more often than they’d care to see.

“Gunshots are preventable for children,” Calhoun said. “Children don't go out with an intent to harm each other. They usually obtain the gun because it was left open or out, and by playing with it. Not knowing that it's loaded or what it can do when they aim it at someone and squeeze the trigger.”

Plunkett says her husband was raised around police officers and guns, she and her husband made it a point to teach their two children about gun safety and education at a young age.

“We have guns in our home, they were never loaded and my children didn’t even know the code to the safe until they were adults. They knew the guns were in our home, and if they ever wanted to see them or had questions, my husband would take them out and educate them, but they were never accessible,” Plunkett explained.

Dr. Guzman agrees that education is key. He says he understands why parents may feel they need guns for the safety of their family, however, there is a safe way to have a weapon in the home - locked up.

“Let's put our guns away. For the safety of our children, let's make sure that we're making the right choices,” Dr. Guzman said. “If you can buy a safe, 100%, get a safe and put that gun away. This is not about who can have a gun or who shouldn't have a gun. The bottom line is our children’s safety.”

Dr. Guzman worries that recent state legislation coupled with a spike in gun sales nationwide could lead to more unintentional child shootings.

“Last year (2020) was a bad year, we saw more injuries than we’d seen in the last five years,” Dr. Guzman explained.

The plea is simple. If there are guns in your home, educate your children and make sure they are in a safe and secure place.

“We want to help people avoid having to be in our emergency department, to be safe at home, and live a long life without ever having to see us,” Dr. Guzman said.

Calhoun, who is also a mother, shares another piece of advice that is often forgotten by parents.

“Make sure you know where your child's going to visit and play,” Calhoun said. “If they're going to another home with another child, have that awkward conversation with the parents to find out if they have guns in their home and what safety precautions they take to protect their children.”

Lastly, Dr.Guzman says when educating families, it is important to note that handguns are not the only kind of gun that can injure a child.

“We hear about handguns and firearm accidents in the news,” Dr. Guzman said. “We can’t forget children are injured by BB guns and pellet guns too. I’ve seen children die from BB guns and pellet guns, so we have to be cognizant at all times.”

“We usually see a cluster of patients from crashes in the three to four days before and after Christmas,” said Sharon Evans, trauma injury prevention coordinator at Cook Children’s. “People are stressed, and it’s the height of travel season. We don’t know what it will be like this year due to the pandemic, but we know this time of year is especially dangerous.”

Since 2015, an average of 12 car wreck victims were admitted to Cook Children’s between the dates of Dec. 20-30. Out of those, three were typically not restrained with a seat belt or car seat.

“If a child is properly restrained in a car seat, we may see some cuts and bruises, but they usually ok,” said Evans. “The ones who are much more seriously injured tend to be children in seat belts who are too small and should be using a booster seat.”

In Texas, children are required to remain in a car seat until they are 4 feet 9 inches tall or 8 years old. Experts like Evans say that is the bare minimum, and it’s more important to pay attention to a child’s size than their age since seat belts are made for adults and don’t fit small bodies properly.

“When children are using a seatbelt prematurely, the belt doesn’t fit across the center of their shoulders like it should and kids will tend to put it behind their back or under their arm,” she explained. “Now, their entire upper body is unrestrained. In a crash, this means the child folds over the seatbelt.”

She says these children can suffer cervical spine injuries, as well as serious internal injuries to the spleen, liver and intestines. This is why it’s so important for children to remain in a car seat or booster seat until they fit into a seat belt. Also, any child under 13 years old should ride in the backseat.

“There are no do-overs,” said Evans. “A lot of times we see families who say their child was really tired or fussy and didn’t want to get into the car seat or they wanted to lay down. We understand how that can happen, but families need to know that kind of normal decision can affect your life forever.”

Most Dangerous State

A recent report released by Go Insurance’s partner nonprofit, Go Safe Labs, shows Texas is the least safe state in the country for children in vehicles. Between 2015-2018, Go Safe Labs found that 1,172 children were injured or killed in traffic accidents in the state, with 55% in rural areas and 45% in urban areas.

Further data from the Texas Department of Transportation shows it’s been more than 20 years since the state has seen a day without a death on its roads. November 7, 2000, marked the last time that happened. Since then, more than 70,000 people have lost their lives on Texas roads, with an average of 10 people dying every day.

“You hear about wrecks every time you turn on the news and I think we’ve almost become desensitized to them,” said Evans. “You have to remember, it could be you and it could be serious.”

Due to the COVID-19 pandemic, this holiday season could see more deaths than usual.

According to a study by the Center for Transportation Safety (CTS) at the Texas A&M Transportation Institute (TTI), the number of Texas traffic crashes in April dropped by nearly 50% compared to 2017-2019 averages. While there were fewer crashes, researchers say there was a 50% increase in traffic fatalities. They believe the data is evidence that the risk of death and injury is greater when roads are more clear, likely because people tend to drive faster with fewer cars on the road.

“There’s no way to predict what will happen this holiday season, if there will be more people on the road or less,” said Evans. “But one thing I know for sure is accidents don’t take a day off.”

What Can Parents Do?

