In 2024, the U.S. Surgeon General recognized firearm violence as a critical public health crisis in the United States. Nationwide, firearms have risen to become the number one cause of mortality among children. Data from the CCHSC revealed that between 2024 and 2026, the hospital encountered 121 unintentional firearm injuries, alongside five pediatric fatalities stemming directly from firearm trauma.

The forum focused on community-driven solutions. A recurring consensus emerged among the panelists: sustainable intervention requires bringing the youth into the conversation, acknowledging and resolving the compounding personal traumas they carry before those crises escalate into violence.

Panelist Rodney McIntosh, Pastor and Director of the non-profit organization Violence Intervention and Prevention Fort Worth (VIPFW), urged community members to actively integrate young people into the safety dialogue, equipping them with foundational tools in social-emotional learning and actionable conflict de-escalation tactics.

Daniel Guzman, M.D., an emergency room physician and program director for Cook Children’s Aim for Safety program, brought a frontline medical perspective, illustrating the realities of firearm accidents in the home and emphasizing that responsible storage and education can reduce injury.

The evening closed with a powerful challenge to the audience:

“We challenge you to do something,” said Eric Gonzalez, Program Manager for Injury Prevention at the Center for Community Health at Cook Children’s Health Care System. “Ask your community, schools, family: why wait to have a conversation when we can do this right now?”

Fort Worth leaders urge parents, educators, and neighbors to initiate open, judgment-free discussions about firearm safety within their homes and community. Keep guns secured. Protect your children. Lock up all firearms.

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According to the Texas Department of State Health Services, about 7,000 people are bitten by venomous snakes in the United States each year. However, about half of all venomous snakebites are “dry,” meaning the snake does not release venom.

“Snakes are often in bluebonnets. You may want to reconsider sending your kids to sit or lay in them,” said Sharon Evans, injury prevention manager at Cook Children's Health Care System.

Snakebites are most common between April and October, with snakes typically most active in the morning and at dusk. Texas is known for two types of venomous snakes: pit vipers and coral snakes. North Texas is home to three species of pit vipers: copperheads, cottonmouths (also known as water moccasins) and rattlesnakes.

“If you are bitten go to the Emergency Department or Urgent Care Center for treatment and evaluation,” said Evans.

Once at the hospital, patients with moderate to severe envenomation may receive antivenom, which is readily available at Cook Children’s Medical Centers. Patients are closely monitored for symptom progression and may require hospital admission for observation and supportive care. 

Cook Children’s reported three snake bites as of March 2026. Last year, 25 snake bites were reported, the first one in April. In 2024, the first snakebite was reported in March. The system treated 27 snakebites that year.

Bluebonnets may not just be home to some slithery friends, but insects too. In cases of insect bites, such as fire ants, Evans suggests caregivers call the North Texas Poison Center.

“Be careful when your children are getting in there,” said Evans.

Evans shared advice for caregivers on how to enjoy the beautiful flowers, while avoiding a trip to the emergency department.  

Keeping safe:

• Look before you walk.
• Avoid walking in tall grass.
• Wear protective boots.
• Never attempt to touch or handle a snake, even if it appears dead.

 What to do if bitten by a snake:

• Do not try to capture, photograph, or kill the snake.
• Do not apply ice, tourniquets, or attempt to suck out venom.
• Immobilize the affected limb and keep it at heart level if possible.

 Signs of venomous snake bite:

• Blurred vision
• Convulsions
• Dizziness
• Excessive sweating
• Fainting
• Fang marks
• Fever
• Increased salivation
• Localized pain and burning
• Muscle contractions
• Muscle incoordination
• Nausea and vomiting
• Numbness and tingling
• Rapid pulse rate
• Skin discoloration
• Swelling in the bite area
• Thirst
• Tissue death
• Weakness

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Summer Safety: Protecting Your Kids from Snakebites in Texas

March marks spring break for families and it is Poison Prevention Month. According to the 2024 Community Health Needs Assessment, one in two children live in homes where medications are not always locked up and four in seven children live in homes where cleaning products are not always stored in a locked area. 

“Unintentional poisoning can happen to anyone, at any age,” said Klaressa Broughton, poison prevention program coordinator at the Center for Community Health. 

In 2025, Cook Children’s saw an increase of poisoning encounters, with 1,031 compared to 818 in 2024. Broughton explains that the top poisoning for 2025 involved children of all ages from birth to 18 and were related to medication and unspecified non-drug poisonings.  

“By practicing Safe Dosing, Safe Storage, and Safe Disposal, you can create layers of protection for your household,” said Broughton. 

She adds having conversations with friends, caregivers and family can ensure kids stay safe while they explore someone else’s home. She suggests opening the conversation with: “Since the kids are at the “into everything stage”, do you mind if we double-check that medications and cleaners are out of reach?” 

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 

• DEA Drug Take Back Day is on April 25th from 10 a.m.-2 p.m.
• 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. 

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Keeping Warm and Having Fun

“If you are going to be outside, dress appropriately,” said Sharon Evans, injury prevention manager at Cook Children’s Health Care System.

Experts advise caregivers to dress little ones in several thin layers to keep warm and dry. Children are at more risk from the cold because their bodies lose heat more quickly. Insulated boots, mittens or gloves, and a hat are recommended.

Make sure children change out of any wet clothes as soon as they come indoors.

“While playing in the snow or “sledding” be aware of your surroundings, be careful to not run into trees or out into the street and mailboxes can be real dangers,” said Evans.

Know the Signs of Hypothermia 

According to the American Academy of Pediatrics, hypothermia, or abnormally low body temperature, "is a dangerous condition that can occur when a person is exposed to extremely cold temperatures." This is a medical emergency, and treatment should be sought immediately. 

 Symptoms of hypothermia include: 

• Blue skin
• Shivering
• A cool chest and stomach are signs that children may be dangerously cold.
• If you see these symptoms, take action immediately to get kids out of the cold. Seek immediate medical attention if you are not able to warm the body.
• Victims of hypothermia can include babies sleeping in cold rooms. 

 Warning signs for infants include: 

• Bright red, cold skin
• Very low energy 

 Warning signs for adults include: 

• Shivering, exhaustion
• Confusion, fumbling hands
• Memory loss, slurred speech, drowsiness 

Coats & Car Seats

While keeping kids warm is a priority during the winter, it should never come at the expense of car seat safety.

“Stay home and inside if possible. If you must be on the roads make sure everyone is buckled up correctly,” said Evans.

Bulky coats, such as puffy jackets, can create extra space between the child and harness straps or seat belt, which can increase the risk of injury in a car crash.  It is recommended to dress in thin layers and use a blanket or put the coat on backwards after the child is buckled in. 

If caregivers decide to start the car to allow it to warm up prior to entering the vehicle, it is important to make sure the car is in a ventilated area, such as an open garage, and that they lock the vehicle when they are not inside.  This will make sure that a child does not enter the vehicle unsupervised and become trapped in the vehicle.

Evans adds families should have snacks, water, and extra blankets in their car in case you get stranded. 

“If you are stranded and waiting for help on the side of the road, please make sure everyone stays buckled up,” said Evans, “often cars may slide/spin near you and hit your car.”

In addition, just as local officials advise people to stay off the roadways, if possible, ice can make dangerous driving conditions for ATV’s, Golf Carts and Go Karts.

 Safe Sleep

With winter weather, keeping infants warm is a priority for caregivers, and it is essential to do so safely.

“Caregivers often use extra blankets and hats for warmth, but these soft items can easily become a suffocation or entanglement hazard,” said Samantha St. John, program coordinator at Cook Children’s Center for Community Health.

A safer alternative is a sleep sack, also called a wearable blanket. A sleep sack provides warmth and comfort without risk because it fits securely around the baby's upper body and is sized so the fabric cannot cover their face, while still allowing plenty of room at the bottom for comfort and movement.

St. John suggests a general rule to follow dress a baby in one more layer of clothing than an adult would find comfortable in the same environment.  In winter months this could mean baby is in a long sleep fleece onesie with a wearable blanket/sleep sack. When dressing baby for bedtime or nap time during the extremely cold temperatures, it may be necessary to add socks, mittens, or hats to baby. Caregivers want to make sure that these items cannot come off during sleep and become a loose item in the crib.  It is also important to make sure baby is not going to overheat.  Signs of overheating can include sweating, a hot chest, or flushed skin.  

 Remember the ABCs of Zzzs:

• 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. 

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Sharon Evans, trauma injury prevention manager for Cook Children's Health Care System, explains that, while these may seem like gifts without much concern, it is important to understand they are vehicles. She offers families tips on how to help their children safely enjoy e-bikes and e-scooters. 

“Always wear a helmet,” emphasizes Evans.

• Always wear a helmet: Make sure you have the right helmet. For e-bikes/e-scooters that go up to 20 mph, a bike helmet is sufficient, but parents may want to invest in a stronger helmet to better protect their children.
• Perform a safety check before each ride:
  • Check the tires. Ensure they are inflated to the recommended pressure on the sidewall.
  • Check brake levers. Squeeze them while rolling the bike forward and backward to ensure the brakes engage and stop the e-bike/e-scooter.
  • Inspect your e-bike/e-scooter for loose nuts or anything that looks abnormal.
• Follow the rules of the road:
  • Always ride on the right, in the same direction as traffic. Use the bike lane if available.
  • top and look both ways before entering a street or crossing an intersection.
  • Stop at all intersections.
  • Obey all traffic lights and traffic signs.
  • Be aware of your surroundings. Do not talk on the phone or text. Do not wear earbuds; you cannot hear what is happening around you.
• Night rides: Make sure you wear bright, reflective clothing. Ensure your e-bike/e-scooter has a light and reflectors.

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Halloween is a fun time where kids and caregivers can let their imagination take hold. Children and adults alike dress up as various characters. A mix of spooky and fun costumes will adorn the streets of North Texas this year, and Cook Children’s Health Care System wants to make sure families are not spooked by any preventable mishaps.

Sharon Evans, trauma injury prevention manager and Laura Romano D.O., hospitalist at Cook Children's, share their expert tips to stop the scariest spooks of the night: preventable injuries.

Pedestrian safety:

Research shows children do not have the cognitive ability to safely cross the street, unsupervised, until they are ten years old.

Evans shares that most pedestrian injuries occur between 3 p.m. and 7 p.m., especially as Daylight Saving Time ends. Pedestrians who are distracted (on the phone, listening to music, etc.) are four times more likely to be injured or killed.

Evans emphasizes that parents are role models and can set a good example by putting down the phone when walking.

“Follow the same rules you want your child to,” said Evans.

• Look left, right, and left again before crossing the street. Then remind them to continue looking until safely across the street.
• Watch for cars backing out or pulling into driveways.
• Put phones, headphones and devices down when crossing the street. It is particularly important to reinforce this message with teenagers.

Dr. Romano adds these pedestrian safety tips for everyone:

•  Make sure your child stays on the sidewalk and crosses at crosswalks or at corners.
• Slow down: Remember to drive very slowly, particularly when coming home from work in the evening.

Trick-or-Treat: Staying Safe in Costume

Your child’s costume should prioritize visibility and mobility to prevent common trip-and-fall injuries.

•  If possible, avoid all black costumes, particularly if your kids are trick-or-treating later in the evening, as dark costumes can be hard to see.
• If your child is wearing a dark costume, make sure that your child is bringing a flashlight or wearing glow sticks to help them be visible.
• Make sure to purchase costumes that are labeled “flame-retardant”. For any DIYers, nylon and polyester are materials that are known to be flame-retardant.
• Use caution with wigs, masks, or other accessories that may cover your kids’ eyes, nose, and mouth, making it difficult to see or breathe.
• Prevent falls by avoiding ill-fitting shoes and costumes that may become tripping hazards.
• Only use make-up products that are “non-toxic”. Test a small area of their skin a few days before use.
• The use of colored contact lenses could lead to eye infections or injuries—stick to only prescription contact lenses!

Tips for Teens

• Sending a responsible adult is always a good idea.
  • Older kids who can go trick-or-treating by themselves should only visit houses they know and follow routes that parents preapprove.
• Trick-or-treat in large groups, not alone or with just one other friend.
• Arrange specific check-in times throughout the evening.
• If your teen is driving to a party, make sure they are driving slowly and know to watch out for little kids.

By Laura Romano, D.O., hospitalist at Cook Children's Medical Center- Fort Worth

 The season of the Great Pumpkin, falling leaves, and fun Halloween costumes has officially arrived! My kids are so excited to show off their Halloween costumes this year. If you see a Fairy Princess and Thomas the Tank Engine wandering around your neighborhood, make sure you say hi!

 As kids get ready for trick-or-treating, there are some important things parents can do to keep them as safe as possible! Here are some answers to some frequently asked questions about Trick or Treating!

 Prepare your little ones for Halloween

• Trick or treating can be fun, but slightly intimidating for little ones. Practice trick-or-treating with your kids. Have them come to your door and say “trick or treat!” and practice saying please and thank you!
• Practice handing out candy. Handing out candy is my daughter’s personal favorite. You MUST take candy from her before you are allowed to leave our yard. She will follow you.
• Talk about what they might see on Halloween and walk around the neighborhood beforehand.

For older kids

• Sending a responsible adult is always a good idea.
• Older kids who can go trick-or-treating by themselves should only visit houses they know and follow routes that are pre-approved by parents.
• They should avoid going by themselves or with just one other friend, and instead go in large groups.
• Arrange specific check-in times throughout the evening.
• If your teen is driving to a party, make sure they are driving slowly and know to watch out for little kids.

Trick or Treat: Give me something good to eat

• For little kids: Avoid candies or treats that are small and might be a choking hazard.
• Check the candy: Practice going through the candy haul with your kids before allowing them to eat any.
  • You want to look for candy that may have been tampered with or look-alike food items that might contain illicit substances like THC or CBD.
• Giving out candy: I always try to make sure we have a peanut-free option for kids! We keep a separate bowl with non-peanut candies like Skittles or Smarties.
• Allergies: Regardless of your child’s allergy status, inspect all candy before they eat any. You want to look out for food allergens like peanuts or candies that are made in nut-containing facilities.

Too much candy?

As a Reese’s lover, my answer is that there is never too much candy. However, as a mom, I try to remember that the combination of sugar, chocolate, and the excitement of Halloween can lead to an upset stomach. Try to limit the intake to just a few pieces on Halloween night.

Keep It Reel: Staying Safe in Costume

• If possible, avoid all black costumes, particularly if your kids are trick-or-treating later in the evening. Dark costumes can be hard to see in the evening.
• If your child is wearing a dark costume, make sure that your child is bringing a flashlight to help them be visible or wear glow sticks.

SUID can occur in infants younger than a year. It includes three causes of death: sudden infant death syndrome (SIDS), accidental suffocation and strangulation in bed (ASSB) and unknown/undetermined reasons. 

“SUID can happen in any sleep environment but is less likely to happen if the baby is in their own crib, bassinet, or portable crib,” explains Samantha St. John, program coordinator at Cook Children’s Center for Community Health.

St. John shares how families can prepare and keep their little one safe as they build their baby registry. The U.S. Consumer Product Safety Commission (CPSC) requires that products include clear labeling with information such as age recommendations, safety warnings, usage instructions, and manufacturer details to help ensure safe use and inform caregivers of potential hazards.  St. John adds that while some items may be marketed to help ease parenthood, they may not be safe.

Safe Sleep:

Weighted sleep sacks: Weighted sleep sacks are often advertised as providing extra comfort to a baby by imitating a parent’s hand resting on the infant’s chest.  However, according to the CPSC, the additional weight on the baby’s chest may hinder movement and breathing, which could increase the risk of SUID.

Alternative: Parents should use unweighted wearable blankets or sleep sacks to keep the baby warm and allow the baby to take full, deep breaths. 

Bumper pads: Crib bumper pads are a common piece of décor for the crib. Due to the significant risk associated with crib bumper pads, the Safe Baby Sleep Act bans the manufacture and sale of this product in the United States. Between 1990 and 2016, bumper pads were responsible for at least 107 infant deaths, according to the CPSC.  Even alternative products that claim to be breathable still pose a risk of suffocation and strangulation.

Lounger: A baby lounger is a portable, cushioned space for a baby, often called an infant lounger, a lounge pillow, or newborn lounger.  Though these products are made for the baby to use while awake and supervised, we often see infants sleeping in these loungers while in their crib, bassinet, or on the couch.  According to the American Academy of Pediatrics (AAP), infants are at risk of suffocation if they roll into the cushioned side of the lounger and their nose and mouth become blocked. 

When in use: Caregivers need to supervise while the baby is awake.  The lounger should be placed on the ground to avoid the risk of falling.  Manufacturer instructions and guidelines should be followed.   

Pillows: It is a common misconception that babies need a pillow in their beds for comfort.  Adding this soft product to their sleep space can increase the risk of suffocation and SIDS. 

Alternative: Save the pillows for when the child is over the age of one and it is developmentally safe.  This includes wedge pillows, regular pillows, anti-roll pillows and head shaping pillows.

Stuffed animals: Toys should never be placed in a baby’s sleep space, as they can increase the risk of suffocation.  Stuffed animals make great décor for the nursery but are not safe for the baby to snuggle with while sleeping until they are over the age of one.

Toys with button batteries: Infants learn by exploring and putting items in their mouths. If swallowed, toys with small button batteries can get stuck in the throat and be a choking hazard or can travel through the digestive tract, causing serious or life-threatening injuries within three hours.  Parents need to inspect toys to ensure the battery case is securely closed, there are no loose or broken parts, and the case is sturdy enough to withstand continued use without the batteries falling out.

Blankets: Blankets are a popular registry item because they are cozy, cute, and useful during cuddle time and for tummy time on the floor.  However, blankets can cover the baby’s face and increase the risk of suffocation while sleeping. 

Alternative: To keep the baby safe and warm, use a wearable blanket or sleep sack.

Swings/rockers/bouncers: Baby swings, rockers, and bouncers are great products on a registry because they can help soothe the baby and allow the baby to enjoy independent time in a different position or location.  For sleep, these products are not a safe place for infants because the incline of the product makes it easier for the baby’s head to fall forward, which can block their airway and increase the risk of suffocation. 

When in use: Swings, rockers, and bouncers are great for supervised awake time, but not for naps or overnight sleep. 

Safety over comfort

In 2024, the CPSC report on Injuries and Deaths Associated with Nursery Products among Children Younger than Age 5, stated more than 60,000 children visited the emergency department in 2023 due to injury related to a nursery product such as an infant carrier, bouncer, swing, or other items. St. John emphasizes that when caregivers are determining which products to purchase, safety should be top of mind.

