For over 32 years, we've been hosting this incredible event, welcoming nurses from over 10 states. This year's symposium is packed with informative talks and workshops designed to keep you at the forefront of student health and well-being.

This live, virtual program will help nurses in primary and secondary schools as they face many unique challenges. We hope you take this opportunity to learn from clinical experts in the comfort of your own home and nurses can receive credit hours.

What's on tap? Here's a sneak peek:

• Substance Use in School-Aged Children: Led by Jeff Temple, Ph.D, from the University of Texas Health Science Center at Houston (UTHealth Houston), this session will equip you with the knowledge and tools to address this growing concern.
• From A to Z: We've got you covered on a wide range of topics, including respiratory illnesses, anxiety, managing students with complex medical needs, and more!
• Local Expertise: Diane Arnaout, M.D. of Cook Children's Pediatrics Forest Park, will be sharing her insights on common childhood illnesses.
• First Responders in Action: Gain valuable firsthand knowledge from a panel featuring our Cook Children’s Medical Director for Emergency Services Taylor Louden, M.D., and EMT Joe Garza.
• Protecting Our Students: Learn how to identify and respond to victims of human trafficking with Elizabeth Peeler, D.O.

But wait, there's more!

• Reviews: Here's what past attendees are saying:
  • "This was the best, most thorough conference I have attended in about 5 years!"
  • "I am not from Texas and really appreciate being able to attend this conference! The information was really good"
  • "This is my 7th symposium and it was the best one overall. I learned something useful from each speaker."
• Webinars Throughout the Year: We don't stop at the symposium! Check out our school nurse resource page for info on ongoing webinars.

Ready to join the fun? Register here.

Have questions? Feel free to reach out to meeting and event coordinator Danielle Allsbrook at Danielle.Allsbrook@cookchildrens.org.

We can't wait to see you there! See you in the summer!

Getting back into a routine after a long summer break can be tough for kids of all ages. In this episode of Raising Joy, we talk to Cook Children's psychologist, Whitney Appleby, Ph.D., about all things school. Dr. Appleby shares her expert advice on how to help kids get a good night's sleep, create a healthy routine, manage anxiety, and avoid burnout. As a mom of three, she knows the struggle is real, but she also knows that with a little planning and effort, we can set our kids up for a successful school year.

If you're looking for some helpful advice on how to get your kids back into a school routine, be sure to listen to this episode of Raising Joy!

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy. For information about resources, view the crisis resource sheets below (available in English and Spanish). A PDF version is also linked under “Downloads.” 

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

We’ve all bought the desired backpack or lunch box, purchased the needed clothes and shoes, and reviewed class schedules and lists with a fine-toothed comb. As parents and caregivers, so much detail and organization goes into getting things ready for going back to school. 

Every one of my girls has a different priority - how many classes do they have with a friend, if they made it into the class they hoped for, if they got the teacher they wanted, and do they get to do the activity this year that they really want to do. 

All of our priorities collide and we forget the most important priority is who we are in the midst of all of these things. As we prepare our kids for returning to school, it can be easy to get caught up in the supplies, schedules and activities. However, preparing our kids for the character traits they will need throughout the year and their lives is also important. 

If I focus on just the year in front of me, I can get a little overwhelmed with the extras and forget that my kids’ integrity matters most. Their character, in terms of their kindness, gratitude, honesty, and making good choices, will carry them further than any other detail of the year.

Kindness

Kindness is not the easiest way all the time. It takes work and fortitude. Choosing kindness is intentional and as an adult, I need reminders and help to choose kindness when others are not. 

Our kids need even more help with this. They need ideas and help processing exactly what kindness looks like when they really don’t feel kind toward someone. 

Sharing with someone who never shares, helping the person that doesn’t help you, responding softly when others use their words to hurt – all of these things and more are hard but effective in the long game of life. 

This is not something that comes naturally. It is important to remind our kids that we don’t know everyone’s story or even all of their story.

We want to be people and raise people that leave a positive mark on others’ lives. So, while we aren’t wanting to kill anyone with kindness, we can be certain that kindness will overshadow meanness every time. 

Gratitude 

I have said, “Name 10 things you are thankful for!” about a million times in my parenting journey. The minute their world is falling apart and nothing is going their way, I am giving them a speech about everything that is good. 

I found years ago, though, that having my kids list the things that they are grateful for made a bigger difference than my lecture. 

Just like kindness, gratitude is also not always easy. Some days I can barely come up with three things for my list when the reality is that I truly have a thousand things a day to be grateful for. Again, our kids need help.  It has been researched and studied for decades, but what we know is true is that gratitude changes our perspective and ultimately the atmosphere around us. 

You put a bunch of ungrateful kids in a classroom together and you have a classroom full of complainers that cannot be happy. You add one grateful kid into the mix and they can change the group. Help your kiddos be the grateful kids. 

One way I often see parents help their kids practice this is through highs and lows at the end of the day or as one of my friends calls it “roses and thorns.” Have your kids name their top three good things and the top three hard things of each day. 

I also recommend having your kids say three things (or 10) they are grateful for on the way to school before the day starts. This helps set the tone for the day.

Honesty 

Honesty can come with some weight. If you don’t choose the honest way, then your words become meaningless to those around you. To be a person of your word comes with consequences, but it also builds you into a trustworthy person.

I find that honesty can be difficult for kids because they are more fearful of the consequences of their honesty than they are of lying.

This is often because they can’t see how lies pile up and that they will have to lie to keep their first lie intact. It’s our job as parents to help them make the hard choice to tell the truth even if there is a short-term consequence. 

Years ago, one of my precious daughters drew on her teacher’s couch and then lied about it saying she didn’t do it. While she wasn’t the only one, she was one of the artists. She had to write a note apologizing for not telling the truth, look her teacher in the eyes and tell her she lied and then I joined her for a lunch hour to try all the options for cleaning ballpoint pen off of a faux leather white couch. She still remembers this! 

Good choices 

As my kids head out of the car every day, I say, “Be kind. Make good choices.” I was reading another mom’s encouragement the other day: “You (and everyone you know) are just one decision from falling off a cliff.” It is the truth. One bad choice can change the course of a whole day, week, month, year or even someone’s life. 

My husband always says that he wants our kids to know how to think. Being able to stop and think through your next move and decision is incredibly important. This is also something all of our kids need help with. 

As parents and caregivers, we want to provide a safe space to think through decisions. We want our kids to learn how to stop and think before impulsively moving into a choice. 

If we can remind them and help them to be mindful, we can help them establish their moral compass that will last them a lifetime. Good choices account for yourself, for others, and for the future. 

As you blaze into this next school year, try to remember that your kids character matters the most in the long game. It doesn’t mean that we don’t focus on the schedules, activities and supplies, but we prioritize their character and the attention it needs and deserves. Also, don’t forget, we are all in this together! 

The Jane Justin School, under the Child Study Center at Cook Children's, is a private school that provides special education to children. This year, 86 students are enrolled.

Early Monday morning, students hugged their parents, took photos in front of the school and met their teachers. Friends reunited with hugs and talked about their summers.

“The friendships are strong here,” said Tracie Mann, Ph.D., Headmaster at Jane Justin School. “A lot of them do things after school together and get together over the summer. Everybody is really excited for the first day.”

“I'm ready to get back to lessons and play with my friends – and not go outside because it's way too hot," student Wyatt Merchant said. 

Students in the Purple Room class are between 7 to 9 years old. They gathered around to color a large “back to school” sheet together.

“We're such a small community of people and we're so welcoming and so warm,“ Dr. Mann said. “I think it makes it easier for children to come in every year and kind of make that transition.”

Summertime is the best time of year (in my opinion!). Schedules can sometimes be looser, we can be outside more and it’s great to have a break from schoolwork! It is common to be more relaxed with the bedtime routine.

As a parent myself, I am happy to let a strict bedtime for the school year fade away. However, a late bedtime and waking up late can end up being troublesome during this time of year when we know we have to return to a more regular schedule.

It isn’t “bad” for kids to go to bed late and awaken late, as long as they are getting the total number of hours of sleep recommended for their age. I have met a few kids that go to bed late but also wake up early so they are tired in the daytime, which can impact their behavior.

Our middle school kids are programmed to go to bed late and awaken late -- this change to the clock inside your brain is part of the pubertal process. Therefore, it can be hard to fight the return to an early morning wake-up in August.

How should you do it? Here is one method. Once a person has been going to bed late for a longer period of time, the brain becomes accustomed to that. So simply getting in bed early won’t mean that a person gets to sleep early.

It’s best to continue with the late bedtime, but get up a bit earlier (like 1 hour earlier) than usual. It’s hard to do but using sunlight exposure (sun to the face) and encouraging breakfast can help. Then kids will be naturally tired earlier the following evening since they arose earlier that morning. Some parents use melatonin (dose of 1-3 mg) given 1 hour earlier than the late bedtime to help with falling asleep as well.

Watching caffeine intake, aiming for calm play in the hours before bedtime and keeping lighting low can also help with resetting bedtime. Screen use (TV, phones, computer monitors, and video game consoles) should stop around 1 hour before the desired bedtime as well.

Remember that bright artificial light (from screens) can trick your brain into thinking it is daytime. Try not to allow afternoon naps, so kids build up their sleepiness- aiming for a reasonable bedtime.

Sometimes writing down the plan for bedtime/waketime change can help. Kids can be an ally here so involve them in the process.

Good luck with the new school year!

Before they can pump weights in the school gym or march with the band this summer, teens in Texas need to complete a form that aims to catch any underlying health concerns.

The annual UIL pre-participation physical evaluation form applies to junior high and high school student athletes and marching band members for the 2023-2024 school year. The form has two parts:

1.      Medical history – a list of yes/no questions about headaches, dizziness, chest pain, seizures, allergies and more. This portion must be filled out every year by the student and parent or guardian.

2.      Physical exam – performed by a physician to check the student’s lungs, joints, vision, weight, heart rate, blood pressure and more. UIL requires the physical exam before the 7th, 9th and 11^th grades. Some districts, including Fort Worth Independent School District (FWISD), require it annually.

Doctors at Cook Children’s say the physical exams are an important safeguard for student athletes. Sports physicals give doctors the chance to check for a variety of concerns – everything from poor eyesight and asthma to a lingering sprain or even a serious heart condition.  

“The goal of a sports participation physical is to review each child’s health history, to perform a thorough exam, and to identify health issues that could predispose the participant to a high risk of having symptoms or an injury while playing sports,” said Ann Natterer, M.D. at Cook Children’s Pediatrics Cityview in Fort Worth.

Why go to your regular pediatrician for this exam?

Dr. Natterer points out several advantages, including patient privacy and getting up-to-date with routine care, such as vaccinations.

“The pediatrician knows the child the best, has access to past medical history, and is also in a better position to facilitate any follow-up evaluations that may be necessary,” she said.

The pediatrician sees the big picture during a sports physical, said Wuroh Timbo, M.D. at Cook Children’s Pediatrics Lake Forest in McKinney. Your teen’s doctor has the files to track changes over time in weight, heart rate, medications and other parts of health history. Your teen’s doctor also knows about any previous illnesses, such as rheumatic fever, which can cause heart valve damage.

“And I think also just having an already established rapport with the families,” Dr. Timbo said. “It’s way easier to communicate with someone you already know. You’re going to get better information and give better information when there’s already a previously established relationship.”

Dr. Timbo recommends that parents make the appointment for their teen’s sports physical as early as possible. Getting the physical exam done early in the summer beats the rush that typically happens just before football workouts and band practice start. In other words … don’t put it off. It’s better to find out in May rather than in August if a student athlete needs vision correction, an inhaler or physical therapy, for instance.

What to Expect

It takes about 15 minutes, Dr. Timbo said, to go through a sports physical. Blank spaces on the UIL form allow the doctor to make note of any abnormalities with the patient’s eyes, ears, throat, lymph nodes, pulse, lungs, abdomen, back, feet and joints.

A sports exam gives patients the chance to ask questions or report any problems that impact their athletic ability. Knee pain and heel pain are the two most common complaints that Dr. Timbo hears. Sometimes the athletes tell him they’ve noticed shortness of breath or frequent headaches.

“Whether it’s something like exercise-induced asthma that we hadn’t caught before, or it’s an injury that re-aggravates every time they do a certain movement, we want to know, and we want to come up with a treatment plan to address it,” he said.

After the exam, the doctor checks one of three options on the UIL form: cleared for participation, cleared after completing additional evaluation or rehabilitation, or not cleared due to concerns. A referral might be needed for further tests with a specialist.

FWISD Director of Athletics Lisa Langston, Ph.D. said a physician’s clearance offers some assurance that the students can safely practice and compete in sports activities. Thanks to the required physical exams, she said, conditions such as cardiac issues and hernias have been detected through the years.  

“The students understand it’s all about their health and wellbeing. We’re not just doing lip service,” Dr. Langston said.

Dr. Timbo urges his patients to listen to their bodies. Speak up if something feels off. Understand that the annual sports physical is geared to pick up on any medical condition that might hinder their performance. Some underlying conditions could even be life-threatening, such as heart rhythm disorders that might lead to sudden cardiac arrest. 

“All doctors want their patients to be active,” he said. “Athletics is good for the body, good for the heart and teaches great life lessons on the ability to work in teams, resiliency and concentration. But we as physicians want to make sure that they’re safe to participate in these activities.”

On this episode of Raising Joy, we meet Dr. Jillian Peterson, founder of The Violence Project, a nonpartisan nonprofit that created the largest and most comprehensive database on the life histories of mass shooters. She is a forensic psychologist, professor of criminology and author of “The Violence Project – How to Stop a Mass Shooting Epidemic.”

Her work has helped school leaders, police departments and universities across the nation adopt realistic tools for violence prevention. Listen in to hear what Dr. Peterson learned about mass shooters in her research and what parents and caregivers can do to help prevent the next school shooting.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

To get an excused absence due to illness, please:

1. Contact your school’s attendance office to communicate your child’s absence. 
2. Submit a parent note in writing within five school days of your child’s return to campus. The excuse note should include the following:

• Student Name
• Student ID Number
• A written statement giving the dates and reason for absence
• Parent/guardian signature
• Parent phone number

3. If your child is absent for multiple days, contact your school for the attendance petition process.

From Cook Children’s Medical Center: Symptoms to be aware of and action to take

Like many hospitals and children’s hospitals around the country, Cook Children's is experiencing a surge in patients diagnosed with RSV, flu and other respiratory illnesses. The increase impacts our ability to care for patients in a timely manner.

RSV is a common respiratory virus. Some children require hospitalization, but most do not.

It is NOT necessary for your child to take a strep throat, flu or RSV test before returning to school.

RSV and Other Illness Guidelines for Parents

Parents should NOT go to the Urgent Care or Emergency Department for only a flu or COVID test. See your pediatrician, who can test for flu, RSV, strep throat and COVID. Adults can also use at-home tests or tests at a pharmacy.

Call your pediatrician if:

• If your child is experiencing mild respiratory symptoms but is not having difficulty breathing and is well-hydrated.
• If you need to have your child tested for RSV, the flu or COVID-19.

Seek immediate medical care if:

• Persistent fever for more than two or three days. However, any temperature greater than 100.4 in an infant under two months of age is considered a medical emergency.
• You have concerns that your child is dehydrated.
• In dehydrated babies, parents will see fewer wet diapers or a lack of tears. Their flat spot on the head can also appear more sunken.
• Breathing faster than usual or can see the skin between the ribs being sucked in.
• If your child requires frequent use of their albuterol rescue inhaler or is having worsening asthma symptoms.

Prevention:

• Get the flu vaccine and stay up to date on the vaccine schedule from the Centers for Disease Control and Prevention.
• Get the COVID vaccine and approved boosters.
• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If sick, wear a mask in public and stay home.

If your child attends a different district, please call your campus to find out what your absentee policy is.

RELATED

• RSV Decreases While Flu Continues to Increase at Cook Children's (checkupnewsroom.com)
• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

The mental health crisis affecting children and teens is no secret. Families across the U.S. have struggled to cope through the pandemic and afterward. In Fort Worth, Texas, a local school district and university are teaming up to provide access to mental health resources to kids and their families.