If you are traveling with children, make sure they are restrained properly. According to Safe Kids North Texas, four out of five car seats are installed incorrectly. For this reason, they offer free car seat checks to ensure your child’s safety. Due to the COVID-19 pandemic, car seat checks are being offered virtually only at this time. You can easily sign up for a check online by clicking here.

According to the study published this month in the journal Pediatrics, just half of mothers surveyed said they always put their babies to sleep on their backs.

The findings are alarming for physicians who say back-sleeping is a key way to reduce the risk of sudden infant death syndrome (SIDS).

“We see it all the time, and it is tragic,” said Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children’s Medical Center. “SIDS is responsible for more infant deaths in the United States than anything else during the first year of life.”

While experts don’t know exactly why back-sleeping is best for preventing SIDS, it is believed that babies who sleep on their stomach get less oxygen and retain more carbon dioxide because they are “rebreathing” air. It is also possible that tummy-sleeping can lead to upper airway obstruction and choking.

“Infants should always sleep on their backs in a crib with a firm surface and a tight fitting sheet. No bumpers, pillows or soft bedding should be used,” mentioned Dr. Warmink.

Another big reason infants arrive in Cook Children’s Emergency Department is co-sleeping. While many parents find comfort in sharing a room with their baby, bed-sharing is never recommended.

“New parents are understandably exhausted, but even a quick nap with a newborn can turn deadly,” said Dr. Warmink. “It’s horrible to see a parent lose a child because they were accidently smothered in their sleep. Sharing a bedroom with an infant makes sense, but never on the same sleep surface.”

Dr. Warmink also insists infants should never sleep on a couch, sofa or cushioned chair, even when alone, and especially not with another person.

About Safe Sleep

Tarrant County has one of the highest infant mortality rates among Texas counties–exceeding the national average. The Center for Prevention of Child Maltreatment is guiding a safe infant sleep awareness campaign in collaboration with Baylor All Saints, JPS and Texas Health Harris Methodist. Learn more here.

"Parents may think buying costumes that are too big allow children to wear the costumes for several years, but outfits that are too big can cause falls," said Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coaltion.

Use these tips as your kids are preparing for Halloween:

1. Select costumes that fit well.
2. Trick-or-treat with your children.
3. To help drivers see kids in the dark, put reflective tape at the top and bottom of costumes. This lets drivers better see your kids' height and movement.
4. Use face paint instead of masks so trick-or-treaters' vision isn't blocked.
5. Plan a familiar trick-or-treating route on safe, well-lit streets, use sidewalks and cross the street at intersections.
6. When crossing the street, use the crosswalk and make eye contact with the drivers so you know they see you and your group.
7. Use a flashlight or glow stick to light the way.

For more safety information

Being a parent is tough. We want you to know that you are not alone. We've compiled tips, resources and practical advice on a variety of safety and prevention topics designed to help you raise a safe and healthy family.

Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coalition, gives these 5 tips:

1. Preparation is key. Plan ahead to see how many and how old the children are that will be at Thanksgiving. Then, pick out toys/activities appropriate for several ages and keep the others out of reach.

2. Create an activity area for children to play, equipped with appropriate toys and activities.

3. Designate an adult to supervise the children. Adults can share this responsibility to reduce holiday stressors

4. Do a quick walk-thru to identify any red flags throughout the home, and in children’s reach: whether it be toys, poisons/medications, unsafe electrical outlets, doors accessing pools, etc.

5. Always ask guests to lock their car doors, so children don’t play hide and seek and get locked inside. Child heat stroke can occur even during cooler months.​

About the source

Dana Walraven is the manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coalition. Being a parent is tough. We want you to know that you are not alone. We've compiled tips, resources and practical advice on a variety of safety and prevention topics designed to help you raise a safe and healthy family. Visit our Cook Children's Safety and Prevention Center today.

Of those drownings, 26 were backyard or community pools.

If you believe swim lessons are nothing more than a fun summer activity, think again. The skills children learn in swim classes could make the difference in life and death.

During swim lessons, kids get used to the water and learn important water safety skills. According to Safe Kids Tarrant County, led by Cook Children's, children who don't know how to swim or who are being supervised by adults who can't swim are eight times more likely to drown or fatally drown.

"Children as young as 2 to 3 years old develop the ability to self-rescue during swim lessons, which means that if they fall into a swimming pool, they can turn around in the water and either float on their back until rescued or use the skills they have learned to swim to the side of the pool," said Tyler Emler, action team chair for drowning prevention for Safe Kids. "The sooner children get in the water, the sooner they become comfortable with swimming. If you wait until children are 6-8 years old to begin swim lessons, they won't have the same comfort level as children who have been in the water since they were younger."

Which swim class is best?

When choosing swim lessons for your child, visit local health clubs and recreational centers to meet with swim instructors and educate yourself on the classes offered. 

According to Emler, the most successful classes teach a love for water while also building necessary swimming and water safety skills.

While swim classes should have accommodations in place to assist children who don't acclimate to the water or who aren't reaching swim class goals, Emler notes that parents can help their child's progress by spending family time in the pool and stopping any pressure a child may feel to master skills more quickly. 

Young children who take swim classes in late spring or early summer should return for indoor winter refresher courses every year until they reach 6 or 7 years old. This way, coordination and muscle memory has a chance to develop, allowing children to maintain skills for longer periods of time.

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.