When looking at items for vehicle safety with a baby, she suggests:

Mirrors/Cameras: Caregivers need to be mindful that these products can become detached in an accident and cause injury to anyone in the vehicle. Any loose and unstored items in the vehicle can become a projectile in a car crash. Mirrors and cameras are often added to registries because parents want to be able to see their baby while they are rear-facing in their car seat. 

Car Seat Accessories: Items such as car seat covers, head support inserts, and toys are not often approved products by car seat manufacturers because they can affect the safety of the child in the car seat. Parents should check their car seat owner’s manual before registering for these additional accessories.

Counterfeit car seats: Fake car seats may not have a manufacturer date, model number, warning label, or instruction manuals.  Caregivers can schedule an appointment to have their car seat checked by visiting www.freecarseatcheck.org.

Vehicle Seat protectors: Vehicle seat protectors are advertised as being able to help protect the fabric of the vehicle seat.  However, many child safety seat manufacturers do not allow the use of these seat protectors.  When registering for this product, parents need to be sure the car seat manufacturer approves the use of vehicle seat protectors.

Free car seat checks

Texas law requires kids to ride in a safety seat that fits by weight and height until age 8 or at least 57 inches tall.

The Injury Prevention Collaborative offers events where you can make an appointment with a certified technician. We offer FREE car seat checks and assistance to families who may need a car seat.

Click the link or call 682-885-2634 to book your appointment. Those without appointments will be seen on a first-come/first-serve basis. You MUST have your child with you, unless you are an expectant parent.

In 2023, 43% of children killed in car crashes were unrestrained, according to the National Highway Traffic Safety Administration (NHTSA). 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.

 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.  

CPSTs at Cook Children's work with patients and their families to ensure a safe discharge from the hospital. Nurses screen patients during admission to confirm they are in the correct car seat or booster. If a family needs a car seat, it is provided free of charge, and a CPST then educates them on its proper use and installation.

“We also provide special needs seats to patients who may have a spica cast and cannot sit up for their conventional car seat, or car beds for premature infants or those that need to lie flat at discharge,” said Sharon Evans, trauma injury prevention manager.

NHTSA data shows more than 300 children under the age of five have been saved due to their car seat.

Texas has only three special needs CPST instructors, and one of them is here at Cook Children's. The hospital also has 24 CPSTs with special needs training. These specialists assess children and families’ needs and order the correct special needs car seat for safe transport upon discharge.

In addition to those efforts, Cook Children’s Center for Community Health hosts events throughout the year. At these fitting stations, caregivers make an appointment to have their car seat checked, or if they need a car seat, it is provided free of charge. 

“The caregivers learn at these events how to correctly install and use their car seat to ensure the child’s safety,” explained Evans.

To become a nationally certified CPST, an individual must attend a four-day CPST course and pass both written exams and a hands-on skills assessment.

“These employees take on extra job responsibilities above and beyond their normal job description just to ensure the children are transported safely,” said Evans.

Know the Four Stages of Car Seats

Trauma Injury Prevention and the Center for Community Health share some tips on keeping your little one safe.

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. According to Evans, it is highly recommended by experts to keep 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 before moving to 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. Evans said many kids between the ages of 4 and 8 get seriously injured due to being put in seat belts too soon.

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. Though the law states children can transition to seatbelts at eight years old, Evans cautions that many children won’t reach 57 inches of height—and should therefore remain in a booster seat—until closer to 10 or 12.

Stay Vigilant for Counterfeits and Fakes

As you are shopping for car seats, keep in mind that many popular brands are being knocked off to create counterfeits. These knockoffs are often cheaper than their legitimate counterparts, but are significantly less likely to protect your child in the event of a car crash.

• Make sure you buy it directly from the manufacturer or a reputable retail store.
• Call the seat’s manufacturer. They can help you determine if it’s a knockoff and will sometimes ask you to submit photos.
• Take your car seat to be checked by a certified child passenger safety technician. They are trained to help determine if it’s fake. 

Electronic scooters are often considered vehicles and must adhere to traffic regulations and local ordinances. Some cities have adopted ordinances specific to e-bikes and e-scooters.

Sharon Evans, trauma injury prevention manager, offers parents tips on how families can safely enjoy their e-bikes and e-scooters.

• Always wear a helmet: Make sure you have the right helmet. For e-bikes/e-scooters that go up to 20 mph, a bike helmet is sufficient, but parents may want to invest in a stronger helmet to protect their children better.
• Perform a safety check before each ride:
  • Check the tires. Ensure they are inflated to the recommended pressure on the sidewall.
  • Check brake levers. Squeeze them while rolling the bike forward and backward to ensure the brakes engage and stop the e-bike/e-scooter.
  • Inspect your e-bike/e-scooter for loose nuts or anything that looks abnormal.
• Follow the rules of the road:
  • Always ride on the right, in the same direction as traffic. Use the bike lane if available.
  • top and look both ways before entering a street or crossing an intersection.
  • Stop at all intersections.
  • Obey all traffic lights and traffic signs.
  • Be aware of your surroundings. Do not talk on the phone or text. Do not wear earbuds; you cannot hear what is happening around you.
• Night rides: Make sure you wear bright, reflective clothing. Ensure your e-bike/e-scooter has a light and reflectors.

Texas surpassed its number of hot car deaths from 2024 on July 14, according to the Texas Department of Health Services (DSHS). A sixth and seventh fatality was reported in August in North Texas.

The increase contributes to the more than 20 hot car deaths reported nationwide this year as of August 26. Vehicular heatstroke is the second-leading cause of vehicle-related deaths in children under 15, trailing only car crashes.

Experts from Cook Children's Health Care System, Viviana Esparza, program coordinator at the Center for Community Health, and Sharon Evans, trauma injury prevention manager, emphasize the preventable nature of these tragedies.

“It can happen to anyone but it is 100% preventable,” Esparza said.

She notes that 52% of hot car child deaths occur when a child is forgotten. According to kidsandcars.org, parents can suffer from exhaustion due to lack of sleep, stress, and changes in their normal routine. Any one of these can cause a parent or caregiver's memory to fail at a time when you least expect it.

“Parents need to realize this can happen to anyone,” Evans said. “They aren’t bad parents but they get distracted or there’s a change in their routine. Make it a habit to put something you need in the back seat with the child.”

Twenty-five percent of hot car child deaths are due to a child gaining access to an unlocked vehicle or a child getting the keys. Evans recommends teaching toddlers and preschool-aged children to honk the horn if they become trapped, enabling them to draw attention to the vehicle.

Esparza says the third most common is knowingly leaving a child in a vehicle for a quick errand. DSHS emphasizes that a cracked window does not protect a child or pet from heatstroke.

“A car heats up about 20 degrees in 10 minutes and the temperature just keeps growing after that, often reaching 130-140 degrees in 30 minutes to an hour,” Evans said.

Esparza encourages families to remember the acronym A.C.T. to prevent heatstroke:

• A: AVOID heatstroke and other heat-related injuries by never leaving your child alone in a car, not even for a minute. When the vehicle is at home, keep the doors locked and keys or key fobs out of a child's reach.
• C: CREATE reminders. Place an item you need, such as a bag, wallet, or cellphone, in the back of your car or next to your child. This is especially important if you're not following your normal routine. If your child is with a care provider, ensure vehicle-related procedures are in place, such as vehicle searches or locking vehicles when not in use. Use technology to your advantage and use apps or other communication methods to stay connected with your childcare provider.
• T: TAKE action. If you see a child alone in a car, call 9-1-1. Emergency personnel want you to call, and they are trained to respond swiftly to these situations. One call could save a life.

 People will see temperatures from 7 degrees to 17 degrees, with wind chills as low as minus 10 degrees. Families need to take precautions. 

Keep Warm 

Babies less than a year old should not sleep in a cold room because they lose body heat more easily than adults, according to the Centers for Disease Control and Prevention (CDC). Yet, it is important to keep infants warm safely. 

• Do not have any pillows or other soft bedding in the crib or bassinet.  
• For sleep, dress babies in footed pajamas, one-piece wearable blankets, or sleep sacks. 
• Make sure newborns are dressed appropriately. Dress them in layers and cover their heads, hand,s and feet. 
• For the most warmth, dress your little ones in wool instead of cotton.  
• Essential winter items include hats and gloves, as well as sweatshirts or T-shirts that can be layered under overcoats or jackets. 
• It is important to remember to take off winter coats and jackets when the child is in the car seat.  

Know the Signs of Hypothermia 

 According to the CDC, hypothermia, or abnormally low body temperature, "is a dangerous condition that can occur when a person is exposed to extremely cold temperatures." This is a medical emergency, and treatment should be sought immediately. 

 Symptoms of hypothermia include: 

• Blue skin, shivering, and a cool chest and stomach are signs that children may be dangerously cold. If you see these signs, take action immediately to get kids out of the cold. Seek immediate medical attention if you are not able to warm the body. 
• Victims of hypothermia can include babies sleeping in cold rooms. 

 Warning signs for infants include: 

• Bright red, cold skin 
• Very low energy 

 Warning signs for adults include: 

•  Shivering, exhaustion 
• Confusion, fumbling hands 
• Memory loss, slurred speech, drowsiness 

Winter Heating Safety  

Keeping warm in frigid temperatures is important, but do so safely. Make sure to have functioning carbon monoxide detectors and fire alarms installed in areas that will wake you up. If you are unable to keep safely warm in your own home, check local resources for warming shelter information. Seek medical attention if you suspect carbon monoxide poisoning. 

•  Use electric space heaters with automatic shut-off switches. 
• Keep heat sources, like space heaters, at least 3 feet away from drapes, furniture, bedding, or other flammable materials. Never cover your space heater. 
• Do not leave children unattended near a space heater. 
• Make sure that the cord of an electric space heater is not a tripping hazard, but do not run the cord under carpets or rugs. 
• Avoid using extension cords to plug in your space heater. 
• Use fireplaces, wood stoves, or other combustion heaters only if they are properly vented to the outside and do not leak gas from the flue or exhaust into the indoor air space. 
• Do not use anything, such as a barbecue grill or propane tank to heat your home. 
• Do not run a vehicle inside of a garage attached to your home. 
• Do not heat your home with a gas oven or stovetop. 
• Do not burn charcoal inside your home. 

 Signs of carbon monoxide poisoning can include: 

• Headache 
• Nausea 
• Dizziness 
• Vomiting 
• Upset Stomach 
• Chest Pain 
• Confusion 

Car safety in frigid temperatures

Proper car seat use is one of the most critical ways parents can keep their young children safe when driving during inclement weather conditions.  

 Here are a few safety tips to consider: 

• Do not strap your children into their car seats with their heavy coats on. In a crash, padding from a coat or thick layers will flatten out, leaving room under the car seat harness. This increases the risk of a child slipping through the straps and being thrown from the car seat. Instead, dress your child in thin layers. Once buckled up, slip the coat on backward with the sleeves on the child’s arms. This way, the coat acts as a blanket and does not affect the fit of the harness. 
• Give yourself extra time to get where you are going. Do not forget to account for traffic.  
• Pack an emergency bag for your car. It’s a good idea to have blankets, warm clothing, hats, and gloves available in case you become stuck in winter weather. You will also want to have nonperishable snacks packed away. 
• Avoid overpasses if possible. Plan alternate routes to your destination and avoid high-traffic areas when possible. 
• Give yourself enough space from the car in front of you to gradually brake. When weather conditions are poor, give yourself double the time it normally takes to come to a complete stop. 

Federal safety officials have recalled the Fisher-Price Snuga Swings and revised their standard for nursing pillows, two moves intended to guard infants against unsafe sleep spaces.

The U.S. Consumer Product Safety Commission (CPSC) and Fisher-Price announced the Snuga Swings recall in October 2024. The swings aren’t designed for sleep. According to the CPSC, the deaths of five babies were reported from 2012-2022 when the swings were being used for sleep. Bedding such as blankets had been added to the swing in most of those fatalities.   

In September 2024, the CPSC issued a new safety standard for nursing pillows to prevent sleeping infants from suffocation, entrapment and falls. The commission knows of 154 infant deaths and 64 injuries from 2010-2022 associated with nursing pillows.

“Your child should be sleeping on a flat, non-inclined mattress,” said Sharon Evans, Cook Children’s Trauma Injury Prevention Coordinator. “Any more than a 10% incline poses a suffocation risk to your baby.  They can get in the chin-to-chest position and have a difficult time breathing. Swings, bouncers, or propping them up in a pillow is unsafe for sleep.”

The U.S. Centers for Disease Control and Prevention (CDC) reported about 3,700 infants younger than one died due to sudden unexpected infant deaths (SUID) in 2022. The report indicates that 28 percent of those deaths were due to accidental suffocation and strangulation in bed. 

Through early November, nine sleep-related deaths were recorded at Cook Children’s in 2024. In the past three years, Cook Children’s has seen several infant fatalities due to sleeping on a nursing pillow.

The safest way for babies to sleep is on their back, on a firm surface with a tight-fitted sheet, in a crib or bassinet, or pack ‘n play with no pillows, blankets, bumper pads, or toys. No other children or adults should share the sleep space.

Evans said caregivers should lay their babies down in a safe sleep environment – not the couch, swing, car seat, or an adult bed – when it’s time for sleep.

“There’s just as much risk to your baby when they are taking a nap as when they sleep overnight,” Evans said. “Every sleep time needs to follow safe sleep practices.”

The new CPSC safety standard for nursing pillows relates to labeling, firmness, seam strength, and restraints. It applies to pillows designed to position and support an infant while feeding. The rule is scheduled to take effect in April 2025.

“Nursing pillows are intended to be used for feeding when both the infant and the caregiver are awake, and the caregiver can ensure that the infant’s airways are not covered by the pillow,” according to the CPSC. Injuries occur when a sleeping infant rolls face down on the pillow or their neck falls forward or back, preventing their ability to breathe.

The new standard adds this statement to the label: “Move baby to an infant sleep product, like a crib or bassinet, if baby falls asleep or if you feel drowsy.” 

 RELATED STORIES:

Popular Weighted Sleep Sacks Pulled From Shelves After Suffocation Risk Identified

Winter Warning: Blankets Pose Risk to Safe Infant Sleep

The Texas Department of State Health Services has not reported an outbreak.  

Cook Children’s pediatricians Devona Martin, M.D., and Jenica Rose-Stine, D.O., say they have seen a surge in cases at their primary care clinic in Willow Park, Texas.  

“Over the past few months, we have noticed a big increase in the number of cases of salmonella,” Dr. Martin said. “This usually presents as diarrhea that has blood or mucus and fever. Each case is reported to the Health Department to try to track down a cause, but a common source has not been identified.”  

Since July, the Emergency Department at Cook Children’s Medical Center – Fort Worth has also reported increased numbers of patients with salmonella.  

“In the ED, we usually see less than 20 patients per month with a diarrheal illness caused by salmonella,” said Stephanie Felton, D.O., associate medical director of the Cook Children’s Emergency Department. “In the month of July, we had 43 positive cases. We had 59 in August, 71 in September, and 74 in October.”  

Last week at Cook Children’s, 11 out of 229 patients tested for Salmonella were positive, resulting in a 5% positivity rate.  

Dr. Felton, Dr. Martin, and Dr. Rose-Stine provide answers to commonly asked questions about Salmonella.  

What is salmonella?  

Salmonella is a bacteria that can cause gastrointestinal illness and fever called salmonellosis. It is one of the most common causes of foodborne illness in the United States.  

What is the difference between salmonella and E. coli?  

Although salmonella and E. coli cause similar illnesses, they are different kinds of bacteria. E. coli more commonly produces a toxin that can lead to kidney damage, a condition called hemolytic uremic syndrome. This isn’t seen as often with salmonella.  

What are the symptoms of a salmonella infection?  

Symptoms of salmonellosis are diarrhea with blood and/or mucus, vomiting, abdominal cramps, and fever. 

How do children contract salmonellosis?  

Salmonella infection can be contracted by consuming contaminated food products, including poultry, eggs, produce, infant formula, and water. It can also be spread through contact with infected animals, like reptiles and birds, or other people who are infected if strict hand hygiene isn’t followed.  

Is salmonella contagious?  

Yes, salmonella is contagious and can be spread by person-to-person contact or by touching contaminated surfaces. The incubation period usually is between eight and 72 hours following exposure. You may be asymptomatic during this time.  

Salmonella is not as contagious as the viral stomach bugs we often see.  

How can parents and caregivers prevent infection?  

We can prevent infection with proper hand washing, especially before eating and after touching animals. Make sure that your counter spaces and sinks are clear of any bottles, sippy cups, or dishware before washing any fruits or vegetables. Cook and prepare all poultry and meat products appropriately. 

Only use FDA-approved formulas for your infants. Thoroughly clean all bottles, pacifiers, and toys before handing them to your children.  

How are salmonella infections treated?  

Treatment primarily involves rehydration and rest. Infants less than three months old or children with moderate to severe illness may receive antibiotics. These infections usually clear on their own.  

What should parents do if they think their child has a salmonella infection?  

If you are worried about your child having salmonella, please contact your primary care physician. He or she can run stool studies to confirm the diagnosis.  

Unless your child has blood, mucus, or fever with their diarrheal illness, it’s likely a stomach virus and not salmonella. Keep your child at home and make sure they hydrate!  

If your child is acutely ill or if you are concerned about dehydration or prolonged fevers (100.4 degrees Fahrenheit for five days or greater) please bring your child to the Emergency Department for an evaluation.  

Halloween is a magical time as children dress up to be whatever they can imagine. While your little vampire, princess, or superhero prepares to gather all the candy possible, consider how to make this spooky night spectacular and avoid mishaps.

“Trick-or-treating is what my kids are most looking forward to this year, as I’m sure most kids are,” said Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center – Fort Worth. “However, as a mom and a pediatrician, I know that there are things that we need to do to keep our kids safe this holiday!”

Sharon Evans, trauma injury prevention coordinator at Cook Children’s, also emphasizes the importance of safety.

“We worry about kids tripping and falling as they run in their costumes, but mainly that they may be hit by a car as they are out trick or treating,” Evans said. “Twice as many kids are struck by a car on Halloween than on any other day, so it’s vital you are not distracted while you’re driving.”

Ramon L. Kinloch, M.D., a pediatrician at Cook Children's Pediatrics Forest Park, says this is his favorite time of year.

“I’ve always enjoyed decorating, dressing up and trick-or- treating, but what makes it extra special, is the fact that both my wife and I get to celebrate our birthdays,” Dr. Kinloch said. “She’s a Halloween baby!”

Dr. Kinloch, Dr. Romano and Evans shared a few tips for families to consider before heading out with their little trick-or-treaters.

Tips for Street and Traffic Safety

• Stay on sidewalks when possible. When on the street, walk facing traffic.
• When crossing the street, only cross at corners. Look left, look right, and then look left again for any cars before crossing. Never assume the vehicle is going to stop. Do not run across the street!
• If you are driving, please drive slowly in residential neighborhoods. Be careful when pulling out of your driveway and making turns at intersections. Turn your headlights on.