Ottis Goodwin is the director of Family and Community Resources at Fort Worth ISD. He joins us on this episode of Raising Joy to talk about his school district’s new program with Texas Christian University, as well as how kids are doing in the wake of COVID-19.  

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

School nurse Lori Hamman provides first aid and comfort to the students at Wedgwood 6^th Grade Center who arrive at her office with assorted injuries and illnesses on any given day.

She treats nosebleeds, headaches and vomiting. She helps manage asthma flareups and the extremes of diabetic blood sugar levels.  At set times, she dispenses medication to students with chronic conditions like seizures or attention-deficit/hyperactivity disorder. Occasionally, an upset sixth-grader will need a few minutes in Hamman’s office just to calm down.

“It can vary from minor things to complex things like a broken bone,” she said of her job at Wedgwood, in the Fort Worth Independent School District (FWISD). “That’s kind of the exciting thing about being a school nurse.”

Rekha Sivadasan, M.D. at Cook Children’s Pediatrics in Frisco described school nurses as a valuable extension of the pediatrician’s office. Dr. Sivadasan hears from school nurses who may call to check on a patient’s immunization records, or to discuss a severe food allergy, or to alert her that a student has elevated blood pressure. Communication and collaboration – among pediatricians, school nurses, and parents or guardians – make the best approach, per Dr. Sivadasan.

“Ultimately, the child benefits to know that there are different people who have eyes on them to help the child feel safe, to feel cared for, to feel loved,” Dr. Sivadasan said. “If they know that there are different entities that are all working together to ensure their success and their good health, then I think that just adds to the security and confidence for the child.”  

Expert input shared by school nurses plays an important role in developing accommodations for students who have disabilities, Dr. Sivadasan said. Other critical duties may include reporting suspected child abuse to state authorities, and notifying help for a student who expresses suicidal ideation.  

 “If a child has something that is bothering him or her -- whether it’s physically, emotionally, behaviorally, mentally – the nurse is their go-to person at school,” Dr. Sivadasan said. 

School nursing is a specialized practice of the nursing profession. What difference does it make when school nurses work together with a child’s doctor and parents? The American Academy of Pediatrics explains: “Academic achievement, improved attendance and better graduation rates can be a direct result of a coordinated team effort among the medical, family, and educational homes all recognizing that good health and strong education cannot be separated.”

Tips for Parents

At Wedgwood, Hamman encourages parents to communicate directly with her at the beginning of the academic year if their child has a chronic condition. She enjoys the relationships formed when students come to her office.

“It’s a safe place,” Hamman said. “I don’t expect homework from them or written assignments or testing. They can just come in and relax and destress.”

Depending on the grade level, Hamman and her colleagues at FWISD encounter a wide array of ailments and issues, from playground bruises and wiggly teeth to drug abuse and pregnancy. Some students require specialized care for catheters or feeding tubes. Others turn to their school nurses for help with mental health. Meanwhile, the nurses are gearing up for the 2022-2023 flu season while continuing to check on students out with COVID-19. 

School nurses also implement screenings for spinal abnormalities, growth, hearing and vision. Hamman recalled one student who had trouble seeing the eye chart. 

“I made a referral and now she has glasses," Hamman said. "I rescreened her, and she can see 20/20.” 

We talked to a group of experienced local nurses about key things parents should know:

• Send any meds to school in the original packaging with a specific written request signed by a physician or licensed prescriber.
• If your phone number or address changes, or if your emergency contact’s information changes, tell the school nurse and data clerk. They might need to reach you.  
• Make sure the nurse’s office has your child’s most current shot records.
• If your child’s health history changes, tell the school nurse. This includes a new diagnosis or starting/stopping a regular medication. 
• Give signed permission for the school nurse to communicate with your family’s health care provider.

School nurses say their role involves social work, counseling, advocacy, record-keeping and disease prevention. Why do they love what they do? Here are some perspectives.

More than Band-Aids

Shannon Cooper, Director II for FWISD Health Services, said the biggest change in her 17 years of school nursing is the increase in diabetes, asthma and medications. “It has become so much more complex,” she said. Cooper said the familiar presence of nurses at school shapes in a positive way the students’ view of health care. 

Verby Nash, Health Services nurse specialist, recalled a few unusual situations in her experience, including a student with a bead stuck up the nose, and a teacher hit by a car during morning drop-off. As they gain the trust of families, school nurses might be asked to examine a baby’s rash or a grandparent’s blood pressure.

“We do what we can to help and assess,” Nash said. “We are not doctors. We cannot diagnose. We cannot prescribe. We are very, very careful about that.”

The nurses educate teachers and staff about various illnesses and what symptoms warrant a trip to the nurse’s office. 

“It’s not just Band-Aids and tummy aches, which unfortunately is still what some people think,” Nash said. “We are there to advocate for those students because if they’re not feeling good, they cannot be successful in class.”

Cassandra Miles, Health Services nurse specialist, said school nurses are a source of “safe, sound and appropriate” information when students come to their offices to talk. She considers it a privilege to serve children and teens from pre-kindergarten through high school graduation.

“For many students, we may be the only person who they see medically,” Miles said. “Or we may be the gateway to those resources in the community or to get to the pediatrician or the mental health provider.”   

Seventy-one FWISD campuses participate in free Goodside Health telehealth services. Morningside Elementary School nurse Sasha Dawkins said pointed out the benefits of telehealth appointments in reducing student absenteeism and allowing parents to stay at work.

One frequent challenge Dawkins encounters on the job is collecting the required vaccination paperwork. 

“It may take a few more phone calls or a few more letters to get parents to understand the importance of being up-to-date on their shot records,” she said. “Sometimes at the beginning of the year it can be a little bit of a struggle to get the documents you need.”

She welcomes questions and hopes to provide support and resources. And Dawkins feels motivated every day by the opportunity to help students. “I love making a difference in someone’s life. That’s the biggest joy for me. That is the reason I became a nurse.”

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.

Nutrition experts at Cook Children’s want parents to know that lunch in the school cafeteria presents unique challenges and opportunities for students to form healthy eating habits.

First, the challenges …. Foods that some kids don’t like or won’t try. Too little time to eat.  Vending machines. And famished kids and teens who skip lunch and go home so hungry they eat meal-sized snacks after school.

And the opportunities …. Appropriate portion size. Attractive options. Nourishment helps students concentrate in the classroom, power through PE, and hit their growth milestones.  

As the 2022-2023 academic year gets underway with new lunch routines, families are encouraged to have ongoing conversations with their children about what they’re eating or not eating. Best practices will incorporate vegetables, lean proteins and whole grains in every meal. Getting your child’s input on preferences can help make the most out of their lunch period.

“Look at the menu ahead of time and make a plan so that they’re being mindful about eating veggies and other healthful foods,” said Kathryn Wheeler, D.O. at Cook Children’s Pediatrics Clearfork. “Preparation will help empower the kids to make good choices.”

Lunch Line Options

The Journal of the Academy of Nutrition and Dietetics reported that youth between 2-18 years old get almost half of their daily calories from added sugars and solid fats in sodas, fruit drinks, desserts, pizza and whole milk. The National School Lunch Program sets limits on sodium, saturated fat and calories. Five components are included in school-served lunches:

1. Fruits (fresh, frozen, dried or canned in light syrup or juice)
2. Vegetables including dark green, red/orange, beans or peas (fresh, frozen or canned)
3. Grains  
4. Meat or meat alternatives such as beans
5. Low-fat milk

Registered dietitian Lauren Williams works in the Risk Evaluation to Achieve Cardiovascular Health (REACH) program, which serves children and teens with high cholesterol, lipids disorders, diabetes and obesity at the Cook Children’s Endocrine Clinic. Williams sometimes hears complaints about school lunch from her patients.

“They might only eat the fruit because they don't really like the main entree, or they might only eat the main entree because the vegetables are overcooked or unappealing,” she said. ‘They might only like one or two components out of the five that are served. And if they don’t supplement with something from home, they may be left hungry.”

Another concern is inadequate time to eat lunch, which forces children to eat so quickly that they don’t respond to the fullness cues sent from the stomach to the brain. In a hurry, they overeat.

“What they're being inherently taught by having 10 minutes to eat is ‘I have to eat this quickly because if I don't eat right now, I don't eat,’” Williams said. This may also lead to the habit of eating quickly at other meals. Or if their lunch break happens at 10:45 am, they might be hungry and overindulge in snacks later in the afternoon.   

Williams recommends that parents talk to their children about what they ate at school. Bonus points if this is a conversation had around the dinner table since family dinners are another important part of healthy eating. If they’re not liking what the cafeteria serves, then bring a lunch from home.

Packed Lunches

Consider making sandwiches, wraps, pasta or salads. Include a protein (such as turkey or ham, cheese, Greek yogurt, beans or nuts); a starch (beans or whole-grain bread or tortillas); and fruit and vegetables for fiber (carrots, celery sticks, bell peppers, apple slices).  Williams also suggests a side of hummus or a dip to keep things fun and entice kids to eat more vegetables.

“It doesn't have to be fancy,” she said. “It just has to fill their tummy with some nutrition to get them through the day.”

More back-to-school advice from the dietitian:

• Rely on familiar favorite foods. “If you know that your 8-year-old is perfectly fine with having carrots most days with lunch, then that's OK,” Williams said.
• Ask your child about anything that might make them apprehensive in the cafeteria environment, especially on a new campus. Normalize the discussion of their lunch routine. “Don't be too hard on your kids if they don't choose the broccoli or green beans. Find out why.”
• Keep a handy stash of nutritious foods for after-school snacks. Her top picks include peanut butter crackers, non-fat yogurt, cut-up veggies and low-fat cheese sticks. Keep in mind that snacks should bridge the gap until dinner and not be meal-sized portions.

“You can't always guarantee that a child is going to choose fruit over a cupcake or cookie, but having it there and accessible makes it a whole lot more likely,” she said.

At annual check-ups with her patients, Dr. Wheeler talks with children and families about the benefits that come from consuming the right foods. She emphasizes the role that nutrition can play in preventing diseases down the road, one small step at a time, such as eating less processed foods and more fresh produce.  

“We know that all those good habits they have in childhood lay the foundation for a healthy lifestyle as they grow up,” she said. “Parents can be such great models.”

When it comes to life-threatening food allergies at school, teachers make all the difference. 

“It is about prevention,” said Ankita Singh, D.O., pediatrician at Cook Children’s Pediatrics Walsh Ranch. “Teachers need to be involved from the beginning and incorporate the food-related safety precautions just like it is part of the normal school day.”

As a mom of two kids with life-threatening food allergies, I know that the school experience largely depends on the understanding and empathy of those involved. Kindness goes a long way.

One in 13 children has severe food allergies (about two per classroom), and 75% of these cases occur in children with no prior family diagnosis. Chances are most children will know someone with food allergies and could save a life.

A food allergy reaction can cause symptoms that range from mild to life-threatening. In the United States, food allergy is the leading cause of anaphylaxis outside the hospital setting. Anaphylaxis is a serious, life-threatening allergic reaction that typically affects more than one part of the body at the same time and may include hives, wheezing, high heart rate, rapid swelling and trouble breathing. People who have previously experienced only mild symptoms may suddenly experience a life-threatening reaction.

Clear Communication is Key

Parents need to be very clear from the beginning with everyone at the school – teachers, nurses, administrators and other parents. They should discuss the food allergy action plan with the school nurse, informing them what foods the child should avoid and what to do in case the food was eaten, or they have been in contact with it.

“For lunches and birthday parties in the child’s classroom, the school should tell the parents not to include the allergens to avoid cross-contamination and the risk of severe allergic reactions,” Dr. Singh said. “Make sure the child is aware of what to do if there is exposure at school. Run through the scenario at home so all aspects are covered the best you can without being there.”

The nurse should also receive two epinephrine autoinjectors – the first-line treatment for anaphylaxis which works to reverse the life-threatening symptoms. A delay in using epinephrine is common in severe food allergic reaction deaths.

“Parents need to be vigilant about checking the epinephrine autoinjectors for expiration dates as well as dosage,” Dr. Singh said. “There are different doses for weight and age as children get older.”

If epinephrine is used, the child must be monitored at the emergency department as they could still have a rebound reaction.

Empowering Kids to be Kind

About one-third of children with food allergies report being bullied because of their allergies. The reported bullying ranges from verbal teasing or criticism to more obvious acts such as an allergen being waved in their face or intentionally putting it in their food. Therefore teachers leading by example can show what it means to put others before yourself. This can change the trajectory for children with food allergies.

“The best way to go about it is education such as a doctor talking to the students about food allergies or a fun presentation led by the teacher empowering the children to protect their classmates with the allergies,” Dr. Singh said. “If kids understand why food allergies happen, it can decrease bullying.”

Tips from Food Allergy Research & Education to prevent food allergy bullying:

• Encourage open communication – be sure children understand what bullying is and what to do if they are bullied. Emphasize reporting bullying to a trusted adult.
• Teach children the skills they need to stand up to bullies – saying “stop” or “leave me alone” with confidence, using humor and walking away.
• Recognize the signs of bullying – these can include torn clothing or damaged books, unexplained reactions or injuries, avoiding school, physical complaints, consistent nightmares, lower grades and loss of interest in school, social isolation and behavior changes.
• If your child is being bullied, be calm and assure him that you’re going to help – don’t encourage retaliation or confront the bully yourself. Talk to the appropriate personnel at your child’s school.
• Encourage teachers, administrators, the school nurse or counselors to offer educational programs about food allergies and bullying
• Set up a buddy system – encourage children who are bullied to stay with a group of trusted friends in high-risk situations, such as at the lunchroom or while walking home from school.

Food allergy parents have a lot to handle and may seem overprotective at times. But if they get it wrong, they don’t get to hit the reset button.

Seven in 10 young people say they would tell a friend if they are having thoughts of suicide. Research also shows that peers have a greater impact as protective factors during adolescence than parents do. This is why the Hope Squad program focuses on training students to help their peers in schools across the U.S.

On this episode of the Raising Joy, we’re talking to Guidance and Counseling Coordinator Kasey Holder with Mansfield Independent School District, MISD student Kaylee Berger and Kristi Wiley with the Jordan Elizabeth Harris Foundation. They share how the program has changed the culture at school and why they think giving students tools to help their friends is saving lives.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Texas schools received a top score for efforts to promote engagement with families and community partners. The report card also gave high marks to the Lone Star State for taking steps to help school employees recognize students at risk for mental health problems, substance use and suicide.

But the grades for Texas in several other categories – including the extent of Medicaid coverage, well-being checks and the ratio of school psychologists/counselors – came in lower. Findings were issued in February 2022 by the Hopeful Futures Campaign, made up of 17 organizations including the National Alliance on Mental Illness and UNICEF USA. 

“We urge readers to use the report cards as a starting point to spark a dialogue about what is working in their state and what policies and practices are needed to improve school mental health,” according to the introduction.

The Hopeful Futures Campaign describes its analysis as a snapshot of each state’s school mental health structures. Texas earned scores on both the high and low ends, depending on the category.

Just breathe. Open up. You matter. That’s the truth behind the Cook Children’s Joy Campaign, an ongoing rollout of information designed to raise awareness about young people struggling with their mental health. Cook Children’s kicked off the Joy Campaign one year ago in response to an alarming rise in suicide attempts locally and nationally. The Raising Joy podcast and other resources aim to equip families with key messages of resiliency. 

Opportunities for Improvement

According to the report card, staffing for mental health professionals falls short in schools across Texas:

·       1 school psychologist for every 4,962 students (recommended ratio is 1:500)

·       1 school social worker for every 13,604 students (recommended ratio is 1:250)

·       1 school counselor for every 423 students (recommended ratio is 1:250)

The report card’s point about personnel resonated with some of the experts who work every day to help North Texas children and teens.

Michelle Broadwater, assistant director of counseling services at Birdville Independent School District in Haltom City, said 10 crisis intervention counselors share duties at 33 elementary schools in her district. Those counselors are stretched thin with children dealing with trauma, anger, unregulated emotions and lack of social-emotional skills in the 2021-2022 school term, Broadwater said.  

“How to walk down the hall or how to behave in the cafeteria … our behaviors are really a challenge this year,” she said. “The counselors do a lot of putting out fires, constant fires. They’re literally running from one classroom to another.”

Students in the upper grades, Broadwater said, have increased anxiety and stress about falling behind academically due to online learning during the COVID-19 pandemic. The counselors at some BISD middle schools and high schools do as many as 10 suicide risk assessments each day.  

“They feel a little bit inadequate because they see that their students are hurting,” she said. “We talk about students, but our staff are in crisis too, and they’re struggling.”

The Birdville district recently joined the Texas Child Health Access Through Telemedicine service, which provides students with limited mental health care beyond what the school counselors can provide, at no charge. Broadwater credited the BISD Board of Trustees with recognizing the increased need.

Greg Gibbons, a licensed clinical social worker for Wise Health System in Decatur, pointed out that additional counselors on campus would allow more time to build rapport with the students.

“The relationship makes a huge difference. It’s that safe space within the school environment,” to hopefully prevent mental problems from escalating, Gibbons said. “That early intervention would be critical.”

Most of the clients he sees in his practice are elementary and middle school students from Decatur and the outlying rural areas. Gibbons cited ADHD, oppositional defiance, anxiety and depression as the most common complaints that his clients report. To get an appointment, there’s about a six-week waitlist.

Gibbons listed various efforts that could ease the crunch: peer support groups in the schools, social media campaigns to destigmatize mental illness, and more educational conversations like the Parent Cafés organized in Wise County by the Cook Children’s Center for Children’s Health, led by Cook Children’s.

He also emphasized the importance of training teachers to recognize the signs of mental illness, particularly in students who don’t stand out. “Sometimes it’s the shy kid that you don’t know is being bullied on the bus and is just trying to keep to themselves, or it’s the girl who’s hiding her cutting under her hoodie,” he said.

The report card further recommended that Texas adopt annual checks of students and staff members’ mental wellness, excused absences for mental health concerns, and expanded Medicaid coverage.

Progress and Strengths

Meanwhile, the report card gave high scores for these bright spots in Texas schools:

• Inclusion of mental health as part of the K-12 health instruction
• Anti-bullying measures
• Training the teachers to recognize and intervene when a student needs help
• The Texas Education Agency task force was established by the Legislature in 2019 to study the mental and behavioral health climate in the schools
• Policies that foster engagement with families and the community

Blair Williams, a community health analyst at the Cook Children’s Center for Children’s Health, said she heard creative problem-solving ideas from community leaders and partners who participated in our 2021 Community Health Needs Assessment (CHNA). Williams includes coalitions, healthcare systems, clinics, churches, public health experts and nonprofit organizations among the many groups that have stepped up to support schools.   

“The common thread with all of our community partners is that they genuinely want what’s best for children and families, and they’re willing to collaborate and explore partnerships in order to do that,” she said.

Williams highlighted the UNICEF Kid Power® platform as an example of a community collaboration that benefits the physical and mental health of schoolchildren. Through a partnership with Cook Children’s, the Kid Power videos are available free of charge for schools in Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant, and Wise counties. The videos promote exercise and life skills such as showing respect, making new friends and resolving conflict.

The 2021 CHNA parent survey conducted last year by the Center for Children’s Health yielded data on various health questions. One finding indicated in the survey? That 1 in 3 school-aged children ages 6-17 have at least one of the most commonly diagnosed mental health conditions (ADHD, anxiety, depression or behavioral/conduct problems). Also, more than 63,000 children are going without needed mental health care in the eight-county service area around Cook Children’s.

Williams said the Center shares the CHNA data with local organizations for strategic planning and grant-writing purposes – another example of community teamwork in Fort Worth and the surrounding area. 

Schools are working diligently to address the many variables that impact a child’s mental health and mental well-being, Williams said. The incorporation of social-emotional lessons helps too, she said, built into the school culture or curriculum so that students learn ways to cope and manage their emotions. 

 “We’re all going in the right direction,” she said. “There is a heightened awareness of the mental health needs of children, and many community partners are helping to connect families with available resources in their community.”

Participants in CHNA focus groups reported the challenge of finding providers who take their insurance, or sometimes difficulty with transportation to the appointments. Williams says those barriers make the schools a key location for delivery of mental health services. “Having those resources in the school is a protective factor for child mental health.”

Mixed emotions including frustration, worry and anxiousness (to name a few) fill my being yet again on the eve of the day my kids return back to school. It is no longer a new experience for me or the many other parents who have experienced the same feelings over the last 22 months.

 The significant positivity rate in our community and the marked rapid increase in the pediatric cases and pediatric hospitalizations in the last week and a half (all while kids are out of school) is what causes some of my angst. Unfortunately, now it is not too uncommon to hear situations in which people “did all the right things” but COVID still veered its way in. So while I have been able to shield and protect my own children from being infected during the pandemic so far, I fear that the time will come when the inevitable will happen to my own. What’s different now?

 In the midst of all these emotions, I look for the silver lining in our current situation. My kids are NOW vaccinated! Although we are well aware that even fully vaccinated people are susceptible to infection they are less likely to develop severe disease and the need for hospitalization. So in the midst of the mixed emotions I have come to the point of realization and acceptance that this time around I will not likely be able to shield my own children from becoming infected with the current COVID omicron variant.

 The current significant community positivity rate makes exposure and subsequent infection while attending school more likely in the era of optional masking and confusion regarding isolation/quarantine recommendations. In the midst of an ongoing roller coaster of emotions, I will hold on to what I can control and continue to practice and encourage my own children to practice preventive precautions as best we can, including vaccination (done), hand washing and mask-wearing.

 I make the same recommendations to my own patients and their families including the following disease prevention strategies:

• Eat a balanced diet and exercise regularly
• Get plenty of sleep
• Drink plenty of water
• Do not send sick children to school (regardless of COVID exposures or not). Keeping sick children home is the best way to prevent spread in the school setting. 
• Get yourself/or your child tested if you/they develop any symptoms of COVID-19. Testing and identifying infections and subsequent proper isolation practices will prevent further spread.
• Get vaccinated if you haven't already and get a booster if you or your child are eligible (primary series approved for 5 years old and up, boosters approved from 16 and up and anticipating approval for 12-15 year olds soon).
• Practice good hand hygiene, wear a mask and avoid large crowds.

 Given the ongoing change and updates to guidance regarding isolation/quarantine guidelines for different populations of the community, we know that navigating these situations can become confusing and overwhelming. For questions regarding testing, length of quarantine or isolation, and the COVID-19 vaccine for your child, please ask your pediatrician for guidance.

 Wishing you a Happy and Healthy New Year!

Dr. Soria-Olmos

Get to know Bianka Soria-Olmos, D.O.

Dr. Soria-Olmos is a Cook Children's pediatrician in Haslet. She was born and raised in Fort Worth, Texas, so Cook Children's has always had a special place in her heart. She came to know Cook Children's when she was just a kid herself. She went to the medical center a number of times with her active younger brother, who needed care following several mishaps with broken bones. The visits inspired her to decide, "I want to be a Cook Children’s doctor one day."

In pursuit of her dream, Dr. Soria-Olmos attended Texas Christian University (TCU) for a degree in biology and to fulfill the pre-medical school requirements. After graduating from TCU, she chose to stay local and attended medical school at the University of North Texas Health Science Center/Texas College of Osteopathic Medicine in Fort Worth. She completed part of her pediatric clerkship at Cook Children's, learning about pediatric medicine by attending rounds with pediatric hospitalists. It was then she knew she wanted to be a pediatrician.

She began her career with Cook Children's in 2014 as a pediatric hospitalist caring for sick children admitted to the hospital. Today, she works at Cook Children's primary care office in Haslet. Her special interests include child safety, child development and asthma.

Hey friends. Our phone lines are blowing up with exposure and quarantine questions. I love that you guys are calling – it’s the right thing to do! And we are here for ya.

But just wanted to spell out some common scenarios so that you have quick answers:

What does the CDC consider a “close exposure”?

• Being within six feet of someone indoors for more than 15 minutes in a day.
• This is common in classroom settings where kids aren’t masking.
• The CDC does not consider it a “close exposure” if both kids are masked (what a GREAT REASON to mask all kids in school!).

What should I do if my child had a close (classroom or otherwise) exposure to COVID-19?

• Keep your kiddo home for 10-14 days after exposure to the positive person.
• Make sure your child wears a mask in any indoor setting for 14 days, if over age 2.
• An infection could show itself anytime in those 14 days – but if you get to day 10 and the child has zero symptoms, most of the time it’s fine to end quarantine.
• Sometimes a negative test on Days 5-7 will allow return to school on Day 7 of quarantine if no symptoms appear.

What if my child has been vaccinated and then exposed? Does she have to quarantine?

• Nope. If she is symptom-free, she does not have to quarantine.
• The CDC does recommend a COVID-19 test on day 3-5 after exposure though, to be on the safe side.
• Your child should wear a mask indoors for a minimum of 14 days after the exposure, even if vaccinated.

What should I do if someone in my house tests positive for COVID-19?

• Try to keep them in their room as much as possible, and using their own bathroom.
• If they’re older than 2, have them wear a mask in shared spaces.
• Don’t share towels, cups, utensils or bathroom supplies.
• Wash your hands a lot.

What if someone in my home tests positive for COVID? Can my child go to school?

• If your child is VACCINATED and has no symptoms, yes. Get a COVID test 3-5 days after the last close exposure to that person.
• Regardless of vaccine status, have the child wear a mask in indoor spaces (if over age 2) for at least 14 days
• If unvaccinated, they need to quarantine for 10 days after their last exposure to that person. If the COVID+ person cannot isolate (say a parent who must help with childcare), the child must quarantine for 24 days (14 days they could potentially catch it, and 10 days to become non-infectious if they do have it). Again, these times could be shortened with negative testing and no symptoms, as discussed above.

My child has been in close contact with someone who was positive for COVID, and is starting to show symptoms. What do I do?

• Don’t panic. Remember that most of the time, COVID-19 is mild in kids.
• The child must isolate at home for at least 14 days from first symptoms, and must be 24 hours without fever and improving.
• Have the child mask indoors for at least 14 days, if over age 2
• Get your child a test for COVID
• If the test is negative, consider a repeat in 24 hours (or if it was a rapid, consider a PCR)
• COVID is a virus, and will need time to run its course. Typically, the only thing kids need is time.
• If your child is under 3 months old, call your pediatrician.
• Make sure he’s breathing comfortably.
• Make sure he’s drinking enough to urinate every 6-8 hours.
• Make sure he’s acting coherent and normal.
• He’ll probably be more tired, and may be dealing with coughing and congestion.
• Some kids have GI symptoms like vomiting or diarrhea.
• We are okay with fever for up to 5 days. We don’t want fevers trending higher over time.
• We don’t want breathing to become labored, wheezy, or faster.

My child tested positive for COVID-19, but has no symptoms. What do we do?

Your child is infected and needs to be in isolation from others even though they don't have any symptoms.

• You may end your child’s isolation if 10 days pass after the positive test with no symptoms.
• If over age 2, have them mask in indoor spaces for at least 14 days

What if my kid has symptoms of COVID-19, but I don’t know of any positive contacts. What do I do?

• Typically if a child is showing symptoms of COVID-19 (which, let’s face it, can look like a whole lot of other viruses), and they have no known exposures, I will perform a rapid or PCR test on them. If it is negative, they can go back to school as long as fever-free for 24 hours and symptoms are improving.
• If I am VERY suspicious for COVID (let’s say they’re having shortness of breath and have lost their sense of smell), I will ether get a PCR (more accurate than the rapid test), or I will repeat testing in 24 hours.

Quick reminder about RAPID versus PCR testing:

• Rapid testing (the kind we do in the office which is done in 15 minutes) is 80-85% sensitive. This means if it’s negative, and I really think a kid has COVID, I will re-test again in 1-2 days, or send them for a PCR
• PCR testing (often drive-thru or hospital testing that takes a day or two to come back): 99% sensitive! One test is sufficient to rule in/rule out COVID.

Our kids are back to school!

The beginning of a new school year has a ton of opportunity, some excitement and some nerves. And this year there’s probably a little extra floating around.

And while we’re all thinking about COVID-19 and watching for those symptoms (fever, cough, congestion, sore throat and stomach issues), let’s not sleep on the other illnesses that we are seeing as kids roll back into school.

Here are four common childhood illnesses that seem to increase when we go back to school:

1. Strep throat - Fever and sore throat without a cold or cold symptoms is often a sign your child could have strep throat. Add in a rash or swollen lymph nodes in the neck and it’s even more likely. Kids with strep throat symptoms will likely need to be screened for strep throat and COVID-19. The good news about a positive strep test is that it allows your child to feel better and get back to school quickly.
2. Common colds - Not every upper respiratory illness is COVID-19 but trying to determine the difference between the two can be tricky. I expect as we get further into the school year, we’ll be doing more and more testing to help determine between the two in an effort to get kids back to school whenever possible.
3. Pink eye - Red, painful and itchy eyes are a common back-to-school problem. Many pink eye infections are viral but there are bacterial causes. Drops can be called in if a bacteria is suspected and, don’t forget, that allergies can cause these symptoms as well.
4. Head lice - If your child starts to itch their scalp, be on the lookout for head lice or nits that could be the cause. Other parents in the class will be notified if a child develops lice so they can be on the lookout. Prompt and aggressive treatment can keep it from re-circulating through the class.

Don’t forget about these common childhood illnesses and others as we get back to school.

Stay in close contact with your pediatrician when symptoms develop so we can help you keep your child and their classmates safe and healthy!

We, the physicians at Cook Children’s Health Care System, are directly connected to the district or school either as concerned parents or as pediatricians who care for the children we mutually share with your district/school.

We are writing to you to express our concerns about the Delta Variant of COVID-19 and to recommend that our school district implement safety protocols beyond those that have been in place this summer to address this exigent threat. The rapid increases in COVID-19 cases, hospitalizations and deaths locally and throughout the US in recent weeks are alarming and require an appropriate response. Indeed, we are seeing rising COVID-19 cases in our practices.

Please find below the Cook Children’s 10-Point Guide for Safely Reopening Schools crafted by Marc Mazade, M.D., Medical Director of Infection Control and Prevention at Cook Children’s Medical Center.

We stress key recommendations to mitigate the spread of this infectious new variant of the COVID-19 virus with the start of this school year:

• Strongly encourage universal masking for students and staff in accordance with CDC and American Academy of Pediatrics recommendations.
• Minimize contacts for each student to the greatest degree possible.
• Encourage and support all opportunities for eligible children to receive COVID-19 vaccination.

The Cook Children’s Promise states: “Knowing that every child’s life is sacred, it is the Promise of Cook Children’s to improve the health of every child through the prevention and treatment of illness, disease and injury.” Please help us honor the health and sanctity of our children’s lives through your sincere attention to these recommendations. We would welcome the opportunity to collaborate with the district/school in promoting the health and safety of our community during this new and troubling phase of the pandemic. We will gladly provide additional data if it would be helpful, and we are available to answer any questions that arise.

We appreciate your time and look forward to further conversation on this important topic.

With respect and care,

Cook Children's Physicians

The rising number of COVID-19 cases in North Texas is due to the delta variant, which is more contagious than other strains of COVID-19, and a significant number of unvaccinated people. With Texas doing away with virtual learning this school year and the COVID-19 vaccine not yet available for those under 12, many parents and children are understandably feeling anxious.

Amanda Jordan, Psy.D., a licensed psychologist at Cook Children’s Alliance, can relate. She has a child starting kindergarten in the fall and is experiencing similar feelings.

“I want parents to understand you can’t take care of others if you don’t take care of yourself first,” Dr. Jordan said. “You have to check in with yourself first to see how you’re feeling because you don’t want your children to pick up on your negative energy.”