Tips for Responsible Supervision for Younger Children

• Parents and caregivers need to actively supervise their children. This means no phones, socializing, or drinking. Carry flashlights and be aware of your surroundings.
• Parents and caregivers need to be within arm’s reach of their child at all times. Hold hands when crossing the street.
• Consider putting a nametag with your home phone number on the inside of the child’s costume in case they get lost.
• Accompany very young children to the door to help with picking candy.

Tips for Teenagers

• Trick-or-treat in large groups, not alone. Only visit houses with porch lights on and never to go inside a house.
• Remember to follow pedestrian safety tips. Carry a flashlight or be sure to place reflectors on your costume. Stay off cell phones while walking across the street.
• Parents and caregivers, make sure you know the exact route your teenager will be going and how long they’ll be gone. If they don’t have a cell phone, let them borrow one. Arrange times to check in with your teenager.
• If your teenager will be driving, encourage them to drive very slowly and watch out for children. Consider picking up and dropping off your teen.

Candy Inspection and Allergy Tips

• Inspect all candies before your child eats them.
• If your child has an allergy, be extra cautious to read labels for the presence of anything that may be a trigger for your child. If you’re unsure, discard the item—better safe than sorry!
• Look out for food allergens like peanuts or candies that are made in nut-containing facilities.
• Some candies and gums can be choking hazards for your little ones depending on their age and development.
• Look for candy that may have been tampered with or candy that is potentially a “look alike” food item that might contain illicit substances like THC or CBD.

Tips for Carving a Pumpkin

• Only adults should hold the carving knives.
• Keep all sharp objects away from kids when carving pumpkins.
• Instead of carving, allow children to use markers or paint to draw faces, or pictures, then an adult can carve the pumpkin.
• Give little kids other jobs to keep them busy, like scooping out the insides or helping to clean up.
• Work in a well-lit area and always have an adult supervising.
• Consider the use of a battery-operated flameless candle, flashlight, or glow stick to illuminate your jack-o’-lantern. 

Costume Precautions

• Wear light-colored costumes that have high visibility at night. Increase visibility by adding reflective or glow-in-the-dark tape or paint to their costume or trick or treat bag.
• Make sure to purchase costumes that are labeled “flame-retardant”. For any DIYers, nylon and polyester are materials that are known to be flame-retardant.
• Use caution with wigs, masks or other accessories that may cover your kids’ eyes, nose and mouth making it difficult to see or breathe.
• Prevent falls by avoiding ill-fitting shoes and costumes that may become tripping hazards.
• Only use make-up products that are “non-toxic”. Test a small area of their skin a few days before use.
• The use of colored contact lenses could lead to eye infections or injuries—stick to only prescription contact lenses!

As you prepare for a night full of fun, we wish you and your family a safe and happy Halloween!

Friday night lights are beaming bright in high school football stadiums all across the country. Players are suited up, taped up and ready to rumble in an inherently unpredictable game where anything can happen. A turnover that shifts the momentum. A missed tackle that gives up a touchdown. A Hail Mary that wins the game. In football, only one thing is for sure — the risk of injury to players.

Among all high school sports, football ranks No. 1 in injury rates, according to a study published in the Orthopaedic Journal of Sports Medicine. It’s no surprise given the nature of the game, says Dan Guzman, M.D., an emergency medicine physician at Cook Children’s Medical Center – Fort Worth.

“It's a violent sport, and we know players are trained to go out and get that ball and hit hard,” Dr. Guzman said. “So we're going to, unfortunately, have injuries as a result of that aggressive play.”

In some cases, the results are tragic.

In 2023, the National Center for Catastrophic Sports Injuries reported 16 football-related deaths in its Annual Survey of Football Injury Research. Five deaths were at the college level, seven in high school, two in middle school and two in youth league. Three deaths were directly related to football and a result of a traumatic brain injury. Ten fatalities were classified as exertional/medical fatalities, which includes sudden cardiac arrest and heatstroke, that occured during football-related activity. 

In August, National Public Radio (NPR) reported that at least seven high school and middle school football players died during that month from head injuries or suspected heatstroke.

Tackling Trauma

Dr. Guzman has seen his fair share of football-related injuries in Cook Children’s Emergency Department. Most players visit the ER for orthopedic injuries of upper or lower extremities. Dr. Guzman suggests recent efforts to protect the head and neck from traumatic injury are leading to an increase in shoulder and arm injuries. Although these injuries can be serious and lead to loss of playing time, the trade-off is necessary to decrease the risk of traumatic brain injury or concussion, and to protect more critical areas of the body. 

“Coaches are teaching kids to not use their head and neck to initiate contact and, instead, use their shoulder, so I think we've seen a slight increase in the number of shoulder and clavicle injuries and shoulder separations,” Dr. Guzman said.

Not all injuries warrant a trip to the ER, but can have just as significant out of activity implications as their more serious counterparts. Bruises, sprains and strains are some of the most frequent injuries seen in football, according to Jeffrey Bass, MS, ATC, LAT, OPE-C, a licensed and board certified athletic trainer at Cook Children’s Orthopedics and Sports Medicine Walsh Ranch. Bass is also a football medical observer in the Big 12 Conference and a regular on the sidelines at high school football games, where he’s often referred to as “Doc” while he works to protect young athletes from injury.

“It’s a term of endearment based on the fact that the athletic trainer’s work can parallel that of a physician and because they can fill many roles, especially in rural areas,” he said. “The good news is I’ve never been confused with any of our local doctors, and I’ve never been asked to operate on anyone or deliver a baby.”

With 46 years of experience in the industry, Bass knows what makes a good football program, and a focus on player safety is at the top of his list.

“We know that about 95% of participants involved in competitive athletics are going to have a time loss injury,” Bass said. “It’s not a matter of if, it’s just when.”

With the risk of injury in competitive athletics so high, especially in a full-contact sport like football, it’s important that parents know that their child’s football program is ready and equipped to respond to an injury, be it minor or severe. We asked our experts to tell us what’s most important when it comes to player safety so parents can worry less and focus more on cheering their athlete into the endzone. 

What are the most important safety elements of a football program?

Be Prepared
Texas Senate Bill 82 outlines safety regulations for public school extracurricular activities. It mandates safety training for all coaches or athletic event sponsors, along with an emergency drill incorporating this training. It also requires that student athletes be provided training in recognizing symptoms of catastrophic injuries, such as head and neck injuries, concussion, heatstroke, and more. 

The University Interscholastic League (UIL) advises that schools have a detailed emergency action plan to respond to player and spectator medical emergencies during sporting events. Having a plan is the single most important element of a safe football program, according to Bass.

“It’s about having a plan in place, knowing that the likelihood of injury is going to be well above 50% to at least one player,” Bass said. “Do I have the necessary equipment? Do we have splints? Does someone have a phone to call 911? Do we have an AED? Who will make sure gates are unlocked for the ambulance? Do I have the processes in place to deal with an emergency? If we don't have EMS on site, how is that going to change our approach to the need of care and transport? If I'm trying to do it on the fly when everybody's excited, that is not the ideal time to be discussing these things.”

Prioritize Professionals
“Whether it's basketball, football, baseball or any other sport, parents need to know, not just assume, that in the event medical care is needed, there is somebody there that's qualified to care for their child,” Bass said. “We realize there are differences, obviously, between the larger public schools with more established programs and smaller or private school programs, but it’s still full-contact tackle football, and it doesn't make any difference what level that it's played at. You still need to know who is there to care for your child if they are injured.”

In addition to physicians, board certified athletic trainers like Bass often serve as a team’s chief medical professional both on the sideline and in the locker room. Athletic trainers are allied health professionals who specialize in injury prevention, assessment, diagnosis, care and rehabilitation for athletes.

But not all schools have the resources to have a physician or athletic trainer on the sideline for every game. In this case, someone trained in basic CPR should be present, Dr. Guzman says.

“That's the most lifesaving part of this entire conversation,” Dr. Guzman said. “If a player goes down who's unresponsive for whatever reason, then someone can start and initiate CPR within seconds.”

As a Project ADAM partner, Cook Children’s is helping more that 530 schools in North Texas become “Heart Safe” by training school staff and coaches on CPR, how to use an automated external defibrillator (AED) and how to create an emergency plan.

What can parents do to help protect their athletes?

Stay Informed
Ask questions and communicate openly with coaching staff about their protocols in the event of an injury. With a concussion, for example, understand how your player will be evaluated on the sideline. Who and what will determine if they are or are not ready to go back into the game? Going back too soon, Dr. Guzman says, can lead to a traumatic brain injury.

“It’s really important to have that open door communication with the school and coaching staff, " Dr. Guzman said. “Make sure that all those things are in place to keep our kids safe. Don't just think that it's being taken care of. The state of Texas does a pretty good job of making sure that there are lots of protocols in place to keep kids safe, whether it's in the school or at these events, but I think we still need to be a part of that conversation as parents.”

Stay Alert
Kids don’t always speak up when they are hurt for fear of being benched or considered weak. Committed players will often try to tough it out, and that’s not always best for their health. Playing with an injury can lead to a more serious complication that ultimately increases an athlete's time away from the game.

“Parents have to watch for those subtle changes in their children,” Dr. Guzman said. “Whether they're walking a little differently or they're not picking up their backpack the same way.”

Bass says part of his role as an athletic trainer is to educate players about what their body is telling them, and to help them understand the process for getting them through that injury and back in the game.

“I tell them it’s how we deal with injury that ultimately determines the character of what kind of player we’re going to be,” Bass said. “So if we have something that is swollen, that is uncomfortable and just doesn't look the way it should, that's something we need to have evaluated.”

When an injury does occur, the John and Tracy Sellers Sports Complex at Cook Children’s Orthopedics and Sports Medicine Walsh Ranch, helps young athletes get back in the game with training and rehabilitation services. The Sellers Sports Complex also offers injury prevention programs and sport and position-specific training led by certified athletic trainers.

For more on this and health and safety tips for young athletes, click on the links below.

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It's the end of summertime, and that means it's time to get in one last vacation. With families taking trips over the Labor Day weekend, it is important to educate parents and caregivers on drowning prevention and safety outside of their normal environment. We talked to experts at Cook Children’s Medical Center – Fort Worth, about their advice when families travel out of their normal environment with children who will be around water.

“Parents have to be very vigilant. They need to use whatever locks and barriers that may be in place. Let the children know they are not supposed to go out to the water unless an adult is with them,” Sharon Evans, Trauma Injury Prevention Coordinator, said. 

Parents need to be prepared when it comes to their children being around water at their destination. Evans suggests parents buy traveling alarms to put on the doors that either buzz or siren when the door is open. Along with alarms, communicating with your partner is vital so that someone is always on watch. This can look like communicating taking naps separately. 

Even with putting safety measures and communication in place, be prepared and know CPR and the address in case there is need to call 911.

Evans addresses when children should start swim lessons by recognizing that each parent has to decide what is right for their child. The American Academy of Pediatrics (AAP) suggest children start swimming lessons around the age of one year where they are learning how to be safe and float on their back in the water. Now is the perfect time to remind parents to choose safety over fashion when it comes to their children’s swimwear.

“There are studies showing brightly colored swimsuits are easier to see in the water than more mundane colors. It’s hard to keep your eyes on the child when they are jumping in and splashing around in the water, so any help with a brightly colored swimsuit or life vest would be a great help,” Evans said.

Whether you are traveling to an Airbnb or a family home, recognize that your child is going to explore whether you want them to or not. It is smart to become familiar with the new environment before they do.

“You want to become familiar with the environment first. What kind of access points can the child use?” Jillian Mitchell, Program Coordinator, Community Health, said.

Mitchell encourages parents to pack temporary locking devices for doors and gates. She also emphasizes that communicating with your children and setting expectations of what the trip will look like is important. When it comes to the water, Mitchell emphasizes that a child’s first interaction with water will be bath time as an infant at home. In order to help with the child’s interaction with water in other locations, like on vacation, parents should aim to make bath time a hands on and positive experience.

When you travel to the beach or the pool, Mitchell highlights that you get to choose where you sit. Knowing this information, it should be key in parents’ minds to position themselves where they can see their children.

“Try to sit near a lifeguard, in a designated swim area on vacation. That area is designated for a reason,” Mitchell said.

Two of Cook Children’s values are imagination and safety. For this scenario where families travel out of their normal environment, parents’ should focus on uncovering new solutions and discoveries when it comes to their children being around water, and creating an environment that is physically and psychologically safe for their kids. Learn more about how to lifeguard your child here.

On May 2, 2024, the Consumer Product Safety Commission (CPSC) recalled the Mill Valley Jr.—a six-drawer kids’ dresser sold exclusively at Rooms to Go—after determining it to be a tip-over risk. The distributor, LFN Ltd., is offering a free, updated replacement to anyone who bought the recalled model. Until these replacements arrive, the CPSC is urging consumers to keep their families away from the dresser. 

 This dresser recall is the first action CPSC has taken under the STURDY (Stop Tip-overs of Unstable, Risky Dressers on Youth) standard since it went into effect in 2023. STURDY requires rigorous safety testing for the stability of dressers, armoires, wardrobes, and other clothing storage units, and the Mill Valley Jr. violated the performance requirements.

Furniture tipping is an often overlooked, yet all-too-frequent cause of injury and death in children. In honor of National Safety Month, we’re highlighting the risks of tip-overs and how to prevent them.

How Big of a Risk is Furniture Tipping?

Every year, hospital emergency rooms see thousands of injuries and dozens of deaths—the majority of which occur in children under six years old—from furniture tipping. Though Cook Children’s hasn’t encountered a tipping-related fatality in many years, serious injuries persist.

“We've had liver lacerations, pancreatic lacerations, and broken bones as a result of furniture falling on kids,” said Cook Children’s Trauma Injury Prevention Coordinator, Sharon Evans. 

According to Evans, dressers, bookshelves, and televisions are the top three culprits in tip-over cases. The majority of incidents involve climbing or the application of force, so if you know your child likes to climb or hang on furniture, their risk for harm is even higher. 

How to Prevent Tip-Over Incidents

1. Anchor It!: A quick, simple, and effective way to protect your kids is to anchor all furniture, TVs, and appliances to the wall. Many products now come with anchor kits, but if yours doesn’t, you can find them at home improvement stores like Home Depot or Lowe’s. 
2. Make sure your furniture is STURDY compliant: The CPSC STURDY standard requires all dressers, armoires, wardrobes, and other clothing storage units to undergo rigorous testing for stability—and include anchor kits. To ensure the utmost safety of your furniture, ask the seller or manufacturer if it is STURDY compliant before you buy.  
3. Store your heaviest items at the bottom of your furniture: When loading up a dresser or bookshelf, place your heaviest clothing, books, and any other weighty items in the bottom drawer or shelf. Reserve your lightest items for top shelves and drawers. 
4. Keep tempting items off of furniture: To prevent your children from climbing, keep tempting items like toys, remote controls, or anything else they might want to get a hold of away from the top of furniture.
5. Keep TV cords out of reach of children: Ensure any cords or wires are out of reach to prevent your child from pulling a TV or piece of furniture over. 
6. Supervise children in rooms where these safety tips have not been implemented: Until you follow these guidelines, supervise your children closely around all furniture, TVs, and appliances.

A Quick Fix That Saves Lives

Evans implores parents to consider anchoring furniture as another simple, yet vital step in childproofing their home. The time it takes to complete the task pales in comparison to the peace of mind of knowing your child is safe.

“These things can be easy to blow off because you don't think it's going to happen to you,” Evans said. “But it does happen, and it's way easier to repair a wall than it is to repair a child.”

To learn more about how to anchor furniture and prevent tip-overs, visit https://www.anchorit.gov/.

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 

The Safe Baby Sleep Council, led by Cook Children’s, takes a partnership approach to educating families and providing resources across much of North Texas.

In various locations from hospitals to health fairs to caregiver classes – even at Mayfest – the coalition’s 41 member organizations deliver the same reliable message. When parents of newborns request a birth certificate in Tarrant County, for instance, they receive a brochure about safe sleep, courtesy of the council. 

“Our hope is that families hear why safe sleep is important at their birthing hospital, and then when they receive their birth certificate, they are hearing the same message again,” said Samantha St. John, program coordinator for safe sleep at the Cook Children’s Center for Community Health (C4CH). “Consistency is key.”

Every year in the United States, about 3,500 babies die unexpectedly during sleep. Sometimes the cause can be determined, such as accidental suffocation or strangulation. But if the baby had no apparent medical problems, and their sleep space contained nothing potentially hazardous, the death is considered Sudden Infant Death Syndrome (SIDS). SIDS accounts for about one-third of all sleep deaths in infants younger than 1 year old.  

October is SIDS Awareness Month, a time to highlight the work of the Safe Baby Sleep Council in our region. St. John said council members are passionate about helping families create the safest sleep environment possible to reduce the chance of SIDS.

They want parents to know the safest way for babies to sleep is on their back, on a firm surface with a tight fitted sheet in a crib or bassinet or pack ‘n play, and with no pillows or blankets or toys. Co-sleeping with parents or siblings – in an adult bed, couch or recliner, for example -- isn’t safe for infants.

“There is a misconception that SIDS is a diagnosis, but you can't take your baby to the physician to be tested for SIDS. SIDS is simply the lack of a reason the infant should have passed away,” she said.

According to the National Institutes of Health, the risk for SIDS increases if three factors intersect: first, the infant has a condition that affects their heartrate or breathing; second, if they’re undergoing a spurt of rapid growth or development; third, if something external creates stress, such as exposure to secondhand smoke or being placed to sleep on their stomachs.

Spreading the Word

Safe Sleep is one of five injury prevention campaigns at C4CH along with gun safety, poison control, drowning prevention and car seats. The Initiative started in 2014 within Cook Children's Medical Center and then branched out to area hospitals. It grew over the years to include Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Tarrant County Public Health and other organizations that serve families. 

St. John coordinates the coalition partners and supplies the materials they hand out at their offices and community events. Sometimes bundled together, the main resources are:

• Sleep sacks
• Educational slim cards in English and Spanish
• “Sleep Baby Safe and Snug” children’s books, purchased through Charlie's Kids foundation and available in English and Spanish

Between October 2022 and mid-September 2023, the council distributed 3,540 sleep sacks and 28,404 books and brochures, funded by Cook Children’s.

“We're able to provide all the education and resources to our partners so they do not have to worry about budgeting for these materials or recreating resources that are already available,” St. John said.

The children’s book is popular because it is written in a rhythmic pattern that babies enjoy. An added bonus -- reading promotes bonding.