As for parents, Dr. Jordan says it is important to engage with other parents, make sure to create and maintain their own schedule, talk with their partner/spouse and seek professional help when necessary.

Dr. Jordan says once parents have worked through their anxiety, it is good to start preparing children for their ‘new normal’ as early as possible. She says it’s important to pose open-ended questions such as, “I wonder what your first day will be like?” or “I wonder who your teacher will be this year?” These types of questions allow your child to open up about how they’re feeling and can lead to other questions or concerns they may have.

Dr. Jordan also stresses the importance of establishing a routine as school beings again because many children have been off of their schedule for more than a year. This routine includes bedtimes, meal times, changing eating habits, etc.

“There has been so much flexibility with virtual learning,” Dr. Jordan said. “Children have been going to bed and waking up later than normal, and could do their work at their own pace.”

She says starting a ‘school year’ routine before school officially starts can help ease some of the anxiety on the parents and children.

Another technique Dr. Jordan recommends to parents is called ‘Name it to tame it.’

“It is important to help children put a name on their feelings,” she said. “As parents, we want to fix things and say things like ‘don’t be scared’ or ‘you’re going to be fine,’ but you must validate their feelings.”

Dr. Jordan says to respond to children by validating their feelings and letting them know you understand how they feel and let them know they always have a safe space to express their feelings.

Along with the anxiety of returning to school, medical professionals at Cook Children’s are also getting questions about children wearing masks in the classrooms. Alice Phillips, M.D., a Cook Children’s pediatrician at Cook Children’s Cityview says she stands behind the recent recommendations from the American Association of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), that all children K-12 should wear masks in classrooms this school year.

“I believe children need to be in school for their social skills, mental health, and other key personal connections,” Dr. Phillips said. “I recognize it’s a hot topic, but for students to stay in school without shutdowns or quarantines, we must do it safely.”

Dr. Phillips says the new delta variant is spreading rapidly in our unvaccinated population. At Cook Children’s we have seen a rise in the number of children testing positive for COVID as well as an increase in the number of children being hospitalized. For this reason, she believes it is even more important to make sure all children have masks on in the classroom, no matter their vaccination status.

“Parents have to begin modeling mask-wearing behavior at home, and support their children if they feel pressured to do otherwise by their peers,” Dr. Phillips said.

To prepare children to wear masks in the classroom, she says it’s important to explain to children the reality of doing ‘hard things,’  for our friends and communities. Equally important is providing encouragement to children when they're doing the right thing.

“I understand that it’s hard to be brave sometimes,” Dr. Phillips said. “The best we can do is encourage, support, and validate children’s feelings and let them know the ‘why’ behind masking and the importance of keeping themselves and others safe.”

Dr. Phillips says her advice to all adults is to get vaccinated and be an example. She advises all adults to wear a mask when they are in the grocery store and other public settings as recommended by the current CDC guidelines, 

“If parents are vaccinated and their children are not, I still advise the entire family to mask up to support the child and protect them,” she said.

If you have any questions about preparing for your children to head back to the classroom or need guidance for masking, contact your child’s pediatrician.

Read more about preparing for the upcoming school year here:

Cook Children's 10-Point Guide for Safely Reopening Schools

Should My Child Wear a Mask to School this Fall? 

Getting ready to go back to school?

Don’t forget to schedule your child’s well visit to make sure all concerns are addressed and all vaccines are up to date. Plus, your pediatrician can sign those sports physical forms at the well visit too.

Not only is a yearly sports physical required by the school district to be cleared for sports, going to your pediatrician for a yearly well checkup is vital to the health of your child. At a wellness visit, we review growth and development, catch up on vaccines, address any concerns from the child or parent, as well as perform a complete physical exam. We also assess vision, hearing and order any labs or imaging deemed necessary.

It is far better to obtain your child’s sports physical from board-certified pediatricians, such as a Cook Children’s physician, who perform a complete well-child checklist. Specific to the sports physical component, we take a heart history of the patient and family and check from head to toe for any joint or muscle issues. This is a great way to evaluate the health of your young athlete.

In 2019, more than 495,000 boys and 330,000 girls participated in high school athletics in Texas. Participating in sports is a great way for your child to remain physically active. Healthy bodies fight off infections such as COVID-19 better. We recommend at least one hour of strenuous physical activity daily (this means the heart is pumping hard, and you’re breaking a sweat!).

Please call your pediatrician today and schedule your child’s well visit. School starts back in less than three weeks!

1. Make sure all children are up to date on the routine childhood vaccinations needed for school entry. Access to medical offices, fear of leaving home and of waiting room exposures, and closed schedules of weary medical providers taking long-awaited vacations could result in a drop in vaccination rates against measles, mumps, rubella, pertussis, and the bacteria causing meningitis. A slight drop in vaccine coverage for measles, pertussis, and mumps translates quickly to a loss of herd immunity and outbreaks of serious, vaccine-preventable illnesses.

2. Revisit the latest masking decisions in light of the recent surge in COVID-19 cases. The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) advocate for masking in schools, especially in areas with moderate to high transmission of COVID-19. Follow guidance from your local health department which will be in line with the current state of the pandemic and regional community health recommendations.  We have learned during the pandemic that most children, 2 years of age and older, can wear a mask.

3. Encourage COVID-19 vaccination of all eligible children and adults. COVID-19 efficiently spreads from adults and teenagers to younger children, not often the reverse. The key to keeping schools open during the COVID-19 pandemic is getting unimmunized parents and all eligible family members vaccinated.

4. Arrange for mobile COVID-19 vaccination units to be present during orientation and events such as 'meet–the-teacher' nights. Gains in U.S. vaccine acceptance are likely to come amidst the group of people who don’t have a solid reason to avoid vaccination. Surveys reveal that most of these people were hoping that the pandemic was wrapping up and that they would not have to take a risk by taking an “untested” vaccine. They are reasonable people who describe themselves as cautious, slow adopters of things that are new. Most are not necessarily opposed to vaccination philosophically. They were just hoping to wait out the pandemic while relying on social distancing, masking, and herd immunity to keep them from having to getting a vaccine. With the loosening of restrictions and the surge in cases due to the Delta variant, many are now ready to stop holding out.

5. Continue to utilize strategies promoting social distancing in the classroom (by using partitions, separating desks, and cohorting of student groups), during passing periods (by keeping them short to discourage standing around in small groups and conversing), and during meal times (by moving meals outside in the fresh air, limiting line length for meal service, and by observing social distancing).

6. Re-enforce good hand-hygiene practices and cleaning of shared workstation areas with demonstrations that highlight effective hand hygiene and disinfection techniques.

7. Quarantine unvaccinated children and school staff members exposed to COVID-19 per CDC guidance. Vaccinated exposed persons may still get sick with COVID-19 and could be contagious, though their risk of hospitalization and severe disease is extremely low. Quarantine exposed, vaccinated persons if they develop symptoms of COVID-19 until testing results are available.

8. Provide interactive and technologically sound, distance-learning alternatives for immunocompromised students who should not be in the classroom during the pandemic.

9. Encourage precautions for bus riders like masking and opening windows to promote adequate ventilation and reduce the transmission of COVID-19 while traveling to and from school.

10. Above all, send recurring reminders to parents not to send ill children to daycare and to school. Many parents are returning to the workplace for the first time in over a year. They may be experiencing pressures to be physically present, rather than staying home with an ill child. Memories are short when pressures are high. However, we are still in the midst of a global COVID-19 pandemic that has already claimed the lives of more than 600,000 people in the U.S.

The American Academy of Pediatrics is recommending that all children over age 2 wear masks in school this fall. The internet rejoiced, everyone agreed it was a great plan, scientists and politicians shook hands, and no one had anything to say about it.

Ha. Kidding. I promptly picked up some curly fries and wine when I heard about it and laid face-down on my office floor. Not the most sanitary place to do some deep breathing, but whatever.

I hate to joke about serious things like this, but if I don’t, I may cry. The idea of a uniform and agreed-upon plan for halting the spread of a disease that could prevent the deaths of many seems like a pipe dream at this point.

Let’s walk through this and see if I can help you with your decisions this fall.

What did the American Academy of Pediatrics recommend?

• “Everything possible must be done to keep school in-person.” This is because the rates of academic struggle, obesity, and mental health crisis all rose tremendously this past year. Kids need to be in school. We all agree on that.
• They recommend all eligible kids receive the COVID vaccine (12 and up currently)
• Universal masking for anyone in school over age 2 (all students and all staff)
• Flexibility in policy – COVID is an ever-changing scenario and if something isn’t working well, schools need to recognize it and change it
• Attendance of students should be closely watched, and mental health resources for both students and staff should be available
• There should be ongoing federal, state, and local funding to schools to help them with all this.

Why is the AAP recommending all kids wear masks this Fall?

• The AAP is asking all students to wear masks in order to not only protect those that cannot be vaccinated yet, but also the families of these children, and the community as a whole.
• The AAP advocates for children. ALL children. Not just your kid. The wealthy ones. The poor ones. The sick ones. The healthy ones. The physically and mentally challenged. The kid who is being raised by his elderly grandmother and doesn’t have the means or transportation to get that vaccine yet. The kid who doesn’t have enough food at home but gets 2 good meals at school. The child who doesn’t have access to the fancy laptop or functioning internet. The AAP gives us advice based on what will help our community better support and protect our kids.
• Guess what? Last year, we masked in schools. We washed hands more. We asked sick kids to stay home. And schools were then found to not contribute significantly to the spread of COVID-19. (Click here for more information)
• We also noticed a pleasant, NONEXISTENT flu and RSV season as an added side-bonus.
• What happened this summer? We took our masks off, had playdates, saw friends, had parties. And now have plunged into a winter-sized scourge of viral illness. My office has been booked days in advance. The hospital is full. In July. These school strategies work not only in regards to COVID, but all viral illness– both focused studies and my own practice numbers have proven this.

What is the “Delta variant”?

• The COVID virus is mutating (as we expected), and this is the newest and most common version of it in the U.S. right now
• It is crazy, freaking contagious. More so than the original bad boy.
• Verdict’s out on whether it makes you sicker. I suspect it will put a larger burden on hospitals just given the number of unvaccinated people who may be infected.
• Vaccines seem to be working well against it.
• A recent study from the United Kingdom showed that children and adults under 50 were 2.5 times more likely to become infected with Delta.

Why should my vaccinated kid wear a mask?

• Because keeping track of who is vaccinated and who isn’t is a huge burden on schools. And trust me, they have already suffered enough burden.
• Because many kids cannot have the vaccine yet, or haven’t had access to it.
• Because we don’t yet know how well the vaccines work against the new COVID variants and until we are more comfortable with seeing how effective it will be, this is the most low-risk and safe thing we can do.

Will masking harm my kid? Why are all these people saying these awful things about masks?

• Putting a piece of thin cloth on your child’s face does not harm your child.
• I have written one mask exemption this entire year. One. It was for a child with a very rare lung disease. The child’s lungs are anatomically and physiologically very different than a normal child’s and keeping oxygen levels up even without a mask was a struggle for this kiddo.
• The worst I’ve seen is a mild face rash here and there. Otherwise, don’t believe the hype. Masks are not causing TMJ problems, lost social development, increased CO2 levels, increased illness, etc etc. It’s a lot of weak arguments with no evidence and as a pediatrician who saw and examined thousands of children this past year: the kids are fine.

Does masking protect other people? Or me?

• Both.
• Even if your child is the only child wearing a mask in the class, it will protect him. (Click here for more information)
• This all works better if everyone masks.
• If an unmasked sneeze happens nearby, a mask prevents your child from inhaling AS MUCH virus into his airway – and there is brewing evidence that the MORE virus particles you inhale into your body, the more severe the subsequent illness may be.
• I also think it really keeps kids from touching their face, picking their nose, putting fingers in mouth, etc. Our absolute lack of flu and RSV last winter can attest to this.

What if only some kids are wearing masks? Will my kids get bullied?

• I don’t know. I doubt it. We did a whole year where everyone masked and school-aged and young kids were generally pretty cool and flexible about it. Most don’t seem to care either way. The bullies in this scenario often seem to be the adults.

When are the vaccines for the younger kids going to be ready?

• Pfizer’s clinical trial data for children age 5 to 11 is likely coming in September. If approved, shots for kids this age will be available within 1-2 weeks after that.
• Ages 2 to under 5 coming soon after that, in October.
• 6 months to 2 years soon after that.

What about my child under 2 who can’t wear a mask?

• It’s okay. Send them to daycare. Send them to mother’s day out. Do the swim lesson. Get the speech therapy. You need it to work, thrive, survive. COVID seems to be milder in young kids. And while I can never guarantee anything in life 100%, I think the benefits outweigh the risks for kids in this age group.

What if the daycare doesn’t require their staff to be masked? Vaccinated?

• I’m hopeful that daycare centers will strongly encourage their staffs to vaccinate and mask up, but I know that not all will. I think you should ask the questions and expect answers from childcare centers. You can certainly make that a part of your decision-making process when choosing where to place your child.

Do kids really get severely sick with COVID?

• COVID in children is mostly mild. No one debates that. But kids (especially the older kids) contribute to the spread in the community.
• Let’s not forget the times it’s not mild. I’ve seen kids with post-COVID chronic fatigue, long-term smell and taste change or loss, multisystem inflammatory problems, psychosis, and cardiac issues that have kept them out of sports for the year.
• We are still learning about the long-term consequences of COVID infection. There is thought that up to 30% of people who have had COVID will develop long-term medical problems.
• I talked to one of the Cook Children’s Pediatric ICU doctors the other day, Dr. Linda Thompson. I wanted her input about kids with more severe illness as she has seen much more of it than I. She said she’s seen more severe illness in older children compared to the younger ages. She also mentioned “please let everyone know I vaccinated my 14-year-old as soon as I could.”

What do you recommend, Dr. Diane? What will you be doing with your kids?

My kids (6 and 7 years old) will be going to school in-person this fall. They will be wearing masks regardless of what the other children are doing. They can take them off when outside. We will talk about it a lot before it happens, and expectations will be clear.

We will practice wearing them while we watch our screen time to get used to them again on our faces. We will pick the favorite fabrics. If our community numbers drop and my children are able to safely get vaccinated this winter, I can’t wait to tell them to take ‘em off.

But until enough of us get vaccinated, COVID is not going away. And it will likely surge again this winter.

As long as the numbers keep climbing in the community, we have to protect not only the kids, but all of us. Remember those hospital numbers in January? Remember the goal of not over-straining our medical resources? Remember Uncle Pete who had a heart attack and there wasn’t a single hospital bed available for him last winter?

I’ve said it before and I’ll say it again: we are building this boat as we float in it. We don’t know what the future holds for us and we are making the best decisions we can in a situation that no one has yet conquered. Having patience as we gather the data and learn from our successes and mistakes is the beautiful and necessary process of science.

Prepping for college starts far before senior year. You child needs to show years of volunteer/ community activities, sports participation, music/ arts, and special interests throughout their high school years. What makes them unique? What will set them apart from every other 3.5 GPA student on the wait list for universities? Here’s a list of things to focus on in high school to allow them to be the prized college applicant.

1. Learn another language: either learn from bilingual parents starting in childhood, or take 2-3 years of foreign language classes.
2. Be involved in a leadership role in your school: join special interest clubs and actually attend their monthly activities, join yearbook club, student council, or prom committee.
3. Volunteer through your church or community: animal rescue center, nursing homes, YMCA, anywhere where there is a need. Not just one weekend per year, but show long term commitment of volunteering of your time and talents to an organization that means something to your teen.
4. Sports/ music/ art: find your passion, be a good team mate, practice hard.
5. Travel: doesn’t have to be far or expensive, but let them experience a part of the world outside of their bubble.
6. Take ACT/ SAT early, and allow for a couple attempts, but don’t go overboard. It’s just one test score. Your child may have severe test anxiety and their score doesn’t accurately reflect their true ability.
7. Tour numerous college campuses, near and far from home. Research which colleges have the programs of interest for your teen and visit them so you get a feel for how the campus and city could support your (almost) adult child.
8. Take AP classes: this will get your teen ready for the fast pace of knowledge about to be thrown at them, and they can acquire college credit when they pass the end of year AP exams.
9. Get a part time job: babysitting, youth sports referee, waiter, anything. Some spending money is the bonus, the important thing is your teen demonstrating their ability to be on time and dependable.