“Oftentimes we hear that parents share a bed because they want to bond with their baby. But bonding really happens much more when we're awake,” St. John said. “A great interaction with our babies is to read books.”

When caregivers learn the facts, they’re motivated to tell others. Jennifer Gadnai, MBA, BSN, RN serves as the council’s co-chair. She said the word is getting out through Safe Baby Sleep courses and other venues. And in a partnership with the City of Fort Worth, the safe sleep message gets additional exposure as a public service announcement on the banners of city buses and benches.

“This is getting the life-saving education to the people who need it the most,” Gadnai said.

Gadnai’s passion for safe sleep stems from her work in the Emergency Department (ED) at Cook Children’s. “Over my 17 years here I have seen too many sleep-related deaths in our ED,” she said. “It’s a horrible event and devastating for all involved.”

Out in the Community

Coalition members interact with families at community events, where information tables and pack ‘n play displays draw the attention of people passing by. Table attendants will ask: What’s unsafe in the pack ‘n play demonstration?

“Parents will point out the obvious like the blankets, but they'll often miss things like the wedge pillow or the hat on the doll's head or that there's a pacifier tethered to the doll's clothing,” St. John said. It’s an opportunity, then, to teach some the lesser-known points of safe sleep, like the importance of a tight fitted sheet. 

Another type of community outreach occurs in visits to area high schools. Daniel Guzman, M.D., Cook Children’s emergency medicine physician and medical director of C4CH, speaks to home economics classes about various injury prevention topics. In those conversations, students frequently tell Dr. Guzman that infant brothers and sisters sleep on their tummies or under a blanket. He wants teens to know they can and should make a difference at home.

“If they see their sibling on their tummy, turn them over and place them on their backs. It's as easy as that. That might save a life right there,” Dr. Guzman said. “Or remove any stuffed animals or blankets from the crib.”

Hearing the facts from a trusted source helps the safe sleep message resonate. “It's always about if you can change one life,” Dr. Guzman said. “If it's one person who responds, that change goes a long way. It saves lives.”  

Related stories:

• 30 Infant Deaths Lined to Unsafe Sleep Prompt Call for Awareness
• Safe Sleep Starts with Babies in Their Own Separate Sleep Area

According to the latest available data (June 30), Cook Children’s has treated 29 patients for gunshot wounds in 2023. Two of those patients died from their injuries.

Findings from Cook Children’s 2021 Community Health Needs Assessment survey revealed:

• Of households with guns in Cook Children’s eight-county service area, 1 in 5 children live in a home with guns that are not always safely locked away (locking up the firearm and storing ammunition in a separate location).
• Ten percent of young children, 20% of 6–11 year olds and 30% of 12–17 year olds live in a home with a gun that is not always safely locked away.

“As a physician focused on injury prevention, I know local leaders are instrumental in educating children and families about the risks unlocked guns pose in the home,” said Daniel Guzman, M.D., emergency medicine physician and program director of the Aim for Safety program at Cook Children’s. “We’re grateful for the leadership Fort Worth has shown on this important issue.”

Partners in this proclamation included Lock Arms for Life, a Texas-based nonprofit that works every day to get all guns locked when not in use.

Before leaving your infant with a friend, grandparent, other relative or babysitter, it’s important to make sure the caregiver practices the basics of safe sleep. It might feel like an awkward or unnecessary topic to bring up with your mother or mother-in-law or favorite auntie who provides free babysitting. But not all caregivers are aware of the safe sleep practices backed by medical evidence, as they have been updated over the years.

At nighttime and every nap – whether at home or away, with parents or sitters -- the safest way for infants to sleep is: 

• on their backs
• alone (no co-sleeping)
• in a crib or bassinet with a firm and flat mattress
• without pillows, sheets, blankets, toys or other objects

More than 3,500 sleep-related infant deaths occur annually in the U.S., according to the Centers for Disease Control and Prevention. In 2022, 25 infants at Cook Children’s Medical Center in Fort Worth died from cardiac arrest, respiratory failure or other trauma due to unsafe sleep incidents that happened at their homes. A majority of those deaths involved co-sleeping with at least one parent or caregiver who awoke to find the child unresponsive.

So far in 2023, Cook Children’s has seen nine deaths due to unsafe sleep conditions, including co-sleeping with adults. Suffocation can occur if someone rolls onto the baby or if bedding covers the baby’s face.

Juan Cocjin, M.D., of Cook Children’s Neighborhood Clinic – Renaissance, said grandparents shouldn’t assume that it’s OK for babies to bed-share, even if that’s the norm the grandparents are used to or have done in the past.

It’s a sensitive topic because sleep customs get passed down in families from one generation to the next, Dr. Cocjin says.

Some of his patients are being raised by grandparents or even great-grandparents. He occasionally hears a caregiver say their baby shares a bed with others in the family. While these conversations can be tough, it’s important to break through misconceptions that co-sleeping is safe.

“I share with them the hazards of co-sleeping,” Dr. Cocjin said.

Creating a safe sleep environment for your baby takes consistent practice until it becomes automatic. Dr. Cocjin urges grandparents to seek out reputable sources of information and have an open mind about what the experts say. As he puts it: You can’t stick with unsafe habits hoping “maybe it’ll be OK.’’

Communication

Cook Children’s social worker Lorie Palacios, LMSW spreads the word in English and Spanish as a Safe Baby Sleep Council member, a coalition of partners including the Cook Children’s Center for Community Health. She shares safe sleep education at injury prevention at community events.

Palacios emphasizes the importance of sharing your safe sleep plan with everyone who cares for your baby. If mom and dad don’t live together, for instance, they should communicate about their baby’s sleeping arrangements in both residences. Ask if your baby’s caregivers have a crib or bassinet.  

“We want to make sure that conversation is happening,” she said. Transparency and communication are key.

Palacios pointed out that licensed day care facilities in Texas are required to follow protocols for safe sleep. That’s not the case when a friend or family member volunteers to watch your infant. And if a parent feels indebted to the babysitter, she said, they might worry that they’ll be seen as critical or questioning the sitter’s abilities if they speak up about safe sleep.

“If you’re dependent on a family member, especially a grandparent, that’s a very difficult conversation to have with someone you love and trust,” Palacios said.

When Palacios’ children were little, their grandmother kept them while Palacios worked. One day she found her 3-month-old daughter sleeping on the grandmother’s bed with a pillow and blanket.

“I had a playpen. I had a bassinet,” Palacios said. “All these things were available, but those were not the things that my mom used when she was raising her babies. To her, the bassinet felt awkward.”

Prior to that day, Palacios said she and her mom had only touched on the topic of safe sleep.

“The toughest thing is this idea that you’re questioning your elders,” she said. “I wasn’t really pushy because I wanted to maintain my respect.”

After that day, Palacios clearly and specifically told her mom her expectations for the baby’s sleep environment going forward. The words weren’t easy to say; but her mom respected Palacios’ wishes.

When you rely on a network of relatives or neighbors to help care for your baby, she said, you need to stand your ground on matters of safety. A caregiver might mean well but be misguided.

“It definitely takes a little more courage to find your voice when you’re part of a big village,” Palacios said. 

--------------------------------

More about safe sleep from Cook Children’s Checkup Newsroom:

• Safe Sleep Starts With Babies in Their Own Separate Sleep Area (checkupnewsroom.com)
• Safe Baby Sleep: Keep Decorating 'Extras,' Blankets Out of Infant Cribs (checkupnewsroom.com)
• Pediatrician's Advice: Straight Talk About Sleepless Nights (checkupnewsroom.com)

As families and friends come together to celebrate Independence Day, it's important to keep safety in mind. According to experts at Cook Children's, drowning is the primary threat to children during this holiday. Drowning patients are commonly seen in the emergency room and these incidents can often have severe outcomes.

To ensure a safe and enjoyable holiday weekend, consider the following safety tips:

• Always supervise children when they are in or near water, even if they know how to swim.
• Designate a Water Watcher, an adult who will watch all children while they are in or around water with no distractions.
• Keep pool areas fenced and locked when not in use and remove all pool toys/floats. One to 4-year-olds are at the most risk to drown in a pool.

DROWNING PREVENTION

From June 1 to June 23, 2023, there were 10 drownings treated at Cook Children’s, two of which were fatal. Most of these patients have been in the 5 years old and under age group.

Since Jan. 1, 2023, there have been 25 drownings at Cook Children’s, three of which were fatal. Most drownings in 2023 have occurred in a swimming pool or hot tub.

While most patients survived these incidents, drowning injuries can result in severe effects, especially on a child’s brain development.

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

Drownings can occur even with many adults present. When there are children around water, always designate a Water Watcher, an adult who is in charge of watching all children without any distractions. The Water Watcher should not use a cell phone, socialize, drink alcohol or do anything else that might be a distraction.

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.

Go here for more information on Water Watcher tags. Lifeguardyourchild.org shares many resources and tips for drowning prevention.

HEAT SAFETY

In very hot weather, high humidity, and other conditions, heat in the body can build to dangerous levels. This can cause heat illness, such as heat cramps, heat exhaustion, or heatstroke.

With highs in the upper 90s, be sure to keep these heat safety tips in mind. 

Wear appropriate clothing: Choose lightweight, light-colored, loose-fitting clothes. Wear a hat to shield yourself from the sun, until you feel yourself getting warm. Then remove any items covering your head that can trap heat close to the body.

Schedule outdoor activities carefully: Heatstroke can occur in less than an hour when you are participating in a strenuous activity on a hot day. Try to limit outdoor activity to when it’s coolest, like morning and evening hours. Rest often in shady areas so your child’s body has a chance to recover.

Hydrate: Drink plenty of water during the day, especially if you are engaged in any strenuous activity. Be sure to drink water or a sports drink before, during and after any strenuous activity.

Wear sunscreen: If you go outside, use sunscreen, wear a wide-brimmed hat and sunglasses, and put on sunscreen of SPF 15 or higher 30 minutes before going outside. Continue to reapply according to the package directions.

FIREWORKS

Fireworks can cause severe injuries that are both harmful and painful to children. Children should never handle fireworks. Even seemingly harmless sparklers can heat up to more than 1,200 degrees, making them dangerous for young children. 

Some people light sparklers at home or even set off their own fireworks, but this is dangerous. Some of the people hurt each year aren't the ones setting off the fireworks, but people who are nearby.

The safest way to enjoy fireworks is at a professional display.

If setting off fireworks at home, adults should only set them off in a designated “kid-free” zone. Adults should not hold fireworks in their hands or keep any part of their body over them while lighting. Wear eye protection, and don't carry fireworks in your pocket — the friction could set them off.

Point fireworks away from homes, and keep away from brush and leaves and flammable substances. The National Fire Protection Association estimates that local fire departments respond to more 50,000 fires caused by fireworks each year.

It’s also important to keep children away from bonfires and grills to help prevent any accidental burns.

ATV SAFETY

Though often thrilling for children, off-road motorized vehicles — including all-terrain vehicles (ATVs), ATV mules, go-karts, and even golf carts — can be extremely dangerous for them to ride, especially if they don’t use safety measures once they get on board. Cook Children's sees many patients with injuries from ATV accidents every year.

To prevent such injuries among children, the American Academy of Pediatrics (AAP) recommends that children under 16 should not drive or ride as passengers in two- and four-wheeled off-road vehicles.

ATV Safety:

• Always wear protective gear such as:
• Helmet
• Eye Protection
• Boots, gloves, long pants, jacket
• Do not ride an ATV at night
• Take an ATV safety course
• Never ride on public roads
• Perform ATV safety checks

RELATED

A Cautionary Tale: The Misadventures of Summer & Top Injuries Seen at Cook Children's (checkupnewsroom.com)

Should My Child Ride ATVs? Cook Children's Experts Weigh In (checkupnewsroom.com)

A Pediatrician's Advice for a Safe and Fun Fourth of July (checkupnewsroom.com)

Breathing in secondhand smoke isn’t healthy for children, whether the smoke comes from tobacco or marijuana.

Many of the same toxins and irritants in tobacco smoke are also present in marijuana smoke, according to the American Lung Association. Children who are exposed – at home, in the car or in other places – are indirectly inhaling any particles the smoke contains. No amount of secondhand smoke is safe.

What concerns doctors about secondhand smoke? “It can lead to chronic cough, mucus production and infection,” said Alice Phillips, M.D. at Cook Children’s Pediatrics Cityview. “If the child has asthma, it could trigger an asthma attack.”

It’s an increasingly common experience for Dr. Phillips to smell marijuana when patients and their families come to appointments. She detects the marijuana scent on parents and caregivers, as well as in the clothing of young children.

“In the past, I might have noticed one to two times per month, but now it is multiple times per week or even per day,” she said.

Daniel Guzman, M.D. encounters the marijuana odor on three or four patient families every shift he works in the Cook Children’s Emergency Department (ED). Dr. Guzman said he initiates conversations with those families, particularly if the child came to the ED with breathing problems. He points out his purpose is to share the medical perspective -- not invade anyone’s privacy.

“If they’re coming in for asthma issues, then I always have that conversation about smoke, whether it’s cigarette smoke or marijuana smoke that affects the lungs. We know short term that it can lead to more chronic asthma-like issues and other respiratory problems for these children,” Dr. Guzman said.

Education

Secondhand smoke falls in the category of preventable injuries that Dr. Guzman works to reduce through education. Maintaining a smoke-free environment can be compared to proactive safety measures like car seats, gun locks and lifejackets that are meant to keep children safe.

“That’s where the grassroots of all this starts. You make a change in one person, it can have a significant downstream effect, which can be life-changing,” he said. “It’s just a matter of continuing to have that conversation.”

As part of the routine exams with her teenage patients, Dr. Phillips discusses the risks of smoking, vaping and drug experimentation. Because recreational marijuana is illegal in Texas, the scent can pose a tricky situation in the pediatrician’s office. Parents aren’t always completely open when Dr. Phillips brings up the topic. She tries to communicate in ways that stick to the facts, avoid judgment, and demonstrate concern.

“I am the kids’ doctor but also their advocate,” Dr. Phillips said. “As doctors, we must walk the delicate tightrope of partnering with parents in the care for the kids.”

The American Lung Association advises:

• No one should be around secondhand marijuana smoke.
• Anyone exposed to secondhand marijuana smoke can have detectable levels of tetrahydrocannabinol (THC) in their systems. THC is the psychoactive or mind-altering “high” ingredient in marijuana. 
• Don’t allow smoking at any time or place children are present.

Dr. Phillips points out that children look to the adults in their lives for guidance.

“Little eyes are always watching,” she said. “Just like we need to eat our vegetables to encourage good eating habits, we need to stay away from things which might be harmful to ourselves or potentially encourage the same habit in our kids.”

Story by Eline Wiggins. Video by Tom Riehm. Photos by Reilly Ternan.

Every year, children in Texas are prone to vehicular heatstroke. So far this year, eight children have died of vehicular heatstroke across the US, including a 4-year-old boy in Houston, according to noheatstroke.org. In 2022, three children died of vehicular heatstroke in Texas.

On Monday, Cook Children's and Prosper Fire Department teamed up to remind parents about the dangers of hot cars. First responders showed a live demonstration at Cook Children’s Medical Center – Prosper to simulate a 911 call and emergency response for a child left in a hot car. Speakers included Prosper Fire Chief Stuart Blasingame, Viviana Esparza from Cook Children’s Center for Community Health, Meena Guirguis, M.D,, emergency department physician at Cook Children's Medical Center - Prosper and  Larry Lanar Dyer of El Dorado Chevrolet.

A digital thermometer displayed the internal temperature of a second demonstration vehicle to show how high and how quickly a vehicle can heat up. The temperature inside the vehicle surged passed 135 degrees. 

Young children are particularly at risk for heatstroke, or hyperthermia, because their bodies heat up three to five times faster than an adult’s. Because cars heat up so quickly, a tragedy could happen faster than you think.

“Heatstroke in children can happen in minutes, not hours,” said Meena Guirguis, M.D., emergency department physician with Cook Children's Medical Center - Prosper. “If you see a child left in a vehicle, call 911 immediately.” 

A car can heat up 19 degrees in just 10 minutes. And cracking a window doesn’t help. It’s never OK to leave a child alone in a car, even for a few minutes and even if the car is running.

“Parents suffer from exhaustion due to lack of sleep, stress and changes in their normal routing. Any one of these can cause your memory to fail at a time when you least expect it,” according to kidsandcars.org. “Even the best of parents or caregivers can unknowingly leave a sleeping baby in a car; and the end result can be injury or even death.”

Create reminders by placing something in the back of your car next to your child, such as one of your shoes, a purse or a cell phone, is especially important on days when you're not following a normal routine.

To reduce the number of child vehicular heatstroke deaths, parents should remember to ACT:

• Avoid heatstroke-related injury by never leaving a child alone in a car, not even for a minute. Always lock your doors and trunks— including in your driveway or garage. If a child goes missing, check the pool first, and then check the vehicles, including trunks.
• Create reminders. Routinely place something you'll need at your next stop—like a purse, briefcase or cellphone—in the backseat.
• Take Action. If you see a child alone in a car, take action. Call 911.

What to do if you see a child or pet alone in a vehicle from kidsandcars.org:

• Don’t wait for the driver to return. Call 911 right away. The 911 operator can help give you instructions on how to care for the child or pet.
• If the child or pet is not responsive or is in distress, immediately:
  • Get them out of the car by any means necessary
  • Move the them to a cooler environment (somewhere with AC or shade if AC is not available)
  • Remove child’s clothing to let the heat dissipate from their skin
  • Dampen them with cool water or wet rags, immerse in cool water (not in an ice bath) 
• If the child or pet is responsive and not in distress:
  • Stay with them until help arrives
  • Ask someone else if they can locate the driver. You might suggest they ask security of a store manager to page them

Warning Signs of Heatstroke:

• Hot, flush or red
• Slow, weak pulse or strong, rapid pulse
• Lethargy, confusion or strange behavior
• Nausea
• No sweating

By buckling their children into car seats and lifejackets, parents are taking steps to protect against tragic accidents. Safe sleep practices fit into that same mindset.

Taking precautions in an infant’s sleep space -- just like the precautions involving car seats and lifejackets – helps reduce the risk of serious or fatal injury. That’s why Cook Children’s urges families to make it a priority to create a separate, safe sleep environment for babies 1 year and under. The safest place for babies to sleep is on their backs, on a flat and firm surface, in their own bassinet or crib without pillows, blankets or soft toys.

The message of Safe Sleep gained urgency at Cook Children’s and across the community after we shared that 30 infants died over a 15-month period from cardiac arrest, respiratory failure or other trauma due to sleep incidents that happened at home.

From January through April 2023, five sleep-related deaths were recorded at Cook Children’s, all to infants under 1 year old. These deaths happened on couches, adult beds, and during co-sleeping. 

It isn’t safe for anyone to sleep in the same bed with babies at night or even for quick naps on the couch or in a recliner, due to the risk of unintentional suffocation. Babies can fall, be strangled or wedged between furniture and walls. Loose sheets, a comforter or another person’s body can cover the baby’s face and block the airway.

Co-sleeping already creates unsafe risks for babies. The U.S. Department of Health and Human Services identifies several factors that increase the risk even further, including:

• Co-sleeping with one or more people
• Co-sleeping on a waterbed, old mattress or an especially soft surface
• Napping on a couch or armchair, either alone or next to someone else  
• Co-sleeping with adults whose fatigue or use of medication, drugs or alcohol makes waking up difficult 

More than 3,500 sleep-related infant deaths occur each year in the U.S., according to the Centers for Disease Control and Prevention.

What are some reasons that bed-sharing occurs?

Some parents share reasons such as convenient breastfeeding, generational or cultural habits, busy lifestyles, the expense of cribs, limited space to put a baby bed in a crowded home, and the belief that “it won’t happen to me.”

Bianka Soria-Olmos, D.O. of Cook Children’s Pediatrics Haslet says that when her patients report that they bedshare, she shapes the conversation from an injury prevention perspective. In her experience, most families that choose to co-sleep have tried but given up on putting their infants in a separate sleep place. 

“The majority of the time moms say the baby just won’t stay in the bassinet,” Dr. Soria-Olmos said.

Some parents opt for bed sharing because they believe it will promote strong emotional bonds. Dr. Soria-Olmos wants them to know that co-sleeping isn’t required for bonding. That’s because everything that parents do to care for their baby – feeding, bathing, diaper changes, singing, play and more – creates the parent-child bonds. 

Paulette See, M.D. at Cook Children’s Pediatrics Haslet understands how tempting it can be for parents to bring their baby to bed with them, especially when they’re exhausted. 

“I get where you’re coming from,” said Dr. See, who is a mother and grandmother. “As much as we want to love and cuddle our babies all the time, for them to sleep on their backs in their own space is the safest.” 

In Dr. See’s experience, postpartum anxiety can lead some mothers to incorrectly believe that their baby is safer sleeping in the parent’s bed. It eases their minds to realize they can still see and touch the baby if the bassinet or crib is within arm’s reach, she said.

Dr. See empathizes with patient families who say their baby sleeps longer and cries less in the parents’ bed. But “just because something fits our lifestyle better doesn’t make it right,” she pointed out.

Here’s a comparison Dr. See makes: Your baby might scream in their car seat, but you buckle them in anyway. The same logic applies to the crib, where your baby might cry at first when learning to sleep separately, but you stick with it from a safety standpoint.

Cook Children’s pediatricians and health care providers want to share the information you need to keep your child safe and healthy. Cook Children’s encourages all families to understand that they can check on, feed and comfort their baby without sleeping in the same bed. Share a room, not a bed. A safe sleep space for your baby can either be a bassinet, portable crib or play yard near their parent’s bed.

RELATED:

Pediatrician's Advice: Straight Talk About Sleepless Nights (checkupnewsroom.com)

So the Rock-N-Play’s Been Recalled. Now What? (checkupnewsroom.com)

Pediatricians Offer Virtual Newborn Classes for Parents (checkupnewsroom.com)

The Center for Community Health will be at these upcoming free safety and community events:

Additional information from organizers:

Run4Elise

The Run4Elise is a 5K and 1 Mile fun run that benefits the Swim4Elise Foundation and the Elise Cerami Memorial Scholarship. This family-friendly community event honors the life of Elise Cerami by promoting water safety through swimming scholarships and community outreach education. Go here for more information.

The Center for Community Health led by Cook Children's will share information and resources for Lifeguard Your Child. 

Pop Up Safety Center/Diaper Hub

The Center for Community Health will share information and resources for Lifeguard Your Child, Safe Baby Sleep, Aim for Safety and many other campaigns from the Center for Children's Health and Cook Children's. 

Super Safety Saturday- Burleson

Bring the entire family to Super Safety Saturday. The Burleson Fire Department is partnering with Texas Health Burleson for a family-friendly safety event that will include pool & sun safety education, home safety, bike safety and fire safety. There will also be free bounce houses, fire truck, ambulance and much more. Go here for more information.

The Center for Community Health led by Cook Children's will share information and resources for Safe Baby Sleep and Aim for Safety campaigns.

Argyle Child Safety Fair

It's almost that time again. The 3rd Annual Child Safety Fair is just around the corner on June 10th and it will be bigger and better (though still FREE) than before. There will be a water slide, a rock climbing wall, a water gun arena, a dunk tank, free snow cones, and so much more. And if you're an expectant mother or are looking to ensure that your car seat is installed correctly, we will have a car seat fitting event prior to the Child Safety Fair. Mark your calendar now! There will also be free drug lock boxes, free gun safes, free booster seats, and free bike helmets. Go here for more information. 

The Center for Community Health led by Cook Children's will share information and resources for Lifeguard Your Child, Safe Baby Sleep, Aim for Safety and many other campaigns from the Center for Children's Health and Cook Children's.

Defenderpalooza 2023

We’re excited to host our 2nd Annual Defenderpalooza event and making this event even bigger and better! Go here for more information.

The Center for Community Health led by Cook Children's will share information and resources for our Aim for Safety campaign.

With Christmas around the corner, parents are scrambling to find the perfect gifts for their kids. December is National Safe Toys and Gifts Month, and many of the toys sold in stores and online pose significant dangers to kids of all ages including water beads recently highlighted in the news. Once swallowed, the beads may swell inside the intestine creating a potentially life-threatening blockage.

“Unfortunately the water beads are not always visible on an X-ray, and typically we have to monitor closely to see if any concerning symptoms begin to appear such as vomiting, abdominal pain or distension,” said Bianka Soria-Olmos, D.O., pediatrician and Medical Advisor for Digital Health at Cook Children’s.

Last year, more than 200,000 toy-related injuries were treated in U.S. hospital emergency departments with 74% of those sustained by children 14 years old or younger. Forty-six percent of the injuries were to the head and face – the most commonly affected areas of the body. 

Sharon Evans, trauma injury prevention coordinator at Cook Children’s, says that looking at the recommended age displayed on the toy packaging is often overlooked and more important than people realize.

“The age is set on the research of what is appropriate for mental and physical development and safety,” Evans said. “It doesn’t mean your child is not smart or mature.”

Evans says one of the gifts she would definitely say no to are the Airsoft or Nerf guns – and anything that shoots objects – because the hospital sees a lot of eye injuries from those.

Use these safe toy guidelines when shopping for your children:

• Avoid buying toys with sharp points or other dangerous edges.
• Do not buy toys with small magnets or button batteries which can cause serious injury or death if ingested.
• Buy toys that will withstand impact and not break easily.
• Look for “ASTM” on the label. This means the product meets the national safety standards set by the American Society for Testing and Materials.
• Always include protective gear with sports equipment.
• Do not buy toys with long strings or cords as these can become wrapped around a child’s neck.
• Do not give toys with small parts to young children. If the object fits inside a toilet paper roll or if pieces from the toy could break off and fit into the roll, it is not appropriate for kids younger than 3.
• Always dispose of uninflated or broken balloons immediately. According to the Consumer Product Safety Commission, more children have suffocated from them than any other type of toy.
• Do not buy crayons or markers unless they are labeled nontoxic.

Child Passenger Safety Week is Sept. 18 through Sept. 24. National Seat Check Saturday is Sept. 24, 2022.

Choosing a car seat for your baby can be overwhelming. There are so many different colors, styles and price points. But there’s one more thing to keep in mind – these popular brands are being knocked off to create counterfeit car seats.

These knockoffs may be cheaper, but are less likely to protect your child in a crash. Some parents don’t even know that their seat is a knockoff, due to ecommerce sites or purchasing car seats on social media. The dupes are eerily similar.

Last month, a Cook Children’s Child Passenger Safety Technician found a fake brand car seat, which was a dupe of a popular brand. There were a few differences that could be easily overlooked, unless you know what to look for. 

Cook Children’s has Certified Child Passenger Safety technicians (CPST’s) who know how to properly use and install car seats within the Medical Center to ensure our patients ride safely.  Under the Center for Children’s Health and Safe Kids North Texas there are also CPST’s who work in the community and have partnerships with fire departments, police departments and other community agencies to help educate the communities around us. “My fear is there is going to be more and more fakes out there and parents really need to be vigilant to make sure they have a true crash tested safety seat that will protect their child in the car at all times,” said Sharon Evans, RN, BSN, CPN, CPSTI, trauma injury prevention coordinator at Cook Children’s.

Cook Children’s Child Passenger Safety Technicians educate caregivers/patients/families on car seat safety and know what is required for car seats to meet the Federal Motor Vehicle Safety Standard 213. On the authentic seat, safety warning labels are much more informative with detailed, written information, which are required by law. The fake car seat had safety symbols and pictograms, but no wording.

Fake car seats may have incorrect features altogether, such as strap width, which when placed on authentic car seats will protect an infant or toddler’s fragile bodies in a crash.

The knockoffs do not meet federal safety standard guidelines set by the National Highway Traffic Safety Administration.  Authentic car seats have passed rigorous safety standards and crash safety tests.

Parents and caregivers who shop online will want to stay extra vigilant for fake car seats. The best way to ensure your child’s car seat is authentic is to buy directly from the manufacturer or from a reputable retail store.

Red flags:

• Great deal on a car seat. If it’s “too good to be true,” it probably is.
• Do not purchase from someone on social media.
• Do not purchase from ecommerce sites, which allow for third-party sellers and can lead to a counterfeit car seat.

What can I do? Is my child’s car seat authentic?

• Call the manufacturer. They can help you determine if it’s a knockoff. Sometimes they will ask you to submit photos.
• Take your car seat to be checked by a certified child passenger safety technician. They are trained to help determine if it’s fake.
• Find a Child Passenger Safety Technician: Welcome! | National CPS Certification (safekids.org)
• The National Highway Traffic Safety Administration maintains a directory of many inspection stations.
• Additional information about car seat safety from the Texas Department of State Health Services

Car Seat Check Saturday: Sept. 24, 2022. Events are scheduled across Fort Worth and Willow Park areas.

• Register and view upcoming events at www.freecarseatcheck.org 

Did you know?

Car crashes are a leading cause of death for children, according to the U.S. Department of Transportation. On average, two children under 13 were killed and an estimated 374 were injured every day in 2019 while riding in cars, SUVs, pickups, and vans.

• 608 child passenger vehicle occupants died in traffic crashes in 2019.
• 38% of children who died in 2019 while riding in passenger vehicles were unrestrained, compared to 33% in 2018.

There hasn't been a “death-free” day on Texas highways since 2000, that's more than 78,000 deaths. #EndTheStreakTX (txdot.gov)

• This year so far 2,839 deaths, as of Sept. 14, 2022
• 2021 had 4492 deaths
• 2020 had 3897 deaths (10.5/day)
• 2019 had 3623 deaths (10/day)

The family finished eating dinner when the girl told her mother, Katie Jacobsen, that she swallowed a button battery that was from a toy. They had extra honey packets on hand, which helped ease the battery through the girl’s stomach.

Button batteries and lithium coin batteries are dangerous for children if ingested. These small, shiny batteries are found in remotes, key fobs, thermometers, toys, and many other devices found in the home.

When a child swallows a button battery, the saliva triggers an electrical current. This causes a chemical reaction that can severely burn the esophagus in as little as two hours, according to Safe Kids Worldwide.

If a battery is ingested, parents should immediately call 911, and seek medical attention at the emergency room. If your child is over 12 months old, Cook Children's experts confirm that parents can offer the child honey, if available.

LaQuatre R. Rhodes, D.O., says battery ingestions are seen a couple of times per month by the Cook Children’s Gastroenterology team in Prosper.

“Ingestion of button batteries can cause severe complications including respiratory difficulty, injury to the respiratory tract, injury to esophagus, stomach, or intestines, bleeding, and even death so it’s very important to seek immediate medical attention and ultimately prevent ingestion,” Dr. Rhodes said.

She says if a mucosal injury is present, monitoring is required after removal. Repeat endoscopy and imaging are done on the patient to assess for complications. Long-term follow-up may be needed depending on the severity of the injury, Rhodes said.

From 1997 to 2010, an estimated 40,400 children 13 years and under were treated in hospital emergency departments for battery-related injuries, including confirmed or possible battery ingestions, according to the Centers for Disease Control and Prevention. Nearly three-quarters of the injuries involved children 4 years and under; 10% required hospitalization, the CDC said.

Dr. Rhodes answered more questions for us about coin battery ingestions:

What are the symptoms to look out for that might indicate that my child swallowed a button battery?

Abdominal pain, bleeding, cough, breathing difficulty, sore throat, chest pain, fever, and weight loss are symptoms to look for if a child swallowed a button battery.

What should parents do if their child swallowed a battery?

Seek medical attention: call 911 or head to the emergency room. For children over 12 months old, give Carafate or honey soon after ingestion. This may help improve injury to the esophagus and stomach, but do not delay seeking medical attention. The National Battery Ingestion Hotline is available at 800-498-8666, 24 hours a day, seven days a week.

How soon should you give honey or Carafate to your child after swallowing a button battery?

Immediately and ideally less than 12 hours of ingestion. However, do not delay seeking medical attention to administer honey.

How do honey and Carafate help prevent injury? How much should I give?

Honey and Carafate coat the battery, which limits electrode activity and neutralizes generated hydroxide. This prevents damage and perforation to the esophagus and stomach.

Carafate is a prescribed medicine that coats and covers the mucosa of the esophagus and stomach to help protect it from injury.

Recommended doses for both honey and Carafate:

• For children over 12 months old,  give 10 ml or 2 teaspoons every 10 minutes with a maximum of 6 doses of honey and 3 doses of Carafate.
• However, do not delay medical attention to administer.
• Do not induce vomiting. Do not delay emergency care to look for honey.

What can medical professionals do if my child swallows a battery?

1.    Check vital signs and evaluate to see if stable.

2.    An X-ray is done to identify the location.

3.    If the battery is in the esophagus less than 2 hours after ingestion, then immediate endoscopic removal. It will be removed by Ear-Nose-Throat or GI depending on location.

4.    If the battery is in the esophagus less than 12 hours after ingestion, the child is stable and able to swallow and ingest consider honey (>1 years) or Carafate while waiting for endoscopy. But do not delay endoscopy to give it.

5.    Beyond esophagus and symptomatic (abdominal pain, bleeding, cough, breathing difficulty, sore throat, chest pain, fever, weight loss) or magnet co-ingestion less than 12 hours of ingestion immediate endoscopic removal if in the stomach. Consult surgery if in the small intestine or colon.

6.    Beyond esophagus and asymptomatic less than 12 hours of ingestion repeat X-ray in 7-14 days or sooner if develops symptoms. If no passage, proceed to endoscopic removal.

7.    If it's been more than 12 hours of ingestion, your child may need an endoscopy, CT scan or endoscopic removal.

8.  If it's been more than 12 hours of ingestion, in the small intestines or colon, and asymptomatic repeat X-ray in 7-14 days or sooner of develops symptoms. If no passage, consult surgery.

What else should parents and caregivers be aware of?

The presence of an ingested button battery is considered a medical emergency, so do not delay seeking medical attention.

Make sure battery compartments are secured and screwed properly. Button batteries are shiny and attractive to children so avoid leaving loose batteries around.

Keeping Children Safe at Home from the American Academy of Pediatrics:

Crawling infants, toddlers and young children often put things in their mouths. Because of this, there are a few things you can do to reduce the risk of accidents.

• Look for batteries in child-resistant packaging. There is one type of lithium coin battery with a bitter coating to discourage swallowing.
• Make sure battery compartments are secure, especially for commonly used items like remote controls and key fobs. Consider taping them shut for an additional layer of security.
• Know what items in your home contain button batteries and lithium coin batteries, including older siblings' toys, calculators, and games.
• Store items that use these batteries out of reach, and out of sight if possible. For example, keep thermometers or remote controls in a secure drawer or cabinet when not in use. Hang keys up high on hooks. If someone receives a musical card, make sure to throw the card out when done or remove the battery before allowing children to keep it in their room. Remind older siblings to keep their stuff off the floor.
• Make sure childcare providers and family members are aware of the safety concerns. Post the number for the National Battery Ingestion Hotline (800-498-8666) with other emergency information in your home.
• Throw out or recycle old batteries right away. Even batteries that are "dead" can be dangerous. To safely dispose of button batteries and lithium coin batteries, wrap them in tape and place them in an outside garbage can.
• Talk with your children about safety. We teach kids to hold hands and look both ways when crossing a street and that a stove is hot. In the same way, we can teach them that handling batteries is for grown-ups. Talk to older children as well to make sure they keep track of items responsibly.

If a child ingests a button battery, immediately call for help, either through 911 or the National Battery Ingestion Hotline at 800-498-8666, which is available 24 hours a day, seven days a week.

As we settle into a new school year, many parents and caregivers may find themselves unsettled about the need for increased security measures in our schools. Given recent gun violence events in Texas and across our nation, school administrators have placed safety at the forefront of their concerns. With this concern, however, also comes heightened and unwanted stress, worry, and anxiety for parents, caregivers, students, and teachers. Recognizing and addressing these emotions can be fundamental in helping our children develop a sense of peace and reassurance for a successful school year.

Before adults begin having conversations with children, it is important for them to process their own thoughts and emotions around the given topic. This is best practice for any conversation, not just those involving difficult topics like school tragedies. 

When caregivers take time to process and discuss their own feelings, it better equips them to manage personal expressions and reactions as well as model desired behaviors for their children. As a parent or caregiver, this small step can have a big impact on the outcome of a child’s thoughts, expressions, and approaches to processing difficult situations. 

Limiting exposure to information in the news and media is another key component of curbing anxiety and stress. We live in a digital age where, inevitably, we are inclined to receive information through various platforms and outlets. Generally, the primary adults in a child’s life are the first line of defense for what a child hears, sees, and does. 

By limiting exposure to harsh content in the news and media, you are helping safeguard and filter information that may or may not have negative implications for your child. If and when your child does have exposure to undesirable items in the media, discuss what was seen or heard, talk through questions and concerns, and validate these feelings. Repeat this process, consistently following up with your child, until a felt sense of safety is established. These actions will show children that their concerns are important and they matter.

Finally, share with your children the importance of "trusting their gut" and speaking up when something doesn’t feel or seem right. Express to them: "If you see something, say something." Teachers, administrators, and school personnel cannot physically have eyes everywhere at all times. Students see and hear things among their peers that school personnel may never know about. 

Encourage your child to speak up if they feel uneasy or have a concern. Oftentimes, students are afraid of the negative social attention this could bring, but their instincts and initiatives to act on something that doesn’t "seem right" could be very impactful in preventing a crisis situation or even saving a life.