All patients with exposure to COVID-19, regardless of symptoms, will need to quarantine for 14 days. This is required, regardless of test results, because COVID-19 can develop between two and 14 days after an exposure.

At Cook Children’s Urgent Care, a patient may be required to have two negative COVID-19 tests before their doctor or nurse practitioner will sign a form allowing the child to return to school. This will likely be the case if the child's symptoms are high risk for the virus. 

If a child tests positive for COVID-19, they will need to stay home for 10 days after the onset of their own symptoms. This could mean a quarantine longer than 14 days. 

Cook Children's Health Care System follows guidelines from the Centers for Disease Control and Prevention (CDC).

We also follow the Infectious Disease Society of America which has issued the following COVID-19 guidelines: 

• Intermediate to high clinical suspicion of COVID-19: A COVID-19 test should be repeated in 24 to 48 hours (different samples if indicated)
• Low clinical suspicion: No re-testing

All patients with high-risk symptoms should be tested for COVID-19 before returning to school based on physician or nurse practitioner discretion.

These symptoms include:

• Fever
• Cough
• Shortness of breath
• Body aches
• Loss of taste/smell
• Headache
• Sore throat
• Sustained vomiting or diarrhea (and usually a combination of the these symptoms)

“Our goal is to make sure we limit the spread of COVID-19 as much as we possibly can to keep everyone healthy,” said Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “If the first test gives a false negative result, we could potentially be sending a contagious child back into the classroom. That is why a second test is needed in cases of high suspicion.” 

All patients with low-risk symptoms and NO known exposure to COVID-19 can be tested before returning to school based on physician discretion. Low-risk symptoms include congestion or runny nose, rash or a single episodes of vomiting or diarrhea.

Click here to read more about COVID-19 testing.

“September of 2020 has been the highest month ever that we've seen suicidal patients admitted to our medical center,” said Kia Carter, M.D., medical director of Psychiatry at Cook Children’s. “We've seen this number rising year after year, so it's not surprising that it's this high. Suicide has become the second leading cause of death for kids and adolescents in the last year, versus two years ago when it was the third leading cause of death.”

This news comes after a near-record month in August when 29 patients were admitted for intentional suicide attempts. The patients admitted to Cook Children’s in September were between the ages of 6 and 18 years old. Dr. Carter says she feels the pandemic has played a moderate role in the increase, but that we typically see higher numbers in the fall months when kids return to school. In September of 2019, for example, Cook Children’s admitted 32 patients for suicide attempts.

“We've definitely seen this number rising in the last five years, but I do think that the amount of stress that we as a society have experienced in the last six months has caused some of our kids and adults to struggle more,” said Dr. Carter.

Virtual school may also be playing a role in mental health of kids. The Rees-Jones Behavioral Health Center at Cook Children’s has become a resource for children and teens who report feeling hopeless and not knowing how to cope with the isolation the pandemic has caused.

“I think everything in proportion is good, but when something is to this extent where some kids have had to do 100% virtual since March, it’s been very difficult,” Dr. Carter explained. “When kids have school, they have an outlet. They have other people to talk to. They have friends and social activities. Now, it’s just them, their parents and siblings.”

She says it’s important to know that some kids do very well with virtual learning, but it’s up to parents to know what works best for their child. Also, some families may have to choose virtual learning if the child or another family member falls into the high-risk category for COVID-19. In that case, parents should remember to ask for help when they need it. School counselors, nurses, teachers and their pediatrician are all great resources.

Warning Signs

Dr. Carter says the biggest thing to look for is a change in your child’s behavior, which she acknowledges can be difficult during the pandemic. She says little things like sleeping more than usual or not wanting to engage or interact in activities they used to enjoy can be signs of depression.

“Start engaging a little more and check in, like ‘Hey, are you feeling okay? I noticed you were getting a little angry at us for no reason,'” she said.

While it’s easy to write off irritation as a side effect of being a teenager, it is one of the primary symptoms of depression in children and adolescents.

Other signs to watch for include:

• Declining grades
• Lack of concern about appearance and hygiene
• Changes in eating and/or sleep
• Self-injury such as cutting
• Less motivation
• Alcohol/drug use
• Acting highly anxious or agitated
• Recklessness

Dr. Carter says girls are more likely to be hospitalized for attempting suicide, but boys tend to make more lethal attempts. As for age, Cook Children’s data shows 14 to 15 years old is the average for suicide attempt admissions, but more recently, the majority of patients have been around 12 to 13 years of age.

With many kids at home alone due to COVID-19, increased access to things like medication, firearms and the internet may also be contributing to the increase in patients. Dr. Carter says her team has also seen more patients participating in social media challenges where kids are hurting themselves.

“We have seen a rise in cutting behaviors, which are a form of self-injury. This is not always considered a suicide attempt but more of a maladaptive behavioral response to stress.”

She says these are things often picked up on social media, reinforcing the importance of knowing what your child is looking at and who they are talking to on the internet.

What Can Parents Do?

Get help.

If you’re concerned for the immediate safety of your child, take them to an emergency room. Trained professionals will evaluate your child to see what next steps need to be taken.

If you’re concerned about your child’s mental health (but not that they will harm themselves), you can contact your pediatrician, school nurse or counselor for a list of outpatient resources in your area.

If you feel your child may need a higher level of care (but it’s not an emergency), you can call Cook Children’s Behavioral Health Intake Department at 682-885-3917. Our team will help arrange referral for outpatient therapy and medication management, partial hospitalization day treatment options or inpatient treatment if needed.

Partial hospitalization allows children to receive treatment including medication management, family and group therapy at the Rees-Jones Behavioral Health Center during the day, while allowing them to go home at night. Children who are deemed an immediate danger to themselves may be admitted to the inpatient unit for 24/7 monitoring and treatment. The Rees-Jones Behavioral Health Center, is one of the few places in North Texas that offers inpatient psychiatric care for children between the ages of 2 and 12.

“Our biggest hope is that we can help families find the support and resources they need, and that we can educate our school systems about warning signs and screenings because they are hopefully going to come in contact with those kids before we do,” said Dr. Carter. “We don't want the numbers to continue to rise and we continue to lose our children. Remember that suicide is preventable.”

In the following video, our team answers the questions they hear most frequently, including how COVID-19 has impacted the program.

Learn more on our website.

Now that schools have opened, who needs COVID-19 testing?

Rapid testing for COVID-19 can be helpful to promote isolation for positive cases, and to prevent prolonged unnecessary isolation for those children exposed to COVID-19 or with questionable symptoms. The symptoms that most likely warrant testing are combinations of the following: fever and headache, vomiting, diarrhea, congestion, loss of taste or smell, cough, muscle soreness, extreme fatigue and shortness of breath. Children with diabetes may see unexplained difficulties with sugar control. Any combination of these symptoms should be taken more seriously if there has been a known contact with a COVID-19 case.

Does a child who has had COVID-19 need a negative test to return to school?

While we have seen some schools and athletic programs requiring a negative test in order to return, this is based on outdated guidance. Testing may remain positive for weeks after symptoms have passed but does not mean that the child remains contagious. The current guidance is that students may return when their symptoms have resolved for 24 hours AND they are 10 days since the start of symptoms. In practicalities, most of these students will be waiting until the 10 days pass. If a child was hospitalized, it is recommend that they wait 20 days from the start of symptoms.

If a child is exposed to COVID-19, can we end their quarantine early with a negative test?

Testing is reasonable if symptoms develop to make a diagnosis, but quarantine should continue for 14 days from the end of the last contact. A negative test should not provide false reassurance as symptoms could continue to develop throughout the 14 day period despite a negative test.

Many parents are concerned about whether their child is at more risk for COVID-19. Which patients are at risk for more severe disease?

Risk factors for severe disease at any age include: cancer; COPD; immunosuppressed state due to organ transplant; obesity (BMI >30); serious heart disease such as heart failure, coronary artery disease, and cardiomyopathies; sickle cell disease; and type II diabetes.

Individuals with the following conditions MAY be at increased risk for severe diseases: asthma; stroke; cystic fibrosis; hypertension; immunocompromised state due blood or bone marrow transplant, steroids, or immunosuppressing medications; neurologic conditions; HIV; liver disease; pregnancy; pulmonary fibrosis; smoking; thalassemia; and type I diabetes.

Children who are medically complex, who have serious genetic, neurologic, metabolic disorders, or congenital heart disease might be at increased risk for severe illness from COVID-19, as well as children with obesity, diabetes, asthma and chronic lung disease, or immunosuppression.

What do you do when a child has a family member who is at risk for severe disease? Does the child’s age matter?

In this situation, distance learning might remain the best option for this family. Because the disease can be contracted at any age, this should not factor into the decision. While child to adult spread may not happen as easily as adult to child, there are studies that show it does occur.

Do children who are planning to do virtual learning need to have their vaccines updated?

According to the Texas Department of State Health Services (TDSHS), vaccine rules are still in effect regardless of whether a student is participating in on-campus or virtual learning.

Read more about Cook Children's recommendations for safely returning to school on our website.

*This post includes information provided by Marc Mazade, M.D., medical director of Infection Control and Prevention at Cook Children’s and Justin Smith, M.D., pediatrician at Cook Children’s Pediatric Trophy Club.

For parents who have a child starting school in person, it’s normal to have some anxiety about the entire process, staying informed and connected may reduce these feelings and can give you a way to express concerns that you have regarding practices at your child’s school.

Consider the following if your child is set to start in-person learning and or will eventually be transitioning from virtual at-home learning to in-person learning:

Get organized and stay informed: Make sure you are aware of the safety guidelines that your school will be taking when students are back in the classroom.

Will face coverings be required for ALL children? If so ensure you have taken the last few weeks of summer to have child practice wearing their face covering or mask and encourage minimizing touching the face while putting the mask on or taking it off. Other things to consider regarding masks/face coverings:

• Ensure the mask/face covering you choose fits snugly yet comfortably against the face, covers the nose and mouth completely, and if its design is “re-usable” ensure the material allows washing and drying without damage to shape or build of the mask.
• Once you have found the type/style of mask your child is comfortable in ensure you have several available as backups.
• Tips on practice for wearing a mask (gathered from several different expert pediatricians)
• Have the child wear the mask/face covering during times likes watching a movie or playing a game. Allow them to take breaks but also praise them when they have successfully worn the mask or covering for a significant amount of time.
• For younger children needing help with wearing a mask use a favorite stuffed animal to demonstrate proper mask wearing, or find pictures of children or their favorite cartoons wearing masks.
• Modeling is very important. As a family model wearing masks/face coverings, children learn by example and this is one of the best ways to teach a child the importance of wearing a mask.
• Get in the habit of checking in with your child each morning for signs of illness. If there is ANY concern at all take the child’s temperature (if the child has a temperature of 100.4F or higher even without any other symptoms the child should NOT go to school).
• Thereafter monitor for any other symptoms: ensure your child does NOT have sore throat, cough, diarrhea/vomiting, headache or body aches.

Even if symptoms seem mild they should be recognized and taken into account in order to avoid potential spread of any infectious illness. This will remain important as the cooler weather and fall season are typical for other respiratory illnesses to arise such as influenza.

• If your child is sick and develops symptoms of COVID make sure you are aware of where you child can be tested. Also make sure you know who the school’s point of contact is for reporting illness. Find out what options for instruction/learning will be available for the child if quarantine is required. Make sure you are familiar with the school’s plan of communicating with families when a positive case or exposure to COVID-19 have occurred.
• Ensure your child is up to date on ALL recommended vaccines including the flu vaccine when it becomes available this year. We do not know how these two respiratory illness will affect severity of illness if a child or adult is co-infected.
• Review and practice proper hand washing techniques with your child at home and ensure they are aware of the options available at school for hand hygiene.
• Adjust daily before and after school routines to include the following if you had not been doing them already: remember to pack hand sanitizer and extra face coverings/masks. Have children change out of school clothes into clean set of clothes and wash hands as soon as they return home.
• Make sure the school has up to date contact information including emergency contacts as well as individuals authorized to pick up your child. If the list includes anyone who is considered high risk for developing severe illness for COVID-19 consider choosing an alternate person.
• Plan for potential school closures or quarantine periods. Consider if you will be able to take time off work should the child require quarantine at home. If the parent is unable to work from home or take time off work it is important to identify an adult who would be able to supervise the child during this time.

Stay alert: We know these times of significant change and decreased social interactions can contribute to stress and anxiety in children as well as adults.

Talk to your child about what to expect regarding how school will look different from before. For example desks may be set far apart for distancing purposes, teachers and staff will likely be using masks/face coverings and in some instances eye protection or googles, lunch time may occur at staggered times in smaller groups. Sports and other outside activities may involve different precautions than before. Be alert to changes in your child’s behavior that may indicate they are struggling with stress, anxiety or depression.

These include excessive crying or irritation, excessive worry or sadness, change in eating habits or sleep habits or difficulties concentrating among other changes in their typical behavior.

Remember there has already been a lot of stress with handling the many unknowns and issues the COVID pandemic has brought, it is important for children and adults to take breaks when necessary, get plenty of sleep, exercise and eat well and stay socially connected during this time.

Related Content:

• Returning to School During the COVID-19 Pandemic: Virtual Learning
• Regreso a la escuela durante la pandemia de COVID: Planificación para el aprendizaje en persona
• Regreso a la escuela durante la pandemia de COVID-19: Planificación para el aprendizaje virtual

Did you know that schools consider French fries and ketchup as vegetable servings in their cafeteria served lunches?! In just a few minutes in the evenings, you can prepare a more nutritious lunch for your kiddos.

You can prepare these meals even if you’re not sending your child off to school yet. Go ahead and get in the routine of lunch prep at night, and they can eat their “school lunch” during the noon break from virtual school. In fact, prepping lunch and snacks will limit the constant grazing we might have gotten into the bad habit of over the lockdown and summer.

 Here are my healthy takes on kid-friendly favorites.

Kids Meal Prep Ideas for school lunches:

1.“Pizza Lunchables”: 1 or 2 Wheat English muffin halves, with side of low salt pizza sauce (make your own real quick with low or no salt tomato sauce seasoned with pepper and oregano), shredded mozzarella, and turkey pepperonis. Side Veggie: sliced bell peppers. Side Fruit: fresh mandarin orange

2.“Lunchables”: Handful (approx. 12) of wheat or veggie crackers, 3 slices of low salt, no preservative deli turkey or ham cut in quarters, 3 slices of low fat cheese cut in quarters. Side Veggie: celery sticks with hummus or ranch dip. Side Fruit: No sugar added fruit cup

3.Roll Ups: Corn or wheat tortilla with sliced cheese or spreadable cheese (such as laughing cow) and low salt no preservative deli meat. Can add spinach and/or smashed avocado as well. Slice in 6 equal pieces to have cute pinwheels. Side Veggie: carrots and dip. Side Fruit: grapes

4.Egg muffins:

Recipe: 1 cup Bisquick

• 1 lb cooked turkey sausage or ground turkey
• 4 eggs, beaten
• 1 cup shredded cheddar cheese
• *Optional: 1 cup chopped veggies such as peppers and mushrooms
• Mix all ingredients and split between 12 servings in a muffin tin. Bake at 350 degrees for 20mins
•  Side Veggie: cucumber slices and cherry tomatoes. Side Fruit: berries

5. Pasta salad: Cooked whole wheat or veggie pasta with chopped grilled chicken and vegetables such as tomatoes, zucchini, and spinach. Add a little dressing to the pasta salad such as pesto or Italian dressing. Side Fruit: apple slices.

6. Quesadillas: Corn or wheat tortillas with bean & cheese or chicken & cheese. Side Veggie: broccoli and dip. Side Fruit: mango or peach slices

7.”Chicken Nuggets”:

• Recipe: Cut 1 lb chicken breasts into strips or large chunks.
• Coat in flour mixture: 1 cup or more whole wheat or oat flour mixed with ¼ cup ground flax seeds, ½ tsp salt & pepper, 1 tsp garlic powder, and 1 tsp paprika. Now dredge coated chicken in beaten eggs, and then again coat with flour mixture.
• Bake or air fry until cooked through. (Double recipe to make for dinner, then to have leftovers for next day’s lunches.)
• Side Veggie: veggie chips or sticks. Side Fruit: fruit & veggie squeeze pouch

8. Meatballs:

• Recipe: 1 lb ground beef or turkey
• ½ can pureed pumpkin
• 2 slices wheat bread, torn apart in small pieces
• ¼ cup flax seeds
• 1 egg
• ½ tsp each salt & pepper
• 1 tsp garlic powder
• 2 tbsp low sugar ketchup
• Mix all ingredient until well combined. Make 1-2 inch balls and place on greased sheet pan. Bake 15-20mins at 350 degrees until cooked through. Can serve with ketchup or bbq sauce. (Double recipe to make for dinner, then have leftovers for lunch next day.)
• Side Veggie: Cauliflower and hummus or ranch. Side Fruit: pineapple
• Extra additions to above lunch ideas, 1 per day: small individual cookie packs, all natural fruit twists (actual fruit instead of packs of fruit snacks), granola bar, fruit & nut bar such as LaraBar, ¼ cup trail mix, ½ cup honey wheat pretzels.
• No juice, soda or sports drinks; instead have water or 2% milk.

I hope you enjoy! 

Sleep, it’s important, right?!

Has your kid's new COVID-19 schedule got them going to bed after midnight and sleeping until noon?

Well it’s time NOW to start getting back into a normal sleep schedule for school, even if they are learning online.

So how much sleep does your child need? This is a good estimate, but teenagers can require up to 12 hours of sleep while they’re going through a growth spurt.

How much sleep does my child need?

• 3-6 year olds need 10-12 hours of sleep
• 7-12 year olds need 10-11 hours of sleep
• 13-18 year olds need 8-9 hours of sleep

If your child has a midnight or (gasp!) even later bedtime right now, start working on adjusting their bedtime slowly over the next few weeks. I propose the following schedule:

• Aug 1: 11:30 p.m.
• Aug 2: 11:15 p.m.
• Aug 3: 11 p.m.
• Aug 4: 10:45 p.m.
• Aug 5: 10:30 p.m.
• Aug 6: 10:15 p.m.
• Aug 7: 10 p.m.
• Aug 8: 9:45 p.m.
• Aug 9: 9:30 p.m.
• Aug 10: 9:15 p.m.
• Aug 11: 9:15 p.m.
• Aug 12: 9 p.m.*

*Early elementary children will likely need a 7 p.m. or 8 p.m. bedtime, adjust the 15-minute pattern above as needed.

Keep in mind that bedtime means lights out, no screen time. Charge your child’s phone in your room, you’d be shocked to find out the long text message conversations happening at 2 a.m.! No TV in the bedroom either. If your child is having trouble with the adjustment in bedtime, it is perfectly fine to give melatonin about 20-30 minutes before bedtime. One or 3 milligrams is appropriate for elementary age, up to 5 milligrams for teenagers. Don’t allow caffeine after noon either.

Best of luck transitioning to school this year! We’re all going to have to work nicely together to get through this, but we can and we will!

Recently, I wrote a post titled, “Is Going Back to School or Online Learning Best for Your Child?” A Pediatrician Shares what Parents Should Consider?”

Following that initial article, we received a lot of questions from you all. I wanted to take this opportunity to answer them all at once.

Let’s get started.

For families with multiple school-age children, is it counter-productive to send some children and keep the others home? I think one of my kids can thrive with online schooling, but it would be much harder for the other two (due to dyslexia, age, socialization needs, etc.).

Not necessarily. While the child at school could contract the virus and bring it home, the fewer children and contacts, the less likely the family is to be exposed. I can easily see a family weighing the risks versus benefits and making different decisions for each child.

When looking at a child as a whole and not just at the physical, can you talk about what repercussions we could be looking at from keeping kids home from school. As a nurse, one of our core principles is looking at the entire patient and not just the patient's body. I think we should have a discussion about the mental health, emotional health, educational health, and even social health repercussions of keeping kids home. This won't be the often very successful home schooling that people do.

Yes, I think it is very important for families to consider both the medical risk of COVID on children and household contacts in the context of how being home from school would affect their child educationally, socially and emotionally. It should definitely be a whole child conversation.

Is it worth sending kiddos with special health needs to public school this year? We had hoped to send our youngest who has cystic fibrosis back to public school for his high school years starting this year.

And ...

Hi Dr. Smith, My soon to be 1st grader is on methotrexate for Crohn’s disease. How worried should I be about sending him to in person school? I’m worried the medication will make it harder for him to recover from Covid. Thank you for your insight!

This decision will be different for every child and every family depending upon the needs and risks for an individual child. These decisions would be best made with the pediatrician or specialist who knows the child's history the best.

If our kids go back to school, are we basically giving up seeing grandparents and anyone high risk? We’ve been very careful all summer in order to be able to spend time with my mom.

This is probably one of the worst parts about this decision for families. Based on the best information available currently, once our kids go back to school, I think we will have to use extreme caution with grandparents and other at risk contacts. Hopefully we will learn more over time what it looks like to protect grandparents and maintain connection.

My oldest is entering kinder, and it just seems/feels like such a big year for him. He loves school, and excels, but is also shy and sensitive to new things and transitions. We also have a grandparent that we see often who has cancer, so sending him would mean that we couldn’t see family. We are leaning towards homeschooling for the year, but don’t want him to miss out on such a big and important year. Is kinder a good year to homeschool or would it be more important to send him for the socialization and such?

Transitional years seem like the one that most families are struggling with. Kindergarten, 6th grade, 9th grade...as well as the obvious 12th grade. Unfortunately, I don't think that there is a straightforward answer but I am trying to remind families that everyone is facing the same decision and your child wouldn't be the only one who stays home...all that to say, there will be several kids starting first grade the next year who also home schooled.

For me it’s, if we as a family decide to send him back to school, how do we protect the rest of the family from germs he may bring home? Is it even possible? And at 13 is social interaction crucial for his mental state (he’s kind of a home-body anyways)?

I think I would be extra cautious about hand washing, perhaps even showering and changing clothes once they get home. Is it possible to keep them completely sterile? Probably not but it might make me feel better to make sure I was doing everything I could. Is social interaction crucial? It definitely depends on the kid. But it might not be as simple as thinking introverts don't need to go but extroverts do-perhaps it's our introverts who have the most to learn from being in a social environment. It's hard to say.

One of my two children has already tested positive. My youngest has not. Is it safe to send the one who has tested Positive back to school? Is there such a thing as immunity?

This is something I truly don't know if we have the answer to. Can a child who has had it get it again? Can they still bring it home even if they are immune? I don’t know the final answer to these questions.

What about the nonverbal language skills kids will lose by not being able to see their teachers and peers facial expressions behind a mask.

I think it’s safe to say that even being at school will not be normal and there will be some downsides and missed opportunities for learning. Even things as simple as not having lunch in the larger community and skipping recess (if a school chooses to do those things) will be something we need to consider.

Guilt. Am I a bad parent if I send my kids because I think they need in school learning? The spring at home was minimally successful and I do not think we have the capacity to do the teaching from home. How do I NOT feel like a bad parent?

I think this one will affect everyone. Trying to make the right decision with limited information and two options directly in front of you is a huge challenge. Dealing with the downfall when things go wrong or there are challenges down the road will inevitably lead this towards you wondering if you made the best decisions.

It’s the Bachelor phenomenon-how can an individual get to the end with two competitors and choose one-completely forgetting that the first was an option and not wondering if they made the right call? It’s probably why it seems to fail more than work out. (Except Sean and Catherine and a few others…)

And it’s not just the decision to send them that will have parents feeling guilty…parents choosing to keep kids home will have similar struggles.

How do you help with the guilt:

1. Remember that you’re not in this alone. Everyone else is having to make the same decisions.
2. Remember that kids are resilient. If they have a parent who loves them and is agonizing over this choice. They are likely to be ok in the long run.
3. Remember that no choice is forever. It feels like you’re making a decision that could have effects on your child for the rest of their life, but we will have options over time. None of them may be great options but we can make changes as we go and modify based on how it’s going.

What should performing arts classes do for safety? Is it safe for a bunch of teenagers to be singing, playing instruments, performing plays and musicals together in one room? 

Yes, I believe that most school will have to forego performing arts classes for the near future due to the risk that these activities could increase the risk of spreading droplets and disease.

How do we keep 2600 high school students from passing this like wildfire when we can’t easily keep them in 1 or 2 classrooms all day? Are teenagers being affected symptomatically similar to “kids” or more like “adults”?

I think secondary schools are going to present the biggest challenge to keeping infections at bay due to their mobility throughout the school day. We may see schools make decisions to keep kids cohorted for core classes and limiting electives or presenting electives in an alternative way. It does appear that adolescents appear to be presenting with more symptomatic disease-which may help monitoring infections and spread easier than in kids who are asymptomatic.

If one child in a classroom is positive will the entire class need to quarantine/virtual school for a 14 day time period?

It does not appear that the class will be shut down if a classmate tests positive for COVID. According to the TEA and local health departments, notification will be provided to families should a person on campus test positive but it is not clear how much information will be provided.

What are the thoughts on preschool. If we have the option is keeping them home worth the reduced risk of Covid despite it keeping the children from other children and a classroom? Will our preschoolers be behind come Kinder?

Keep in mind that many children start their first formal schooling experience with kindergarten and do well. Parents may still make a decision to send their child to preschool but I don’t think it should be out of fear for their education.

My heart breaks for my kindergartener who will start his public school experience looking SO different than his older sister. How much should I allow a 5 year old to endure. What are the “new rules” that are too much to expect (an active) 5 year old to adhere to?

I think they should be prepared that things will be a little different than their preschool years. Masks, recess, PE, lunch-everything will look a little bit different. Reassure them that all of the changes are to help them be safe. But also keep in mind that they probably don’t know what Kindergarten is supposed to look like. So, what does that mean? There’s no point in having significant discussions with them about what they are missing out on. Focus on the positives. The way we frame these discussions with our kids is going to mean a lot to them. Are masks going to be required? Don’t say it’s stupid but we’re going to do it anyway, just say, it’s part of life. Recess with just your class? Think of how much more room you’ll have on the playground. You’ll get so many more turns!

What happens when our 4 yo inevitably picks up another cold of virus at school with the same symptoms. Will we need to get her tested for Covid every time to rule it out? I also have a 6 month old so worried about him getting it from her. Just can’t wrap my head around how this will work when she does get sick with something.

This is going to be one of the biggest challenges of the fall. Because the list of COVID symptoms are so broad, we’re going to have to learn quickly what symptoms require testing and what can be monitored. Early on, I expect we’ll be doing a lot of tests out of precaution until we get better guidance. We’ll all be doing the best we can to minimize unnecessary visits but also to keep everyone as safe as possible.

I’m choosing to start my son out at home this year. How do I approach the decision with him? What is appropriate for elementary aged kids to know about why I made the decision and how do I make sure to address the missing of friends?

I think informing them of your thought process to the level of their development is an important part of how you transition them towards thinking about doing school at home. Finding ways for them to connect with peers will be something that you need to focus on-through technology or finding ways for them to participate in extracurricular activities that are following COVID guidelines are two thoughts that come to min.

Is it ok for a 3rd grader to wear a mask for 8 hours a day at school?

Yes! It will be a learning curve for sure but kids in schools all over the world have adjusted to wearing masks both now and in flu seasons throughout the years. Start practicing now. Explain to them the importance at their level. It’s just like covering your cough, washing your hands and not picking your boogers. Just another thing that we have to teach them in order to keep the environment safe for themselves and their classmates.

Should I have my child tested for antibodies to COVID if I think they had it earlier in the year? If they have antibodies will this help protect them when they go back to school? One of my children has special needs and gets sick very easily. I am fearful for him to go back to school but also fearful that lack of socialization for him will be detrimental.

Unfortunately, the accuracy of antibody testing has not been consistently good-some studies have shown that have shown false positive and negatives at a rate of 50%. In addition, we are not sure what antibodies actually confer immunity.

As Texas enters Phase 3 of Governor Gregg Abbott’s plans reopen the state amid the COVID-19 pandemic, bars, restaurants, amusement parks and sports venues are working to welcome back patrons.

But for many parents, their biggest concern remains what to do during the upcoming school year.

Medical Director of Infection Prevention at Cook Children’s Marc Mazade, M.D, hears questions about how to reopen school again on a daily basis from his patient families as well as his own colleagues.

“Everyone kept asking me, ‘Are kids even going back to school?’ I don’t really know what the plan is. I certainly hope schools reopen in the fall, but we have some work to do,” Dr. Mazade said.

Seeing a need for more guidance, Dr. Mazade worked with more than 50 Cook Children’s physicians to create “Recommendations for the Practical, Fair and Safe Reopening of Public Schools K-12 in the State of Texas.”

The doctors involved work in a variety of primary care offices as well as specialty clinics including Infectious Diseases, Emergency Services, Cardiology, ENT, Neurosciences and more. Dr. Mazade expects this to be a long-term plan, with elements in it that allow for looser restrictions based on current Centers for Disease Control and Prevention (CDC) guidelines for community transmission. He sent these recommendations to the governor and hopes to provide it to schools for the upcoming year.

Dr. Mazade admits to being cautious as kids return to the classroom, but he also believes a common-sense, careful approach will allow children the best opportunity to remain safe.

Students from kindergartners to high school seniors tend to tolerate infection better than adults, especially elderly people. Cook Children’s prescreening of asymptomatic children preparing for a medical procedure identified around 1% of children of all ages shedding the virus locally at the time of this writing.

“In order to put children safely to sleep, we have been testing children who are preparing for surgery for COVID-19 infection," Dr. Mazade said. "As feared, some children who have no symptoms are testing positive for COVID-19. That shows us that children with no symptoms have COVID-19 in our community and infection can spread unknowingly from person to person. We are urging everyone to continue to take precautions to keep everyone safe.”

The physicians worked on the document with the health and safety of students, teachers and their families at the top of mind, but they also thought about a common-sense approach to help bring a return of normalcy to kids’ lives.

“We want children to wear masks, but we also understand that’s going to be difficult for little kids,” Dr. Mazade said. “They may not understand why they are wearing masks, and it may cause problems for them emotionally. In those cases, we are asking for teachers and other adults around these children to take the proper precaution to protect younger children.”

It’s important to everyone involved in creating this document that kids are able to be kids. For instance, under the guidelines, athletes will return to the playing field, but that may mean playing in front of only family where everyone can be properly spaced out for safety.

“As we begin to look at these issues that students may face, we begin to focus on more than the spread of the virus,” Dr. Mazade said. “One of the concerns that came up was making sure we were screening kids for new problems such as starvation and hunger. We don’t know who all are dealing with these issues right now. The kid next door may not get enough to eat any longer. We want to think about screening for depression, too. We added those things to the document because it’s important to be proactive because the stresses are new, different, and so widespread.”

Food allergies are a frequently discussed topic among parents and medical professionals. If you are not a parent of a child with food allergies, chances are high that someone you love, or someone you see daily may be dealing with this challenging diagnosis.

According to FARE (Food Allergy Research and Education), 32 million Americans are living with food allergies. If you take the statistic a little further, that means 1 in 13 children have food allergies. For a parent, it can be terrifying to have to think about leaving their child at school all day.

Now that school is in full swing, you may have questions, or may be wondering if there is more you can do to keep your child safe. As a pediatric ER nurse and parent of two with food allergies, I am here to tell you that knowledge and preparation are keys to a smooth year! Here are some ways to ensure your child is safe at school.