All of these suggestions can and will look differently depending on the age of your child.  So it’s important to take a developmentally appropriate approach when talking with your kids.  Also, these conversations can be time-consuming and prompt further discussion.  Allow plenty of time for such discussions with your child so they don't feel rushed or dismissed.

It is a good sign if your child is expressive and requests more of your time. This means you are fostering and holding a space for them to come to you with big issues and big feelings, and that is something well worth your while. These are small investments that can make a huge difference now and in the future.

Reminders to help facilitate conversations with our kids: 

• Recognize: Name the emotion, talk about it, and deal with it.
• Reflect:  Think about and work through your own feelings around a given topic. Then develop a plan for a discussion with your child.
• Review:  Be a buffer and filter the content your child may see or hear through media platforms.
• Respond & Reassure: Hold space for your child to share his or her thoughts and have a developmentally appropriate conversation by responding appropriately to his or her needs. Provide reassurance to foster a felt sense of safety and security.

From Aug. 22 to Aug. 28, Cook Children’s treated five patients who were struck by vehicles in separate incidents.

As the new school year gets underway for many districts across North Texas, it’s crucial that drivers look out for children, especially in school zones.

Injuries treated:

• 3 patients (pedestrians) struck by vehicles
• 1 patient (pedestrian) struck by an ATV
• 1 patient (bicyclist) struck by a vehicle

Drivers should eliminate distractions and pay attention to their speed, especially in school zones. Always look out for pedestrians and don’t text and drive.

Dan Guzman, M.D., pediatric emergency medicine physician with Cook Children’s Medical Center, says that it’s important that parents also teach their children safety precautions for walking near a road, including paying attention, using sidewalks and crosswalks, and always looking both ways before crossing a street.

“It’s really important to teach your kids and make sure they understand that we need to pay attention because this is your life, there’s only one you and there’s no way to get this back if something bad were to happen,” Dr. Guzman said.

Dr. Guzman says the emergency department sees more children this time of year as kids walk or ride bikes to school and are, unfortunately, struck by vehicles.

“We want our children to be safe and no one wants to hurt a child,” Dr. Guzman said. “We all need to slow down close to school zones and neighborhoods. Make sure we take care of our kids.”

Elementary school children are very active and impulsive. Although they’re learning and growing, school-age children 10 and younger still need guidance and supervision when playing and walking near traffic, according to the National Highway Traffic Safety Administration.

Pedestrian tips:

1. Children less than 10 years old should not be crossing the street without an adult.  All kids are different, but developmentally until they are about 10 years old they don’t have the cognitive ability to judge the speed of an oncoming car.
2. Don’t be distracted while walking.  Stay off your phone and if you HAVE to use headphones, only use one. You have to be aware of your surroundings!
3. Look left, right and back left again before crossing the street. 
4. Only cross at the light, corner or crosswalk. Never cross the street between parked cars.
5. Walk on the sidewalk. If there isn’t a sidewalk walk FACING traffic.
6. Be alert for cars pulling into parking lots and driveways as well as cars backing up.
7. When there is a car approaching or even stopping, make eye contact with the driver and wait for them to motion for you to cross the street. Often times you may think the driver is looking at you but they may be in a “daze” and not truly see you.
8. More than 80% of pedestrians die when hit by a car going 40 mph or faster, and less than 20% die when hit at 20 mph or less. As a driver, SLOW DOWN.

School Zone tips:

1. Slow down and follow all speed limits.
2. Pay attention and look out for pedestrians.
3. Cell phone use is prohibited.
4. Obey crossing guards.
5. Stop for school buses.

Tips for Drivers:

1.  Always stop for pedestrians.
2.  Yield to pedestrians in crosswalks and stop well back from the crosswalk to give other vehicles an opportunity to see the crossing pedestrians so they can stop too.
3. Yield to pedestrians in crosswalks and stop well back from the crosswalk to give other vehicles an opportunity to see the crossing pedestrians so they can stop too.
4. Never pass vehicles stopped at a crosswalk. There may be people crossing where you can’t see.

Media partners: If you are interested in telling this story, please contact Public Relations Manager Kim Brown at Kim.Brown3@cookchildrens.org or at 682-885-1080, 817-266-3728

On Tuesday, Cook Children's set up a digital thermometer display and a vehicle demonstration to raise awareness of hot car dangers and show how high the internal temperatures of a vehicle can soar.

Dana Walraven, manager of Community Health Outreach at Cook Children’s and coordinator with Safe Kids North Texas Fort Worth, shared advice for parents and caregivers as temperatures remain in the 90s and 100s.

Young children are particularly at risk for heatstroke, or hyperthermia, because their bodies heat up three to five times faster than an adult’s. Because cars heat up so quickly tragedies can happen faster than you think. Creating reminders like putting something in the back of your car next to your child such as one of your shoes, a purse or a cell phone is especially important on days when you're not following a normal routine.

So far this summer, MedStar Emergency crews have responded to three incidents where a child was left in a hot car in Tarrant County; all were under 4 years old. 

A car can heat up 19 degrees in just 10 minutes. And cracking a window doesn’t help.

To reduce the number of child vehicular heatstroke deaths, parents should remember to ACT:

Avoid heatstroke-related injury by never leaving a child alone in a car, not even for a minute. Always lock your doors and trunks— including in your driveway or garage. If a child goes missing, check the pool first, and then check the vehicles, including trunks.

Create reminders. Routinely place something you'll need at your next stop—like a purse, briefcase or cellphone—in the backseat.

Take Action. If you see a child alone in a car, take action. Call 911.

2022 Hot Car Deaths | KidsandCars.org

The mobile kiosk, which stands more than 7-feet high and resembles a giant smartphone, rolled out in December at Defender Outdoors, a sports shooting and outdoors equipment retailer in Fort Worth. As part of a first-time collaboration with Cook Children’s, the kiosk was placed near the check-out registers in hopes it attracts the attention of parents and children alike.

“I think this could be a real breakthrough in how we educate our families,” says Dan Guzman, M.D., an emergency room physician who initiated Aim for Safety in 2017 after seeing too many children treated for accidental gun-related injuries at Cook Children’s Medical Center. “It’s a way that’s not in your face — where people may feel more comfortable as opposed to somebody coming up and directly speaking to them about safety (versus standard) practices."

The Aim for Safety educational kiosk — activated by touch — uses advanced technology to engage and teach children as they progress through four levels, stumbling upon unsecured guns hidden in places such as cabinets and drawers while moving through a virtual home. If they find a gun, they must correctly answer questions on how to safely handle the situation in order to progress through the program. Other gun safety-related questions are asked as objects in the rooms are found and touched.

Cook Children’s Aim for Safety program maintains a non-political approach, strictly focusing on educating families about ways to keep everyone safe when guns are in a home, Dr. Guzman says. The program emphasizes three steps: Safe Storage. Safe Children. Safe Play.

Using the kiosk’s touch-screen video program, participants interact and “learn something at the same time,” Dr. Guzman says, adding it’s less intimidating and “there’s no one there to judge you” on whether participants are familiar with standard gun-safety practices in their own homes.

“I think people are free and more open to change, and they’ll listen to the message and learn more about it before they actually make a decision,” Dr. Guzman says. “That’s the approach we want to have… and still deliver a high-quality educational piece that drives home the safety aspects of what we want to do with Aim for Safety.”

Edwina Parker, director of training at Defender Outdoors, says the retailer was “thrilled to be chosen to participate” in Cook Children’s educational kiosk rollout. The company makes gun safety “an integral part of our business, from the sales floor to the range check-in and throughout our training academy,” she says. It also offers private and group lessons with certified instructors on gun safety; handling and shooting; and situational and judgmental training.

“Our partnership with Cook Children’s is very near and dear to our hearts, and we believe education is a fundamental step in firearm safety for adults, as well as children,” Parker says. “We believe our customers will be curious about the kiosk and interested in using it with their children. Our clientele are conscientious gun owners who know and value safety above all, so it’s a natural fit for them.”

“Having an interactive learning tool for children,” she adds, “is a wonderful concept to keep their attention and educate them in a fun way.”

The concept for the Aim for Safety program began with a study led by Dr. Guzman in which Cook Children’s brought parents into a room to observe what their children in an adjacent room (unaware they were being watched) would do when they found a real handgun hidden in a box, backpack or purse. The study’s results showed 90% of the children — even if they had been repeatedly educated on safe gun practices by their parents — looked directly down the barrel of the gun or handled the firearm without telling any adults. Although they were real, the guns couldn’t fire.

The parents in the study who observed their children were shocked when they saw "their kids pick up a gun, pointing it toward their face, put their finger on the trigger — all the things they’d been told not to do,” Dr. Guzman says. They thought their children would "respect the gun" and not do what other kids were doing, “but their kids did the exact same thing,” he says.

Following that study, the Center for Children’s Health at Cook Children’s took the Aim for Safety program to schools and community gatherings to educate families about gun safety, including safe storage. The program also challenges families to have conversations about what to do when children go to other homes, such as a friend’s or relative’s home, where guns might be kept.

Based on what Dr. Guzman has seen, most gun-related injuries are accidental, he says. As of March, 12 children have been treated for gun-related injuries at Cook Children’s this year. Thankfully, none were fatal. Last year, the hospital system reported treating 63 unintentional gun-related injuries, resulting in five deaths.

 “Unfortunately, we see children injured by firearms in our community far too often,” says Rick Merrill, president and CEO of Cook Children’s. “We are so thankful to have incredible community partners like Defender Outdoors who recognize the importance of gun safety and want to join forces with us to keep children safe.”

The kiosk is another way the hospital system can further its reach in the community and educate more families about the safe handling and storage of firearms, says Amy Johnson, program coordinator for the Center for Children’s Health (C4CH) and Safe Kids North Texas Coalition led by Cook Children’s.

Johnson says she’s looking forward to the possibilities it offers. With additional Aim for Safety kiosks planned in the near future, it’s possible the booths could be taken into schools for children to use. Also, a link for the program is being developed for use on computers, she says.

“We could bring that link with us into the schools and have everything that’s on the kiosk there on their computers,” she says.

Dana Walraven, manager of community health within the Center for Children’s Health at Cook Children’s, says she’s also excited about the Aim for Safety kiosk and its potential to reach the community through education and conversations.

Safe storage is an important part of all home safety plans, whether you have children or not, she says.

“Safe storage is key for all items that may be considered dangerous to others, such as medication, cleaning products, and, yes, firearms,” Walraven says. “In fact, gun ammunition also should be stored safely and separate from guns.”

Cook Children’s hope is the Aim for Safety educational kiosk “will be a platform for kids to learn alongside their parents and other adult family members,” she adds.

“Creating safe habits early on will help model safer behaviors later in life,” Walraven says. “Children may still make mistakes as they grow, but making conversations about guns more routine may help encourage safer choices.”

Nine of those drownings in the stretch from January through middle March occurred in swimming pools. Three occurred in bathtubs. The children ranged in age from infancy through 9 years. 

Sharon Evans, trauma injury prevention coordinator at Cook Children’s, pointed out that drownings typically peak between Memorial Day and Labor Day but can occur any time of year. 

“If you have water, there's not an off-season,” she said. “A lot of these seem to happen on the weekends when the weather's nice and people go outside working in the yard. The child falls in the pool or somehow gains access.”

Data from Cook Children’s show two or fewer drownings in January-February each year from 2018 to 2021. The trend this year is unusual and concerning to Evans, who urges parents and caretakers to take precautions and stay vigilant to guard against accidental drowning injuries.

Last year, more than 60% of drownings treated at Cook Children’s occurred 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.

Those barriers – such as locks, alarms and fencing – can help keep unsupervised young children from getting into swimming pools.

“We always talk about those layers of protection. They're not guaranteed to prevent a drowning, but they do slow the child down as far as gaining access,” Evans said. “Toddlers are just curious. They're going to explore and see what they can figure out. As parents, we have to make sure they are safe.”

Sometimes the child who drowns in a backyard pool was playing outdoors with older siblings. Other times, the parent doesn’t realize the child left the house through an unlocked door or doggie door. Ice chests, mop buckets and horse troughs can also present hazards if they hold more than an inch of water, Evans said.

One rule prevails when it comes to bathtubs: Never leave the child alone … not to answer the doorbell, not to pick up the phone, not even for a second.

“I often say with injury prevention across the board, there is no do-over,” Evans said. “Just be alert.”

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.

Dana Walraven, manager of community health outreach for the Center for Children’s Health, led by Cook Children’s, said partners across 11 counties share education, access to swim lessons, safety videos, resources and social media with a consistent theme: Lifeguard Your Child.

“Knowing social media messages alone have reached millions, the messages and awareness are making a difference for a safer community,” Walraven said.

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 swim 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. 

So says Cook Children’s safety experts who reported more than 600 North Texas children were treated at the medical center for serious injuries involving accidents in these types of vehicles from 2017 to 2021. Of those, more than half were between ages 10 to 14.

“It feels like almost every week we see somebody injured who fell off an ATV or rolled a golf cart,” says Dan Guzman, M.D., a pediatric emergency medicine physician at Cook Children’s. He also heads the medical center’s Aim for Safety, an educational firearm safety program designed to reduce unintentional gun-related injuries to children.

“Some come in with bumps and bruises or a broken arm, nothing significant, and they get to go home,” he says. “Then you have those who rolled the golf cart and it landed on them, and they have a severe head injury. We want to reduce and prevent these injuries and deaths by providing community awareness.”

The 625 North Texas children in Cook Children’s report suffered injuries that required treatment in acute care, intensive care, surgery or were held for observation. Of those injured, 312 were ages 10-14. Children ages 5-9 were the next highest category with 180 injured in off-road vehicle accidents.

Six children died from injuries sustained in the accidents during that time frame, according to Cook Children’s report, which included patients younger than 1 year old.

Preventing Injuries

To prevent such injuries among children, the American Academy of Pediatrics (AAP) recommends children under 16 do not drive or ride as passengers in two- and four-wheeled off-road vehicles.

If parents followed AAP guidelines, it would help, says Sharon Evans, trauma injury prevention coordinator at Cook Children’s, pointing out most injuries happened among ages 5-14 based on the hospital’s data.

“That’s a lot of kids who could avoid injuries,” Evans says.

AAP’s guidelines were determined based on the physical and developmental stages of children, Dr. Guzman says.

“What’s really important is that parents understand their kids’ developmental and decision-making skills are not fully developed and potentially place them in danger,” he says. “You wouldn’t let your 12-year-old or 14-year-old drive a car, so why let them drive a golf cart or an ATV without adult supervision?”

“And the dexterity of a 9 or 10-year-old combined with their limited experience and ability to handle a potentially powerful machine—it’s a bad combination and potentially deadly,” Dr. Guzman says. “We’re relying on them to be able to make decisions to stop or brake when there’s a fence. All these factors that we take into consideration as adults when we’re driving…kids can’t process quickly because of lack of experience and their overall development. It makes it really difficult.”

Safety Measures

Since many families allow their children to drive and ride in off-road vehicles before age 16, Dr. Guzman says the next best approach to prevent injuries is to teach them safety measures.

Besides determining whether their children are physically and mentally ready, Evans and Dr. Guzman also recommend adult supervision for children operating or traveling in off-road vehicles, as well as requiring helmets and seatbelts and using whatever safety system the vehicles have in place.

Both suggest parents think ahead before allowing their children access to these vehicles.

“Basically, it goes as fast as a car, but there are no sides. There’s nothing to protect children, especially if they’re in there with no seatbelt, no helmet, no nothing,” Evans says. “There’s always that best practice we wish every parent could do. As a parent, realize it can be deadly and set guidelines before the child even gets close to getting on it—like what the speed is going to be, how far they can go, what area they’re driving in. For example, crossing a road, be it a major one or a rural one, is still dangerous.”

The ATV Safety Institute published a Readiness Checklist to determine when children are prepared to safely handle ATVs. The checklist covers areas such as physical development; visual perception/motor development; social/emotional development; and reason and decision-making ability.

Dr. Guzman says he hopes parents understand most injuries related to off-road vehicle accidents are avoidable.

“We want to make sure families understand we’re not here to preach. We’re just giving them information and a unique perspective,” he says. “Unfortunately, what we do and what we see on a daily basis gives us a window into these tragedies that are totally preventable.”

“I'm aware of eight fake car seats that have been found by car seat technicians at hospitals in the Dallas-Fort Worth region over the past several months,” said Sharon Evans, trauma injury prevention coordinator for Cook Children's Medical Center. 

One of those fake seats was found at Cook Children's this past fall when a family was preparing to take their child home from the Neonatal Intensive Care Unit (NICU). 

“I was teaching a class one night with a family and they brought in the car seat and I was just kind of looking at it like, hmm, something's not right,” said Christie Clemons, NICU child passenger safety tech and instructor. "The more I looked at it, the more I determined this was not an okay car seat.” 

Clemons has been a car seat technician for 10 years and says she's never seen anything like the one that showed up in her class that day. After asking a few questions, Clemons learned the family had purchased the seat on the internet. 

Evans said she became sick to her stomach when she heard about it because the family had been using it, not knowing the difference. 

“I just really worry that if a child's in a crash, they're gonna be severely injured or killed. We know there wasn't a retainer clip, which in the United States, most have a chest clip or a retainer clip. But then as we started looking, the webbing is thinner. The buckle where you snap it together is hollow. I could bend the plastic. I could bend the whole seat. The way the straps are attached. I don't think they would hold during a crash. I'm really afraid the child would be severely injured or die,” Evans said.

So how can parents know whether a car seat is counterfeit or fake?

“There should be a sticker on the car seat that says it meets or exceeds, or it conforms to federal motor vehicle safety standard (FMVSS) 213,” Evans said. 

Clemons says you also want to look for the manufacturer, model number as well as height and weight requirements which are required to be on the car seat by law. 

“The stickers have to be on the car seat to meet FMVSS 213,” Clemons said. “And you don't have to spend a lot of money to get a really great seat. You just need to make sure that it meets the standards that are out there.”

Both Evans and Clemons hope parents will look for these safety standards when shopping online and in stores because if the unthinkable happens, a quality car seat could save a child's life.  And they encourage everyone to look for these safety standards regardless of the retailer. Even when shopping at a big name brand store.  

“None of us want to think about being in a crash, but if you listen to the news every morning,  there's a high chance you will be,” Evan said. “Unfortunately, the number one way kids are injured or killed is in a car crash.”

One of the best ways you can ensure your car seat is safe and installed properly is to sign up for a free car seat check. Cook Children's and Safe Kids North Texas offer virtual car seat checks at freecarseatcheck.org.  

“You’ll shoot your eye out,” she said.