1. First and foremost, visit your child’s allergist every year. (If your child is newly diagnosed and awaiting your first allergist visit, your pediatrician can help you.) Make sure your child has an updated prescription for Epi-Pens. Make sure you have 2 sets; one for home and one for school to keep with the nurse.
2. Ask your child’s allergist or pediatrician to fill out a personalized action plan. The FARE website has action plans that are simple to understand, and can be found at www.foodallergy.org. Make multiple copies of these plans. Give them to your child’s teachers and the school nurse. These are absolutely essential to have! They outline exactly what to do in the case of accidental exposure to an allergen.
3. Know your rights as a parent. Your school should be accommodating your child in the best way possible. Your child is protected by law due to their food allergy. You can request a 504 meeting at your school. During this meeting, you meet to determine how to best meet the needs of your child at school. As an example, in my children’s 504 plans, we specify that they need to not be seated around anyone eating nuts during the lunch period.
4. Make sure your children know to never, ever eat food that you either did not pack for them, or did not provide for the classroom. Get your kids in this habit early, and it will become second nature.
5. Prepare for classroom celebrations. Elementary school especially seems to have many, many food centered celebrations. Provide a box of safe treats to keep in your child’s classroom so that they are not completely left out.
6. Read every label! Food companies are not required to label for allergens, so it is essential to read every ingredient, even if it’s a food your kiddo has consumed before, as production lines can change.
7. Take care of yourself. Caring for a child with food allergies can be stressful. Take heart in knowing it will get easier over time. Reach out to other food allergy families and know you are not alone.

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

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

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

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

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

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

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

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

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

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

What topics did we miss?

Related To This Topic:

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

You’re holding your child’s hand on your way to the first day of school. The squeeze on your hand is tighter than usual. Then suddenly your little one sees a friend, smiles, releases your grip and you watch them run to school together without a care in the world.

Everything is great.

But then you notice a tear in your eye. Suddenly, you realize your child isn’t the one nervous about going back to school. It’s you.

The back-to-school transition can be stressful for many parents, and the reasons are valid.

For example, knowing that your child struggles with change can increase your own feelings of tension.

You may worry that your child will struggle to fit in with peers and make friends.

Maybe your child had a bad experience at day care or a previous school year, leaving you both with lingering anxiety.

Some parents are concerned that schoolwork or a tight schedule may be too difficult for their child or that a teacher will not understand their child's unique needs. 

Maybe, you’ve waited until the last minute and just aren’t ready. The need to buy new clothes and school supplies may cause concerns about finances, and a steady stream of demands on your time can leave you feeling pressured and stressed.

Plus, there’s just the feeling that your young child is growing up too darn fast.

If you are stressed about your child's return to school, you may wonder if you should share your concerns. Sam McCage, clinic manager of Behavioral Health Services in Fort Worth and a licensed psychologist,  says that could be a mistake. Your child looks to you for signs that school is fun, exciting and safe and not something to fear, so it's important to discuss school in an upbeat and encouraging way.

"Recognize that children will sense your anxiety and their own will increase if you express your anxiety too much," McCage said. "If they ask about your concerns, tell them that you are excited for them and confident they will do well."

McCage reminds parents that "it's normal to feel anxiety about your child going back to school, but he says there are strategies to help you effectively manage your stress.

Here's how you can calm your concerns and enjoy this annual adventure with your child.:

• Visit the school and connect with your child's teacher and other school staff.
• Make arrangements for car pools, play dates and after-school care well in advance.
• Be patient and give the teachers time to develop a relationship with your child.
• Make sure you have realistic expectations about how your child should perform in school and extracurricular activities.
• Talk with other parents about how they handle their anxiety.
• Use humor to diffuse the stress.
• Schedule fun family activities with your children.

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

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

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

1. What system do you use for your classroom management?

This question is important because it lets you know the class norms along with what is expected of your child’s behavior.

2. How do you reinforce positive behavior?

This will give you an idea of the rewards and praises the teacher gives out in order to support a more positive learning environment.

3. What is your primary medium for communication?

It's important to know how your child’s teacher plans to get important information to you and vice versa. Maybe they send home letters or maybe they prefer to email. It's always a good idea to know what the teacher prefers to ensure communication is not hampered.

4. What are the top three things I can do at home to help my child succeed?

By finding out the answer to this question, you will know what new material is of great importance in your child’s new grade level. For example, Ownby lets her parents know that practicing multiplication facts was extremely important when she taught third graders. If they are practicing at home, they will be better prepared in the classroom.

5. What supplies do you run out of first?

This is helpful to know in case you would like to send in supplies to school with your child. Many supplies are used on a daily basis and tend to run out quickly.

Other ways to ensure your child gets the most out of the school year include setting high expectations and making sure they attend school on a regular basis (unless they are sick). Parents should also keep an open line of communication with their child's teacher and make sure they understand the parents' goals and expectations for the child. With these points in minds, parents can help make sure their students are being given the opportunities they need to succeed in the classroom.

1. Health. Often, new teachers don’t know about your child’s health history. Many kiddos have severe nut allergies and teachers need to be aware of those food allergies, as well as if your child needs special medication or an EpiPen® injection. You should let your teacher know if your child has asthma, is diabetic or has any other serious health condition.

2. Educational Diagnoses. Teachers may not know your child has been diagnosed with a learning difference, dyslexia or an attention deficit problem. This is an opportunity to let teachers know about a 504 plan or IEP for your child. This is also a great time to let your teacher know what your child’s learning style is such as whether they are an auditory, visual or kinetic learner. Sharing your child’s areas of strengths and weaknesses is also helpful.

3. Emotional and family. Inform your teacher of any emotional factors that may impact your child such as divorce, death, illness or a parent being stationed overseas. It’s helpful for teachers to know the emotional factors that are impacting your child’s life which may help your teacher to understand and communicate better with your child.

4. Don’t settle for orientation. Teachers are bombarded with information at meet and greets during orientation. It’s hard to keep everyone and everything straight. My advice is to set up a conference with your child’s teacher as early as possible. One teacher told me she found it really helpful when parents provided a list of bullet points that included helpful information about their child, including the health and educational diagnoses, the strengths and weaknesses of the child, how the student learns the best, what the student responds to best when giving direction or correction and some points about the student’s social and personality style. Go in and set up an appointment one on one, especially if your child has special needs or considerations.

5. Be a team player. Every teacher I have spoken with has told me what they appreciate more than anything is for the parent to ask the teacher, ‘how can we help you? What information do you want to know?’ Most teachers prefer that team approach.

6. Be honest with yourself about your child. This is sometimes the most difficult tip for parents, but it’s so important. Know your child’s strengths and weakness. One of our biggest problems in today’s society is not teaching accountability. Set that example. Make sure your child knows his or her responsibility. Teachers have a difficult enough job without always blaming them, the school or another child. Please make sure you know how your child contributed to a situation and then take appropriate action from there.

Of course every child is different, and special, which makes communication between you and your teacher so important in having a great school year.

About the author

Lisa Elliott is a licensed psychologist and clinic manager of Cook Children’s Behavioral Health, located at 3201 Teasley Lane, Ste. 202, Denton, TX 76210. To make an appointment, call 940-484-4311. Cook Children’s Psychology provides care focused on children’s behavior, from ages 3 years through 17.

A letter published by the department reports that they are “reviewing individual exposure status, although anyone at the school on January 5, 2016 could have had exposure.” Those who have come into contact with the virus will need to be observed for up to three weeks as symptoms may not develop until later.

Measles is an airborne disease and is highly contagious. Measles can easily spread through breathing, coughing, sneezing or coming in close contact with an infected person. If you or anyone you know develops symptoms of this disease, please contact your health care provider immediately. Notify your provider of your concern prior to the visit so that appropriate precautions can be taken.

Measles begins as a mild infection with fever, congestion, cough and some oral lesions. It then worsens to a severe respiratory infection, with very red eyes, lots of coughing and a rash all over the body with red, slightly raised, round spots. Measles can have complications such as pneumonia, dehydration and in rare occasions swelling of the brain (encephalitis). Measles is especially dangerous for people with weak immune systems.

It is important to remember that measles is a vaccine-preventable disease. Children receive the vaccine at one and four years of age. Adults who have received a measles vaccine series are considered immune. Those who have not been immunized against measles, or have never had measles, should contact their health care provider to get vaccinated.

Most people born in 1957 or after should have documentation of at least one dose of MMR (Measles, Mumps and Rubella) vaccine or other evidence of immunity to Measles. The Centers for Disease Control and Prevention recommends two doses of the vaccine. The first dose should be given at 12 months of age and the second between the ages of 4 to 6 years.

You can find more information about Measles by clicking HERE.

Click here to find a Cook Children's pediatrician in your area to get your child vaccinated.

Last year, the Cook Children's Trauma team saw 22 children, either biking or walking, who were hit by cars from August through the month of October. Eight children were hit by cars in September and 10 in October. 

But with school already started, so are the dangers of kids and cars.

Already, a teen was hit in front of a high school in Crowley. The injuries seem to be minor, but it places an emphasis on how vulnerable children are near or even in front of schools.

More children are hit by cars during September than any other month of the year, according to Safe Kids Worldwide.

“Children do not have the cognitive skills to be crossing streets safely alone until at least age 10,” said Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s. “They haven’t yet developed the depth perception or the ability to maturely judge the speed of an object.”

Kids age 10 and younger should not walk or ride bicycles, scooters or skateboards alone to school because they:

• Are easily distracted by friends and toys.
• Can’t determine the direction of sounds. Some children may be listening for sounds and may not realize that some newer model electric/hybrid may not make much of a sound at all.
• Can’t judge the speed or distance of a moving vehicle.
• Don’t understand how long it takes a vehicle to stop.
• Have too narrow a field of vision.

Even when kids reach age 10, it’s still best for parents to accompany them to school whenever possible.

Teaching Your Child Pedestrian Safety

“When I visit children who have suffered pedestrian injuries, the most common thing they tell me is that they thought the driver saw them,” explained Evans. “It’s important to teach your children that just because they see a driver, it doesn’t mean the driver sees them. They need to make eye contact with the driver and wait for the driver to stop and signal to them before attempting to cross the street.”

While teaching your children to ride their bikes or walk to school, don’t forget to tell them to cross only at crosswalks; look left, right and then left again; and to watch for cars that are turning or backing up. The best way to teach your child pedestrian and bike safety is to be a good role model yourself. It’s also a good idea to encourage your children to wear bright clothing and reflectors when they’re walking before dawn or after dusk.

"It’s important for parents to remember they are the most important models of proper pedestrian behavior for children," said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County Coordinator. "Parents should also make sure they follow the rules when they are driving in school zones, including going the speed limit at all times through the zone and not texting or talking on the phone."

Safe Kids recommend teaching your kids these safe behaviors:

• Look left, right and left again before crossing the street. Cross when the street is clear, and keep looking both ways while crossing. Walk, don’t run.
• Understand and obey traffic signals and signs.
• Walk facing traffic, on sidewalks or paths, so that you can see oncoming cars. If there are no sidewalks, walk as far to the left as possible.

Practice safe behaviors:

• Don’t allow a child under age 10 to cross streets alone as he may not be able to fully appreciate the speed of cars on the road.
• Require children to carry a flashlight at night, dawn and dusk. Add retro-reflective materials to children’s clothing so that a child can be seen by motorists, even in the dark.
• Don’t let kids play in driveways, unfenced yards, streets or parking lots. Drivers may not see or anticipate children playing.

Interactive Infographic: How to not get hit by a car - Safe Kids Worldwide

With an average of 44 kids getting hit while walking every day in the U.S., it’s time for action. HOW TO NOT GET HIT BY A CAR is a fun new interactive infographic that guides walkers through seven common ways kids get hit by cars, and seven ways to avoid it. Parents and kids alike give it great reviews; not only do they think it’s fun to experience the action, they can usually relate to it. Try it out and see if you make any of the common mistakes when you cross the street.

Try the interactive infographic from Safe Kids

For more information

Whether it is the correct use of a child passenger seat, drowning prevention education in the schools, or providing a better awareness of poison hazards to new moms, we are working to create safe homes and communities for children.

• Bicycle safety
• Car safety
• Safe Kids Tarrant County
• CARE Team
• Drowning prevention
• Human trafficking
• Oral health prevention
• Poison prevention
• Sexting
• TV and furniture tip-overs

School physical season is one of my favorite times of the year for many reasons:

• It’s really fun to see kids grow up and get big over time.
• I love watching my patients’ personalities mature.
• I love that the visits become progressively more about my relationship with the child in addition to my relationship with their parents.
• For the most part everyone is healthy and happy.
• For most children, the promise of a new school year and new beginnings is exciting.

I have a few things on my agenda for each back-to-school checkup.

I want to talk about diet, exercise and sleep. I want to talk about how school went last year and what the plans are for the upcoming year.

But checkups are more than just about what I want. In order for the checkup to be a success, it must meet the goals of the child and parent. Parents are all over the place when it comes to their expectations for physicals.

Here are just a few examples:

1.“Let me get out my list.”

Whether your weapon of choice is a spiral-bound notebook or long thumb-scrolling iPhone lists, you know who you are. And frankly, I love you. Having a guide that directs the visit through any questions and concerns that you have is beyond helpful. It keeps me from having to talk about stuff that’s not important to you and wasting both of our time. So, bring it on, Listers, and I promise not to roll my eyes.

2.“I’m just here to get my form signed.”

No worries. That may be all you need and that’s great. In the meantime I can provide a quick screen for height, weight, body mass index, high blood pressure, heart murmurs, risk for sudden cardiac death, hearing and vision (and much more). I can also screen for drug/alcohol abuse, depression, attention problems and other school issues. “Here’s your form, thanks for coming in.”

But seriously, even in those children who come in with no apparent concerns or complaints, we do pick up health problems that need to be addressed to maximize your child’s ability to function well in school or compete at their best in their chosen activity.

3.“I’m not worried, but __________ wanted me to ask about __________.”

This is a tricky one. I’m totally cool with it, but it can be hard to get at exactly what the concerns is if that person isn’t there to ask questions. My advice … if that person is close enough to be providing this type of advice, they could probably come to the appointment. If the concern is coming from the child’s teacher, a quick note explaining what is going on can be really helpful.

Just don’t leave it up to chance that we can figure out what the problem is, especially if you don’t quite understand why they are concerned. Get specific information about the concern or have them come along.

I’m sure there are many more ways that parents think about their children’s checkup, but these are some common ones I notice.

No matter what, regular checkups are an important part of helping you maintain your child’s health. Good health increases their ability to be present for and to participate fully at school and extracurricular activities.

Which category do you fall in? Is there a different one you think I should include?

Sports EKGs are free through the month of August at specific locations in Arlington and Fort Worth. Cook Children's offers a $25 Sports EKG (electrocardiogram) screening test at our Cardiology offices in Mansfield, Southlake and Denton. Adding a sports EKG to your child’s physical can help detect most heart conditions that may lead to sudden cardiac arrest. Click to learn more. 

For school physicals, visit your local Cook Children's pediatrician. Click to find one near you. 

“Stop Slouching!”

Why is my kid’s posture so poor?

THE PROBLEM

Do you get sick and tired of telling your child to sit up straight? Do you ever wonder why so many kids these days have slouched posture and often complain of back pain?

Let’s take a moment to think about a child’s typical day during the week.

1. They spend six hours a day at a desk in school. Most of this time is spent writing notes or typing with their hands in front of them and their head looking down.
2. When they are not in school, much time is spent playing video games, playing on their smartphones, surfing the Internet on the computer or texting. Again, arms are in front of them and head is down
3. They carry around a backpack that often weighs almost as much as they do and often times wear it low, resting on their low back or bottom. Backpacks should weigh no more than 10 percent of their body weight, be worn on both shoulders and fit snuggly to their back.

In April of 2012 – Archives of Pediatric and Adolescent Medicine published an article stating that only 51 percent of children went outside to walk or play per day with either parent.

Another national study found that the average American age 8-18 plays video games for greater than 13 hours per week. Studies also show that children today spend half as much time outdoors as their parents did when they were young. These kids prefer to stay inside to watch TV, surf the Internet, listen to music and even do their homework, rather than go play outside.

How it affects the kids

The positions discussed above, which kids are in for a large majority of their day, place the muscles on the front of their chest into a shortened position. After a while, it is difficult to stretch those muscles back out to attain proper posture independently. Tight muscles on the front of their chest cause them to continue to sit with their shoulders rounded forward and thus the cycle continues. The muscles in the front of their neck also become tightened, pulling their head forward. A forward head can also cause the muscles at the base of the skull in the back of the head to become tense.

Unfortunately, the inactivity caused by the increased time spent indoors also contributes to a poor core. The core consists of the muscles around the center of your body that help your back stay up straight. Without an active core, it is very difficult to maintain good posture and fatigue will set in quickly. A weak core in combination with prolonged periods of inactivity will likely lead to a cycle that is difficult to break, causing poor posture.

What to do

Have a homework station set up for kids. Doing homework on the bed or floor often makes posture worse and increases the curvature of their back while they are sitting. Kids should sit in a chair where their feet can touch the floor and their hips and knees are at 90 degrees. The table height should be so that their forearms are able to rest comfortably while they are working so that their shoulders can relax.

They should be in the same sitting posture for the computer and the screen should be at eye-level to keep their head in a good position as well. There are shelves made to lift computer screens up to eye-level, however, a large dictionary will often do the trick, as well.

The American Heart Association’s recommendation for physical activity for children is at least 60 minutes of moderate-vigorous intensity aerobic activity at least every day. As a parent, try to encourage your child to be active for at least one hour a day, either at school or at home. If you cannot find the time for your child to perform 60 minutes of straight activity, try to perform at least 30 minutes of activity twice per day.

It is never normal for a child to experience back pain or consistent headaches. If your child is experiencing either of these symptoms and is not actively being treated by a healthcare provider, please discuss these concerns with their doctor. Physical therapy can assist with improving posture and core strength to eliminate back pain.

Related information

• Cook Children's Sports Performance Orthopedic Rehab Team Specialists (SPORTS)
• Dynamic stretching
• The basics of sports injury prevention for kids
• The essential backpack 

Then, go inside and get warm. Make hot chocolate with marshmallows. Work together to make a batch of homemade soup. Play cards, board games, or do craft projects. Build a fort or set up a tent so they can play or read books.

When parents need a break, go watch a show or read for a bit. Kids can watch cartoons or play on their mobile devices for a while.

Make some healthy snacks- make popcorn from scratch, celery sticks with peanut butter, cut up fruit and dip in chocolate or other fruit dip; cheese and crackers."

Vanessa Charette, M.D., a pediatrician in Fort Worth: My 7 year old had a blast making colored “crystals” in the kitchen all morning this week. I set him up with a tray of plastic tubes (but cups will do fine), food coloring, water and a dropper and let him mix colors and add water and the “crystals”. He ended up with six different colored bags of crystals.For supplies: All you need are craft water absorbing polyacrylamide gel crystals from a craft store and the food coloring.

We also went sledding! And I let the boys build a giant pillow blanket fort."

Joel Steelman, M.D., endocrinologist: "Entertainment could include bundling up and getting outside. Gotta be safe though with the ice and slipping risk. My daughter and I were out a little over an hour this week, ice sledding on the street. We saw lots of kids using various items – pizza pans, laundry baskets, ect. as impromptu sleds. Just need to make sure that the little ones are warmly dressed and limit outside time. That’s a good active, outside entertainment. For indoors & media that's free - board games, art projectsand puzzles.

And how to you take care of yourself as a parent: "Healthy and sanity as a parent may also include doing a family meal prep together. For me, though, cooking when I’m not rushed is enjoyable. So, I did breakfast for dinner the other night with a little help from my daughter. S’mores if you have an indoor fireplace would be a fun (although not healthy) activity as well."

Kim Mangham, M.D., pediatrician, Keller: Dr. Mangham wants to make sure all the kids are bundled up, before they enjoy the snow. But enjoy the snow! She recommends fun indoor activities such as board games and the family watching a movie together. We recommend her baked oatmeal:

Sandra Peak, M.D., pediatrician, Lewisville: In the Peak household, they have just three words: Chocolate. Chip. Cookies!

Along with vaccinations, hand-washing is one of the most effective ways to prevent flu. Alcohol based hand sanitizers are not effective against enterovirus 68, only good, old fashioned hand-washing.

Hand hygiene is especially important while children are attending school, where nearly every interaction carries the possibility of transmitting viruses.

“Children should wash their hands before and after going to the bathroom, as well as before eating or drinking,” Frank McGehee, M.D., a Cook Children's pediatrician in Fort Worth, said. “They should work the soap into a good lather and scrub for at least 20 seconds—the amount of time it takes to hum ‘Twinkle, Twinkle, Little Star.’ Have them scrub especially well around fingernails and jewelry.”

It’s also a good idea to have children wash their faces frequently during flu season.

Sometimes it's difficult to make your child take the time to wash his or her hands. How do you get your children to wash their hands? We would love to hear from you.

One panda sticker and four green smiley faces. Pretty much sums up my son’s first week at kindergarten. I’m not sure why his teacher used a panda sticker the first day, maybe it’s because he was actually a bear to deal with, but I’m refusing to believe that’s the case. His response to mommy’s enthusiastic questioning about his first day was summed up with a profound, “I’ll explain later.”

Quick update: Dropping him off the first day went pretty much as expected. He was happy to go in, excited even. No tears were shed from either him or me (Mrs. Doc Smitty might’ve gotten a “little” misty-eyed.).

So, why am I getting emotional as I reflect back on his first week of school?

He’s still our little boy, but something is different. He still cried at breakfast yesterday because his 3 year-old little brother wouldn’t share his “talking Diesel 10” toy with him. He still ran through the house to give me and mommy kisses every time the Aggies scored a touchdown last night (which was a lot - whoop!).

But, I noticed this morning as he stood by his mommy to say goodbye; he instantly seemed inches taller, his vocabulary grown up, his mannerisms more mature.

How did that happen in just five days?

I think what hit me the hardest today is that I no longer know about what he does with his days, at least not in the way I could before. Just last week, I could get home from work and get a full run down from his mommy of everything funny he said and everything else he did. Now, those quirky puns and silly rhymes are shared with his classmates and his teacher who aren’t able to file them away to share with his dad. I don’t know what he did at recess except that he reports, “Of course, I played with the girls.” And I’m not even sure who (or even what) that means.

Today, it feels heavy, as if those 5 days will quickly turn into 13 years before I know it. Then I’ll have to deal with the fact that there will be days where I have no idea what he is up to. I may have to rely on infrequent phone calls and even less frequent visits to get a picture of what his life is like.

For now, I’ll cling to every word I can get out of him about his day.

For now, I’ll try to cherish every moment I still have with him.

For now, I will learn to trust those green smiley faces (and count the days to our first teacher conference).

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Time for school, which means shopping for school supplies, meet the teacher night and contracting parasites. Many diseases increase in frequency when you gather school aged children back together again for the start of the year (common colds and strep throat are great examples). Today, I am going to talk about three parasites that tend to cause outbreaks in school classrooms.

Head lice

Head lice are common; some consider their acquisition a rite of passage for elementary school. They are parasitic insects that live on the scalp and cause itching. They are not dangerous but very annoying and can be identified by finding their characteristic eggs (called nits). Less commonly, a caregiver can find live lice moving on the scalp. Treatment most often involves using medicated shampoo. A few tips on treatment:

1. There are many great over the counter shampoos. Follow the written directions closely as too much could be harmful and too little will not be effective. Contact your pediatrician if things are not improving.
2. Many doctors recommend clearing the nits off the scalp with a fine-tooth comb.
3. Many shampoos require a repeat dose in one week.

Scabies

Scabies are less common than head lice. but equally annoying and also not dangerous. The mites that cause scabies burrow down just under the top layer of skin and cause severe itching and a fine red rash. It is common to find the rash on the wrist and between fingers and toes. Diagnosis requires a visit to the doctor who generally makes the diagnosis based on the story and the characteristic rash. Treatment involves applying a cream to the skin to kill the mite.A few tips on treatment:

Apply the cream to all skin from the neck to the toes, not just the area with the rash.Leave the cream on for 8-12 hours (overnight works great).Wash all sheets and towels the next morning on the hottest cycle of your washing machine.Repeat the treatment in 1 week.

Cooties

Cooties are the most common parasite in the elementary age child. All children at one point or another have been exposed to and contracted cooties. Cooties are contracted by close contact with another child of the same age, but opposite gender. Diagnosis is sometimes difficult, but it is pretty safe to assume that all children ages 4-10 are infected at all times. There is no treatment for cooties although it is thought that passing them on to another child does provide some temporary relief.

Thankfully, there is a vaccination for cooties which your child's friend can provide by tracing a circle on your child’s arm and reciting, “Circle, circle, dot, dot…now you have the cootie shot."

The screaming-leg-hanger-on-er

I know there are parents who are terrified of how their child will do on their first day of school. They are picturing their children crying and hanging on to a leg shouting, “Mommy! Don’t leave me here!” My heart goes out to those families because that must be really difficult. It seems painful for the child and is probably the most painful on mom or dad who is attempting to pry themselves away. Then, they have to spend the whole day worrying if their child is OK or building a need for therapy from their mounting sense of abandonment.

Here are some tips:

1. This behavior might be demonstrating some separation anxiety Talk through the drop-off period and the day with your child until you are both sick of talking about it. One of the best methods for combatting anxiety is to be prepared.
2. If possible, send the parent who is less likely to cause this reaction early on. Sometimes it’s mom and sometimes it’s dad. If your child can make an easy break with one, but not the other, let that parent try to help during those early days until the child sees that school isn’t such a terrible place.
3. Make a quick break. Trying to coerce children to say they love you and give you 1,000 kisses only makes things worse. A quick goodbye and we’ll see you soon should suffice.

A quick note of support: Ultimately, you may do everything right and this may still happen to you. Try to remember that their behavior at this extremely stressful moment does not define your ability as a parent. Teachers are used to seeing this. Most of them probably see it every single year in a child or two.

The quiet, but compliant child

I would bet that many kids fall into this category. They aren’t exactly sure what to think about school. They are a little annoyed about their first day of school outfit and a little more annoyed about the fact that they had to take pictures wearing it, holding a sign that says “First Day of School.” (What’s Instagram mom?) They are not openly upset about you leaving them, but they may seem a little anxious.

Here are some tips:

1. They might appreciate it if you walk them into class the first few days and see what they have been up to for a minute or two.
2. Let them know what they are feeling is normal. “It’s OK to be afraid. But every day you go, it will get easier.”
3. This is another instance where a quick, clean break is good. After the child is settled in, say goodbye and leave. No need to make every drop off day sappy … just treat it like it is no big deal.

The “see you later, dad; or not. Whatever it’s cool” child

My child might fall into the previous category, but I have a pretty strong feeling he will fit here. He seems really excited about school and I hope that is actually the case on the day of. I plan to give him lots of latitude to change his mind that day because with 5 year olds, you never know what to expect.

For this child, these tips are more for mom and dad:

1. Keep it together yourself, if you can. Your big boy or girl is growing up and independent. That is actually the goal of parenting. No one wants their college age child to be holding onto their leg at the dorm so you can check that off your parenting accomplishment list.
2. Don’t take it personally. They still love you (for now) and still want you around (occasionally).

There are many more first day of school personalities that your child could show, these are just a sampling. The best advice I can give from hearing back to school stories for years is to be flexible. Come back next week to see if I can follow my own advice. I’ll try not to cry the first day he asks me to stay in the truck while he walks in …

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Does what you think about your children change the way they turn out? How about the way children’s teachers think about them? Could you be unknowingly setting your children up for failure by the way that you think and talk about them? It is difficult to find studies that directly address this question, but there is some interesting, related research.

In 1968, Robert Rosenthal and Lenore Jacobson set out to show that teachers' expectations of students could change how they performed. The thing I love about this study is how it was designed and carried out so beautifully. 

First, they went into a school and performed IQ testing on all the students. They called the test, "The Harvard Test of Inflicted Acquisition." The brilliant thing is that they told ("lied to") the teachers that the test not only assessed IQ, but could also predict which students were ready to make rapid, above average gains over the next year, regardless of their current performance (they called these students “spurters").

The teachers were then told which students were designated as spurters (these students were randomly selected and had nothing to do with their test scores). Thus, the only real difference between the spurters and their classmates was their teacher believed that certain kids were ready to make rapid intellectual gains over the next year.

So, what happened?

The average increase in IQ for the “spurters” was 12 points while the average increase for everyone else was 8 points. In addition, about half of the spurter in first and second grades had an increase of over 20 points. Even more striking were the teachers’ subjective assessments where the spurters showed significantly higher reading grades, scores for intellectual curiosity, behavior and likelihood of future success!

There are lots of possible explanations for these results, but the most commonly held (and likely) belief is that the teachers’ ideas that the child was a spurter changed the way they interacted with and taught that student. Perhaps they were a little more patient when they didn’t understand because they knew they were on the cusp of a big breakthrough. Or, maybe they challenged the student a little more thinking that they should be able to do more. Can you think of any other ways their behavior might have been changed?

This effect of self-fulfilling prophecy whereby the teacher’s positive expectations of the students actually improved their outcomes has come to be called the Pygmalion effect. Pygmalion was a character of Ovid who sculpted a statue of a woman that was so realistic that he fell in love with it (this is ridiculously simplified and changed to a rated G version, you can read the full version on the Wikipedia page if you like). The alternative to the Pygmalion effect is the golem effect whereby negative expectations of others can actually lower their chance of success.

The study isn’t perfect and with studies like this, you can’t make the data fit any situation. However, I do think that there are some pearls of wisdom we can take and apply to our own kids.

1) Avoid the golem effect - I commonly hear parents saying statements like, “He’s soooo bad” about their kids. They usually say them in a joking manner and most are careful not to say them in front of their kids, but not always. And, according to the golem effect, it doesn’t really matter. Continually thinking and speaking about your child in a negative way could change the way that you interact with them and even what you expect from them in a harmful way.

2) Strive for the Pygmalion effect –Speak well of your children and their abilities in front of them and when they aren’t around. Hearing your positive words will not only have a positive impact on them, but can also change your parenting ability with them in a good way. Challenge your kids with something a little harder than you think they can do. Of course you don’t want to make it so hard that it’s overwhelming. That just leads to frustration for everyone. But don’t let them stay at the same level for weeks and weeks without pushing them to do more.

3) Convince others that your child is a spurter - Believe it or not, teachers pass along messages about their students through the years.  This is especially true in the younger ages when warning other teachers about potential problem students ... Not all teachers do this (sorry to my great teacher friends out there). Imagine what this does to these students when a teacher has a negative expectation of a student to begin the year. 

So, what do we do about this? Think about these two scenarios…

A) Child who struggles with math (or any other subject): Spend some time over the summer working with your child in their trouble spots. Get them some tutoring or work with them and get them up to or a little above grade level. Then, have a conversation with their new teacher that goes something like this: “Billy has really struggled with math in the past but we’ve been working on it all summer. He has really come a long way.  We did x, y and z and his tutor says that he has really been progressing very quickly especially over the past few weeks.  We are convinced that this is the year he will really get math and it might even become one of his best subjects.”

B) Child who struggles with behavior and being in trouble: Pick 1 or 2 problem behaviors that your child has developed. Some examples might be: impulse control, talking out of turn, talking back or any other number of things. Work hard to improve those specific behaviors. Don’t try to fix everything all at once … it probably won’t work. If you need to, enlist some help from a private counselor or the school counselor, figure out a few simple strategies that help the child out.  Then have this discussion with his teacher: “We all know that Billy has struggled with (x) in the past.  But, we’ve been working hard on it and have come up with a few things that really help him to control (x).  He has shown such great progress and we really feel that this is a breakthrough year for him.”

So, help your child become a “spurter” and help them improve by having positive expectations for them.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.