Toy guns have changed since the release of that 1983 classic depicting a 1940s family. If Ralphie were a kid today, he may have his sights set on a water-based gel blaster—one of the popular toy guns of this generation. And Ralphie’s mom would likely say the same, for good reason.

Any toy with a projectile has the potential to cause an injury, especially to the eye. Dan Guzman, M.D., is a pediatric emergency medicine physician on the medical staff at Cook Children’s Medical Center. He also leads Cook Children’s Aim for Safety initiative, which is designed to reduce injuries through gun safety education. Dr. Guzman recently purchased a gel water ball gun to see for himself what hazards they pose to children. Also known as gel soft guns, these toy shooters are similar in design to airsoft guns, but their bullets are made of biodegradable water-filled beads.

“The bullets feel really squishy,” Dr. Guzman said. “But they’re definitely a projectile, and any projectile to the face or in the eye is going to hurt or may cause some injury. I shot them at a tree to see what they would do. Some of the bullets exploded into nothing, but there were some that seemed to be crystallized and actually turned into smaller projectiles once they exploded, which concerned me a little bit.”

A review of the Consumer Product Safety Commission’s electronic injury surveillance system found more than 6,500 cases of eye trauma from toy guns with projectiles between 2010 and 2019, according to a study published in the journal Investigative Ophthalmology and Visual Science. The most common injury was ocular contusion, better known as a black eye. The most serious wound was an open globe injury. Most of those injured were boys, and more injuries occured in December than any other month of the year.

“I haven't seen a lot of injuries from these gel guns just yet, because I think they are relatively new, but I suspect after the holiday, I will,” Dr. Guzman said.

If Santa leaves a projectile-firing toy gun under your tree, Dr. Guzman has a few tips to help keep your child, and those anywhere near the line of fire, safe from injury.

“I'm not going to tell you you shouldn't have one,” Dr. Guzman said. “But I’m definitely going to tell you how to do it safely to make sure your kid doesn't end up in my ER with some horrible injury where they've lost vision in one of their eyes and they'll never be able to see out of that eye again.”

Wear eye protection. Many manufacturers place this warning on their toy gun products, and some even come with eye protection.

Supervise your child and teen when playing with toy guns. They may not be as life threatening but they do shoot powerful projectiles and can cause significant and life-altering injury. Kids—especially teens—are naturally impulsive and don’t always think through the potential consequences of their actions, like what could happen if you aim at someone’s head, or turn the gun towards your face to look down the barrel, or shoot from too close of a distance.

“We just want people to be safe,” Dr. Guzman said. “With these eye injuries, many recover, but some don’t. You truly could put an eye out and nobody wants to be responsible for that.”

Teach kids to respect the danger. To some degree, toy guns that shoot projectiles, be them water-based gel beads or plastic pellets, need to be treated with the same respect and caution as a real gun. Closely monitoring your child while playing with a toy gun gives you the opportunity to see how they interact with the gun, correct concerning behavior and opens the door for conversations about safety that may translate to real guns.

As an emergency department physician, Dr. Guzman has witnessed first hand the devastation that can occur when a gun isn’t handled or stored properly. That’s what drives his passion for gun safety.

“I want to give families the tools to be able to make a great decision,” he said. “If we’re going to play with a toy gun that shoots a projectile, it’s important to know some basic safety steps to keep the entire family safe. Those key safety points then help to shape the conversation about real guns.”

It’s a good idea to practice the same safety measures with projectile firing toy guns as you would with a real gun. When not in use, toy guns should be stored away where kids can’t freely access them. And if they do happen upon one, be sure they know how to respond.

“That's another key point,” Dr. Guzman explained. “What do you do when you find something like this, even a toy, when you go to a friend's house? You don't just pick it up and start pointing at people and playing with it. They need to know to respect that object so they can respond safely.”

Make sure your child knows to keep toy guns at home. Never take them to school or a public place where they can be mistaken for a real gun.

While we love taking care of our patients, the last place you want to spend your holiday if you can avoid it is in the emergency department. Play smart and be safe. We “triple-dog-dare ya.”

Over the last six months, Cook Children's has released 20 articles regarding mental health, suicide in youth and teens, and resources to help young people in crisis. Recently, we spoke with experts to learn more about what families can do to help reduce the risk of suicide attempts and learned that there are a few things that start at home. 

What do you do with expired and unused prescription drugs? Do you throw them in the trash? Do you continue to take them after expiration? Or do you simply let them sit in your home?

Experts at Cook Children’s Medical Center say it is more important now than ever to dispose of unused drugs because of the alarming statistics of young people overdosing. In July, Cook Children’s reported a record number of pediatric hospitalizations for drug overdoses in 2021 compared to previous years, particularly with opioids. 

"It is a huge problem right now. We’re seeing more kids in the hospital for opioid overdoses than ever before. The vast majority of them are intentional ingestions," said Artee Gandhi, M.D., medical director of Pain Management at Cook Children’s. 

“Teens and young adults are having ‘pill parties,’ where they are taking pills from their homes, and bringing them to a party with their friends. They then put them in one large bowl and grab handfuls,” Dr. Gandhi explained. “Not only is this unsafe, but different medications have potencies after their expiration dates and you can get sick from the medication being expired.”

Experts at Cook Children’s say the best thing to do is to safely dispose of any drugs that are expired or no longer being used for their intended purposes.

Savannah Panagopoulos, a child safety, and poison prevention specialist for the Center for Children’s Health led by Cook Children’s, says there are a plethora of take-back boxes in the area that allows people to dispose of drugs safely.

“These are permanent sites, where people in the community can come and drop off drugs, to get them out of the house. Taking medications that are no longer needed or expired out of the household could significantly reduce the chance of accidental poisoning or misuse that's intentional,” Savannah said.

Savannah says “50% of potential drug and substance abuse cases start with a friend or family member giving it to someone in the home that it’s not intended for.”

She goes on to explain that only 4% are purchased from a stranger or a drug dealer.

“Not only does disposing of the drugs safely give you peace of mind, but it’s also important to dispose of them to keep our environment safe. Not flushing the drugs down the toilet, putting them in cat litter, etc.,” Dr. Gandhi said.

She also reminds families that flushing drugs down the toilet is dangerous because of the harm it can do to our water systems. Dr. Gandhi says Cook Children’s pharmacy has a take-back box, which is easy and convenient to use. The box is located inside the retail pharmacy at Cook Children's and accepts any medication, with the exception of liquids. 

“You don’t have to talk to anybody, you don’t have to see anyone. You put it in the disposable container and walk away,” she said. 

Cook Children’s also has a system in place that also texts families to remind them to take back their unused medications and to keep them out of the reach of children.

“We do this so families don’t run into a problem with children unintentionally or accidentally ingesting medication that is not safe for them,” Dr. Gandhi said.

Savannah says while most take-back locations are located in pharmacies, there are other locations, such as police stations, that are open 24 hours a day for safe disposal.

“A good rule of thumb is to take off all labels with any identifying information before you drop them off,” Savannah said. ”Although all drop-off locations are in secure areas that is something we tell people to practice for safety and privacy.”

The United States Drug Enforcement Administration (DEA) also hosts national take-back days across the country every year. In April, more than 4,000 law enforcement agencies participated, which resulted in nearly 900,000 drugs being taken out of homes and disposed of safely. The next National Take Back Day is Oct. 23, 2021. Information about national takeback days can be found here.

Both Cook Children’s experts want families to know and spread the word about this resource. It is important to know that you don’t have to wait for a medication to expire and if the medication is expired, you can drop it off before you go and get a fresh prescription.

Cook Children’s Center for Children’s Health has a page dedicated to poison prevention. The North Texas Poison Center is open 24/7 and can be reached at 1-800-222-1222. You can find information about drop-off locations in North Texas, pain management, and more.

It is important to note you cannot dispose of items such as needles, oxygen tanks, thermometers, and sharps when dropping off your medication.

Dr. Gandhi says the most important thing to remember is, if you are done taking medicine and have used it for the intended purpose, dispose of it like you would an antibiotic or anything else.

“This goes for over-the-counter medication such as Tylenol, Ibuprofen, Aleve, etc,” she said.

It was supposed to be an easy but productive Sunday afternoon. My plan for the day was to get a jump start on packing for an upcoming vacation. For once, I was going to get ahead of the game.

Then, I heard these words.

“Mom, I think a piece of my earbud came off and is stuck inside my ear.”

What? That’s not supposed to happen, right? Surely these things are constructed in a way that ensures no piece of it will come off inside my 12-year-old’s ear. I trust earbud manufacturers have thought of that.

Upon examination, a piece of it was, in fact, missing. We scoured the area where my son was sitting, hopeful that it had fallen off onto the chair or floor. It was nowhere to be found.

My only recourse? Urgent care… on a Sunday afternoon… in the middle of an RSV outbreak and COVID-19 surge.

My easy, yet productive Sunday afternoon plan just went out the window. Off to urgent care we went. It would be more than an hour and a half of waiting in the car to get the call that it was our turn to come in to see a physician, and it took all of two minutes for the physician to locate the rogue earbud piece and extract it from my son’s ear canal. Waiting time well spent knowing his ear was free and clear of anything that shouldn’t be there.

The experience left me wondering. Is this a thing? Has it happened to others? If so, how common is it?

I set out to find some answers and tips for those who might find themselves in similar situations. Charles Saadeh, M.D., an ear, nose and throat (ENT) specialist on the medical staff at Cook Children’s Medical Center, kindly answered my questions.

Safety First

Turns out, having a foreign body in the ear canal is one of the more common reasons that patients end up in Dr. Saadeh’s ENT clinic. He estimates that about 10 to 20% of those visits are related to earbuds.

Even so, Dr. Saadeh says earbuds are generally safe if your child has a normal, dry ear without any drainage or hearing impairment. Before you plug those little ears with an earbud, make sure they’re healthy.

Size Matters

Earbuds aren’t one size fits all. Some designs fit better than others. Dr. Saadeh says earbuds should fit well and be comfortable. Research different designs and sizes to determine the best option for your kid. You may have to try a few before you settle on one.

“Over ear headphones are preferable if headphones with earbuds just don’t fit right,” Dr. Saadeh said.

Mind The Volume

The biggest danger with earbuds, or any personal listening device, is the volume. Too loud and your child can permanently damage their hearing.

Noise induced hearing loss is becoming more common. No doubt because of the increased use of personal devices. In fact, 1.1 billion young people globally are at risk for hearing loss due to unsafe listening practices, according to the World Health Organization. That’s partly because many kids turn the volume up too high, damaging the tiny hair cells in the ear that send sound messages to the brain. Once the damage is done, it can’t be repaired.

“You have one chance to protect your hearing,” Dr. Saadeh said. “The hearing damage we do now will catch up to us in 20 to 30 years. So, if it hurts, turn down the volume.”

Dr. Saadeh likes the 60/60 rule. Don’t allow the sound level to climb above 60% of the maximum volume, and listen for no more than 60 minutes at a time. There are volume control settings on devices and apps that parents can use to set sound limits on their child’s electronics. Do an online search for “volume limiter for kids” to get the scoop on these.

Step Away From the Q-Tip

Bless his heart, my son tried to remove that tiny earbud piece by attempting to dig it out with a Q-tip before telling me what had happened. I apparently failed to teach him that we do not, under any circumstances, stick things into our ear canal, even Q-tips. And I’m not disparaging the usefulness of Q-tips here. It’s own box is labeled with this warning.

If you fear your kid has a foreign body in their ear, call your pediatrician or an ENT, and leave it to the professionals to remove. Using a Q-tip may push the object further into the ear and damage the eardrum. I’ve since had this discussion with all three of my fearless boys.

“We can get foreign body cases into the clinic very quickly, although a lot of these issues are not emergencies,” Dr. Saadeh said. “The one thing to keep in mind that is an emergency is a battery. If there is any concern that there's a disc battery in the ear, we consider that an emergency, and it needs to be seen as soon as possible.”

Signs that your child might have something lodged in their ear include complaints of muffled hearing or pain due to fluid build up and subsequent infection behind the foreign body.

So, there you have it. Everything I learned about earbud safety thanks to an untimely mishap. We haven’t sworn off earbuds forever, but we are a little more careful about their design and fit.

By the way, those particular earbuds went into the trash. Actually, my son asked if he could destroy them with a hammer first. He finds deconstructing fun. I allowed it. At least someone besides the steady-handed urgent care doctor did something productive that day.

This is my friend Van.

Van is at my pool. Since all of us parents are now COVID-vaccinated, we are feeling more comfortable with outdoor playdates. And our new pool has been a great escape from the heat!

We parents have loved to see each other. Hanging out and listening to music and eating meals together has been so much fun. We’ve missed it so much.

But our new pool poses a risk that wasn’t there before during backyard playdates.

Over the weekend, five children were victim to drownings in our area, and were rushed to the Cook Children’s ER. Some went home. Others did not.

Look at Van’s wrist. He’s wearing a WATER WATCHER band.

This band says that, no matter how many people are in or around the pool, the wearer is in charge of watching the water. The lifeguard, if you will.

The band is traded out every 15-20 minutes. The person who wears it stands guard by the pool with no distractions.

You don’t have to have this fancy band – though it will be available at my office in Forest Park very soon to pick up, and other Cook Children’s PCP offices as well. You can use anything really – a lanyard, a fancy scrunchie, a jangly bracelet.

As long as the responsibility is assigned, and someone is always watching.

Let’s ENJOY these much-missed moments together! We have earned our time together again after last summer’s solitude.

But let’s be SAFE in and around the water – the statistics are sobering in our area lately and now is the time to lifeguard your child!

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.

What is mRNA, and how does it differ from other vaccines we are familiar with?

Messenger RNA is a new type of vaccine technology. It has been studied for a couple of decades and has been researched for things like cancer vaccines. Messenger RNA is a molecule that we all make billions of copies of in our bodies every day.

The way this vaccine works is that messenger RNA is in the syringe and is injected into your arm. That messenger RNA is taken up by muscle cells and other white blood cells in the area. The messenger RNA tells your body to make the spike protein from the virus. When your body makes the spike protein, that's recognized as foreign, it doesn't belong there. Your immune system learns what the spike protein from coronavirus is, makes a response and develops antibodies, while other parts of your immune system learn about the spike protein. The coronavirus has the spike protein, and if you're exposed to it later, your body says, “Oh, this is that spike protein, I know what to do about this,” and binds it and prevents infection.

How was the COVID-19 vaccine made so quickly and how does that timeline compare to the development of other vaccines? 

The speed of this vaccine is one of the real miracles of modern science. The difference between this vaccine’s development and other vaccines like Prevnar, Menactra or the hepatitis A vaccine is that the steps for those were done one at a time over about six years. For the COVID-19 vaccine, all the steps were all done simultaneously.

If you're developing a Prevnar or a hepatitis B vaccine, you:

• Figure out what kind of vaccine you want to make, a live virus vaccine or a bacterial protein.
• Develop the vaccine.
• Conduct a Phase I trial to look at the dose.
• Conduct a Phase II trial where you look at about 500 or a thousand people, and you give them the vaccine to see if it's safe. 
• Conduct a Phase III trial of 10,000 or 20,000 people to see if it works.
• Get FDA approval.
• Make the vaccine. That may take a year.
• Distribute the vaccine. That may take another six to 12 months.

For Operation Warp Speed, a couple of things worked in our favor. Messenger RNA technology was available and the machines and scientists were already in the labs. Normally, a Phase II trial would take a year or two to get a hundred or more volunteers to enroll. It could take three years to get another 10,000 or 15,000 volunteers. With there being an active pandemic going on, there were more than 30,000 volunteers overnight.

To see if the vaccine works, there has to be enough disease in the community to cause enough infection to see if the vaccine is better than the placebo, or if they're equal. Normally, that may take a couple of years. In this case, the pandemic was so bad that we could see right away that placebo recipients had a lot of COVID-19 and the vaccine recipients didn't. That endpoint was reached quickly and very safely.

Also through Operation Warp Speed, the vaccine was being tested at the same time it was being manufactured and while plans were being made for distribution. Operation Warp Speed also paid for vaccines to be developed by companies, even if they were determined to be ineffective or didn't work. You'd never get a vaccine company to make a hundred million doses of a vaccine and take that financial risk, but Operation Warp Speed paid for that. The fact that there was plenty of disease and that everything was done at the same time allowed for very safe development of the vaccine in about 10 months. I've gotten both of my doses now. I think it's a very safe vaccine.

Is it normal for a vaccine to be released while still in a clinical trial?

I'm not sure that a vaccine has ever been released for EUA (Emergency Use Authorization) before. The reason that is done is that when there's been a pandemic declared, the FDA is allowed to use a vaccine or monoclonal antibodies or an antiviral medication if it's believed that the benefit outweighs the risk and it's deemed to be safe from everything that's known about it. The Phase III trials are still ongoing, which means that for the 40,000 people in the trial for Pfizer that were vaccinated, they are still being watched and are still collecting data.

Would we know by this stage in the trial, if there were major side effects with the COVID-19 vaccine?

You cannot be 100% sure. They watched about 20,000 people who got the vaccine for two full months and looked at every adverse event that happened to those people. When you look at the side effects of all kinds of vaccines throughout history, all of the serious side effects happen within about six to eight weeks. It's very rare to have a side effect from a vaccine after that time if it happens at all. We know that influenza vaccine can cause Guillain-Barre syndrome, which is a temporary paralysis requiring hospitalization. It’s a terrible side effect that happens in about one out of a million doses of influenza vaccine. That happens within six weeks. We know that with the measles, mumps, rubella (MMR) vaccine, you can get low platelets that happens at about three weeks. We know that with any vaccine or medicine, you can have anaphylaxis, which is a severe life-threatening allergic reaction that happens within two hours. For the vaccines that are known throughout history, there's no significant major side effect that's long-term. The only one I can think of is measles vaccine. There can be chronic measles infection that can lead to problems even a decade later, but that's a live virus vaccine. The COVID-19 vaccine has no virus in the vaccine, that would not even be a consideration for this. 

Have there been studies specifically on the safety of the COVID-19 vaccine in children?

There have been some children, 12 years of age and older, in the vaccine trials, but it's not enough that it has been licensed for children yet. There are some trials currently enrolling pediatric patients with Pfizer and Moderna.

Do you know when the COVID-19 studies regarding children will be complete? 

I don't know for sure. I think everyone is hopeful that we'll have some results by the spring, in the next three or four months.

When will the COVID-19 vaccine be available for children? 

There will have to be trials that document safety in children, and document that it works. Then it will go through the FDA, just like it went through for the adult COVID-19 dosing in December 2020. Then the FDA will give a ‘yes’ or ‘no.’ The Advisory Committee for Immunization Practices (ACIP) will then give a recommendation for a time frame and which children should receive the vaccine. I hope it will be here before the summer, but I don't know.

What benefit is there in vaccinating a healthy child if the statistics show that 99% of children recover from COVID-19?

You could say that for chicken pox, and for a lot of things that kids get vaccinated for. I think when you look at a pandemic, and you look at the transmission of the virus, you have to stop transmission of the virus. Even though children are not great transmitters, they still do spread the virus. You would want to add them in safely if the vaccine is safe for children. You would want to immunize children to remove another place for the virus to land. You want as much of your population as possible to be immune to the virus, to slow down community numbers, and stop the pandemic spread. 

What should parents who have children with underlying health conditions know about the COVID-19 vaccine?

Parents should talk to their child’s pediatrician. They need to see if the underlying condition puts the child at increased risk for problems with the COVID-19 disease and make that decision with their doctors. There is not a tremendous amount of data in immunocompromised hosts or other conditions, but there's some data and they'll need to talk to their doctors about their child's specific situation. Keeping in mind that if their child catches COVID-19, that may be riskier than the vaccine, there's always a choice. If you decide that you don't want to get the vaccine, you are saying ‘yes’ to the ongoing risk of infection. Depending on your child’s condition, that may be a reasonable choice.

Are there any medical conditions that would prevent a child from getting the COVID-19 vaccine?

You don’t want to get the vaccine if you are allergic to the vaccine components. There's not a known, proven medical condition where the diagnosis would prevent getting the vaccine. You don't want to get the vaccine if you've had anaphylaxis to the ingredients in the vaccine. If you've had anaphylaxis to the first dose of the vaccine, you wouldn't get the second one. 

Do we know what ingredients in the COVID-19 vaccine causes allergic reactions?

It is thought that part of the allergic reaction may be the polyethylene glycol or the PEG that's in the vaccine. Some individuals are allergic to polysorbates, and that can cross-react with polyethylene glycol. People that are allergic to either of those two compounds would be a contraindication for them to get the vaccine.

It's a very small vaccine. It contains the messenger RNA and a fatty or a lipid capsule around that little piece of RNA. There is a list of what's in that capsule on the Pfizer, CDC and FDA websites. There are no adjuvants nor preservatives in the COVID-19 vaccines that are currently available.

One of the complications of COVID-19 in children is MIS-C. What is MIS-C? 

MIS-C stands for multisystem inflammatory syndrome due to COVID-19 disease. If you catch the SARS-CoV-2 virus, you can get an asymptomatic infection or a symptomatic infection with a cough, fever, and shortness of breath. There are some children who, about the third or fourth week after they start their infection, will develop an inflammatory syndrome. The first part of their initial infection may not have any symptoms at all, and they can still get this inflammatory syndrome. Children with MIS-C have high fevers and appear very ill. They have very abnormal blood values for inflammation, and they have evidence that multiple organ systems are involved. They may have inflammation of the heart, which we can pick up with lab tests. They may have inflammation of the kidneys or the liver. They often will have a rash on their skin, pink eye and/or red swollen lips. When these children are admitted to the hospital, they frequently require intensive care before they get better. 

How should MIS-C be considered when weighing the risk and benefit of the COVID-19 vaccine in children? 

MIS-C is a high morbidity rate, meaning children are terribly ill, often in the intensive care unit (ICU), and occasionally on life support. You don't want your child to get MIS-C, it's serious. For reasons that are not clear to me, the mortality rate is very, very low, which we're grateful for. There aren't very many diseases like that. These children are ill, and the huge majority of them live through that, but not always unscathed. Some will have ongoing damage to the coronary arteries or the heart. When the data comes out about children, the hope is that it will show that those who are vaccinated are not only are protected from COVID-19, but protected from getting MIS-C. That data should be forthcoming. 

What are the side effects and adverse reactions of the COVID-19 vaccine?

There are a group of side effects that are part of the reactogenicity or part of your system saying, “Hey, I need to do something with this new spike protein floating around my body.” These side effects occur within the first 48 to 72 hours after the vaccine and are typically headache, muscle aches, fever, chills, joint pains, and sometimes redness and swelling where they get their vaccine. This occurs in about 20% or 30% of people after the first dose, and it might even be 40% of the people after the second dose.

The other side effects from the vaccine include anaphylaxis where you have a life-threatening allergic reaction within two hours of the vaccine dose, and it often happens within 15 to 30 minutes. You're more at risk for that if you've had anaphylaxis to something else in the past. It's thought that anaphylaxis happens in about one out of 90,000 doses of the vaccine. I have read and have not seen any deaths from that. Everyone has recovered and gone home from the hospital, and they can't get their second dose. That's probably the most serious side effect. Then there are some things that we're not sure about whether or not they're from the vaccine.

If you watch 20,000 people for two months, you can expect some of them will have a heart attack. Some of them will have a stroke. Some of them will be killed in a car wreck. All of those things happen. When you watch a large group of people for two months, it's not always easy to tell if the vaccine triggered the problem that happens. We know that in the Pfizer trial, there were four cases of Bell's palsy, which is paralysis of one side of the face that almost always completely resolves, but not every time. There were no cases of Bell's palsy out of 17,000 people that got the placebo. But four cases out of 17,000 is not above the baseline rate that you'd expect. Nobody knows what to make out of that information. There were about 12 cases of appendicitis after the vaccine and eight cases after the placebo, a tiny difference, but not different than the background rate. There are some side effects that you'll read about that are hard to determine if they're related to the virus, but for sure the anaphylaxis is in some cases. For sure, the reactogenicity side effects can be seen from the vaccine. 

If a child has a history of allergic reactions, should they avoid the COVID-19 vaccine? 

If they have an allergic reaction to something not related to the vaccine, a food allergy, a penicillin allergy, a bee sting allergy, they can still get the vaccine once it's approved for children, but their 15 minute observation period will be 30 minutes instead. Any child who’s had an anaphylaxis type of reaction to anything, needs to talk to their doctor first before they sign up for the vaccine and go over that with them.

What research is going on to track long-term side effects of the COVID-19 vaccine? 

For the people that are in the Phase III trials, it's my understanding that those companies will follow those recipients for two years, and they've already been following them for six or seven months. One of the things that you have to keep in mind about long-term follow-up for these vaccines is that in the current pandemic, you can't justify waiting another year to release these vaccines. With 3,000 or 4,000 deaths a day in the country, it only makes sense for something that's been proven to be safe to be released because the benefit of the vaccine at this point outweighs the risk of getting COVID-19. 

Does the COVID-19 vaccine change your DNA?

No. The vaccine injects messenger RNA into your muscle cell, or your white blood cells nearby. It never enters the nucleus where the DNA is. It doesn't integrate itself into your DNA. The messenger RNA particle is very fragile and it's not even around for very long, it disintegrates and goes away very quickly. This is why the vaccine has to have a deep freeze, and if you thaw it out for too long, it doesn't work. If you open the freezer for too long, and it gets at the wrong temperature for too long, it's inactive. It's a pretty fragile particle, and there's no evidence that it integrates into your DNA. 

Does the COVID-19 vaccine cause infertility? 

No. There were pregnancies during the vaccine trials, and there's no reason to think that it would cause infertility. If you think about it, if you make antibodies to the spike protein from the vaccine, that's exactly what you're going to do if you catch the COVID-19 infection. Either way, you get antibodies to the spike protein. If the COVID-19 infection doesn't make you sterile, the vaccine wouldn't either. 

Is the COVID-19 vaccine safe for pregnant women? 

I recommend that pregnant women speak with their physicians and make their own decision about the vaccine. If pregnant women want the vaccine, they can get it. The American College of Obstetricians and Gynecologists has said there's not any reason not to vaccinate pregnant women. What is recommended is that pregnant women talk to their physicians and make their own decision. Pregnant women have to keep in mind that if they catch COVID-19 during the pregnancy, they fare worse than if they're not pregnant.

Are there any other common myths about the COVID-19 vaccine?

There's no government implanted chip. I've heard the rumor that you get implanted with a chip when you get vaccinated and that the government is going to track you. All I can say is if you have a smartphone, there's probably already someone tracking you.

Highlighting its nationally recognized achievements in patient safety and quality, Cook Children’s Medical Center was named a Top Children’s Hospital nationally by The Leapfrog Group. Announced today, the Leapfrog Top Hospital award is widely acknowledged as one of the most competitive awards American hospitals can receive. The Top Hospital designation is bestowed by The Leapfrog Group, a national watchdog organization of employers and other purchasers widely acknowledged as the toughest standard-setters for health care safety and quality.

“I'm so grateful to our entire team of health care givers, not just those on the frontline, but everyone who’s working to help us drive the highest quality and safety,” said Rick W. Merrill, President and CEO of Cook Children’s Health Care System. “This award is not a surprise to me because I know the incredible work that goes on here at Cook Children’s, and I’m so proud of what we are able to accomplish.”

Over 2,200 hospitals were considered for the award. Among those, Cook Children’s Medical Center received a Top Children’s distinction. A total of 105 hospitals were selected as Top Hospitals, including:

• 9 Top Children’s Hospitals
• 29 Top General Hospitals
• 19 Top Rural Hospitals
• 48 Top Teaching Hospitals

The quality of patient care across many areas of hospital performance is considered in establishing the qualifications for the award, including infection rates, practices for safer surgery, maternity care, and the hospital’s capacity to prevent medication errors. The rigorous standards are defined in each year’s Top Hospital Methodology.

“Being recognized as a Top Hospital is an extraordinary feat and we are honored to recognize Cook Children’s Medical Center this year,” said Leah Binder, president and CEO of The Leapfrog Group. “Despite the extraordinary pressure and strain of the COVID-19 pandemic, Cook Children’s Medical Center has demonstrated an unwavering dedication to patients and to the Fort Worth community. We congratulate the board, staff and clinicians whose efforts made this honor possible.”

To qualify for the Top Hospitals distinction, hospitals must rank top among peers on the Leapfrog Hospital Survey, which assesses hospital performance on the highest standards for quality and patient safety, and achieve top performance in its category. To see the full list of institutions honored as 2020 Top Hospitals, visit www.leapfroggroup.org/tophospitals.

The Centers for Disease Control and Prevention (CDC) is discouraging trick-or-treating nationwide, calling it a high-risk activity for spreading COVID-19. They’re also dissuading trunk-or-treat events (where treats are distributed from trunks of cars in parking lots), indoor parties and haunted houses.

So why are these Halloween favorites considered high-risk?

“We know outdoor activities are much safer than indoor activities,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. “The problem is coming in close contact with people you’re not around regularly, like family members.”

She says masks have been very beneficial in slowing the spread of COVID-19, but warns of a recent rise in cases in Fort Worth and surrounding areas.

“Tarrant County has had an increase in COVID-19 cases over the last couple of weeks, and our positivity rate is hanging around 10% or 11%, which is pretty high,” she said. “The State of Texas is several percentage points below that right now. So now is not a good time to increase face-to-face contact locally.”

As of Oct. 5, 672 people had died of COVID-19 in Tarrant County, and nearly 45,000 others have recovered from the virus. With the current uptick, Dr. Whitworth says maintaining six feet of distance from other people is critically important, regardless of the activity.

“When you talk and exhale, you have droplets come out of your mouth and your nose that you don't see. There are a lot of them and they typically fall within three feet, but not always. You may talk louder or you may cough and they might travel farther. This is why the recommendation is to stay six feet apart” Dr. Whitworth explained. “It is less risky if you're outside because most of those droplets are diffused away and diluted outdoors. Of course, it’s even safer if you can wear a mask.”

In case you’re wondering, she isn’t talking about a Halloween mask. Dr. Whitworth says typical Halloween masks have openings for the mouth and nose, which defeats the purpose of stopping the spread of droplets.

But Halloween doesn’t have to lose all of its magic. Rayne Delgado, program coordinator for the Child Life Zone at Cook Children’s, has suggestions on how to make Halloween fun and safe for children this year.

“There are a lot of things families can do instead of trick-or-treating, like scavenger hunts in the house, family movie night and games.” Rayne said. “Pinterest also has a ton of craft ideas that meet all budgets.”

Here are some specific ideas Rayne shared with us:

Sensory fun

• Make Halloween slime and add googly eyes or critters in it
• Create sensory boxes filled with Halloween candy to find
• Build sensory bins with things like fake spider webbing, dyed-spaghetti noodles, soapy water, black beans, crushed graham crackers, un-popped popcorn, dyed rice, and Halloween trinkets (If age-appropriate)

Cooking activities

• Pumpkin face homemade pizza
• Dessert pizza using Halloween candy
• Carmel apples
• Ice cream cone witches hats
• Mummy hot dogs

Games

• Play Halloween-themed bingo
• Create a family mystery game with a play on Clue.
  • Using different rooms in your house, family members are the characters. Swap weapons for costumes.
  • Try to figure out which family member stole what piece of candy from what room, while wearing which costume. (This can also be done virtually with children and their friends. Switch rooms to each other’s houses.)
• Create an escape room in the house.
  • Start with one envelope that needs to be solved. That leads to another with another puzzle and so on until you find the bucket of trinkets/candy.
• Have a costume contest
  • Find things in the house to play dress up with. Who can be the most creative or silliest?

(We have provided templates in the 'Downloads' section of this article.)

“We’ve seen gun sales increase significantly nationwide over the past several months,” said Dan Guzman, M.D., a Cook Children’s emergency physician. “Now, with many children being in the home for longer periods of time, curiosity and boredom are something we need to expect. We have to stay vigilant and make sure we’re doing everything we can to prevent a tragic accident.”

According to Small Arms Analytics and Forecasting, this year’s gun sales have already eclipsed 2019 by more than one million firearms.

“With the hunting season about to begin in earnest and the presidential election season about to start in earnest as well, 2020 will without doubt exceed the previous high of 16.6 million units sold in 2016,” SAAF chief economist Jurgen Brauer wrote in an emailed statement provided to FOX Business.

Last year, 41 children were admitted to Cook Children’s for injuries related to guns (including handguns, rifles, shotguns and other firearms such as BB guns.) With 23 children already injured in 2020, Dr. Guzman fears he could see more of these patients this year than last.

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

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

“As parents need to feel comfortable having open-ended conversations with others where our children may play and stay,” he said. “That includes family members and close friends. Don’t be afraid to ask if there’s a gun in the home and if so, how it is stored. Keep the conversation focused on safety and not politics.”

Dr. Guzman offers these safety tips:

The 3 Ts of firearm safety and children

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

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

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

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

Over the course of a week, there were three different auto pedestrian injuries, where a child was hit by a car and ended up in Cook Children’s Pediatric Intensive Care Unit.

Once the school year ends, Sharon Evans, Trauma Injury Prevention coordinator, calls this time of year “the 100 deadly days of summer” because kids are so much at risk. They are spending more time on their own or with friends and often times without adult supervision.

"Kids are out because they are playing with their friends, going to the ice cream truck or riding their bike. In other words, it’s just kids being kids. But that’s also when children are getting hurt," Evans said. “We are asking parents to make sure their child knows how to cross the street, mainly that they wait until the driver actually motions to them to cross the road. Just because you think the driver is looking at you doesn’t actually mean they ‘see’ you.' These days everyone is so busy or distracted, even while behind the wheel, you can’t take anything for granted."

Studies show children don’t have the cognitive ability to safely cross the street until they are 10 years old.

So even though they can ride a bike and do multiplication tables doesn’t mean they can safely cross the street, Evans said. While they may ride or walk on the sidewalks, you still have the danger of cars backing out and/or turning into driveways. During the summer, Evans said the medical staff at Cook Children’s sees an increase in backovers. 

“With our larger cars and SUVs, you often can’t see the child and that’s where the backovers happen as you are leaving,” she said. “Of course this disaster is even worse because the injury is usually caused by a parent or family member.”

Evans asks parents to be extra aware that kids are out during this time of year and to be on the lookout for them. She adds distracted driving plays into this too.

“Drivers need to be extra aware that kids are out and about,” Evans said. “It’s up to us, as the adults, to be on the lookout for them. Of course, distracted driving plays into this too. We also need to make sure we are all driving the speed limit or below the limit in neighborhoods, around parks or just anywhere kids may be outside and playing. Really it’s up to all of us to be careful and watch out for kids."

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

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

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

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

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

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

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

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

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

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

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

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

Here are 12 day-ngers of Christmas:

1. Fireplace - Lighting a fire is one of my favorite winter time activities but it can be very dangerous for kids. Young children should always be supervised when around the fire and you should have them inspected regularly to prevent potential problems.
2. Candles – If you’re anything like my wife, the first thing you want to do when you get home is light a candle. The smells can really put you in the Christmas spirit but little hands love to explore flames and hot wax can be just as dangerous.
3. Small decorations – Small decorations (manger scenes or small tree ornaments) can be a significant choking hazard this time of year. Because they are often colorful and shiny, they can be spotted from across the house and crawling babies will find them.
4. Glass decorations – Little feet and crawling knees get glass in them frequently this time of year. A solid barrier around the tree and keeping fragile ornaments up high can help.
5. Stocking holders – Heavy stocking hangers can be a risk for kids as they reach up to pull down on the stocking and the heavy holder can cause skull fractures and bruises. Use lighter hooks, tape or otherwise secure the holders in some other way. It could even knock out your child’s two front teeth.
6. Tree allergies – Kids can be allergic to trees and this is the only time of year where we bring in a gigantic live allergen into our homes. If you are an allergic type family, think about an artificial tree; especially if your kid always end up miserable around Christmas-time.
7. Christmas tree water – Yes, kids will drink water anywhere they find it. The Christmas tree base is the perfect height for a crawling baby to lap it right up. Find kid safe tree nutrients or make sure that they are kept away from the base.
8. Holly/mistletoe berries – The old time fear of poinsettias may be true if your child ingests several flowers which can lead to abdominal cramping but the real risk is holly berries. Ingestion can cause severe stomach cramps and diarrhea from even just a berry or two.
9. Unstable tree base – Make sure that your tree is properly installed and the base is broad enough to prevent tip over if a child decides to do some indoor tree climbing practice or is rockin' around it.
10. Ladders – The process of decorating can be just as enjoyable as the decorations themselves. But ladder falls are common …your child doesn’t need to see you toppling over so be careful amateurs. Also be sure and put them away after each use so that little kids don’t decide that they can “help” later.
11. Electrical outlets – This time of year new things need to be plugged in and unplugged but don’t forget about your plug covers and electrical safety. Keep the cover nearby and replace it each time you unplug that tree or other decoration.
12. Hot drinks – Decorating and celebrating Christmas means more hot chocolate and apple cider but wandering little hands are eager to see what’s in that colorful mug…

This time of year can be amazing as a family…but stay alert.

When your baby is in a new house or environment be extra vigilant.

Take precautions as you deck the halls to prepare for safety at home.

Have a Merry Christmas!