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While we have seen some schools and athletic programs requiring a negative test in order to return, this is based on outdated guidance.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.

Doing their best to minimize in-person visits, Cook Children’s Primary Care Physicians and Cook Children’s Urgent Care Physicians are partnering to provide telemedicine visits to help provide the quality pediatric care you expect from Cook Children’s.

A Video Visit allows a patient to have a remote visit with a Cook Children's primary care provider for non-urgent reasons. A patient must have a MyChart account to request a video visit.

• Desktop web browsers
• Mobile devices

Click here for tips on how to prepare for a video vist.  

“Many parents have simple questions that can be answered by a quick conversation with a pediatrician and do not require an in-person visit,” said Justin Smith, M.D., a pediatrician and medical director of Virtual Health for Cook Children’s. “This technology allows our pediatricians to help prevent the spread of COVID-19 while still providing high-level care to our patients.”

Patients can access telemedicine at Cook Children’s via two major pathways.

Both require two steps in preparation for a visit:

1. Patients must have active Cook Children’s MyChart accounts.
2. Patients must have the videoconferencing program Zoom downloaded to their device.

After that, parents can choose to either:

• Request a visit with their regular pediatrician by selecting the “Appointments” tab in MyChart or by calling their pediatrician’s office to set up an appointment. These appointments will be available during regular office times. When the time comes for a visit, patients go back to the appointments tab to complete e-check in and start the video visit. Click here to learn more.
• If your child’s regular pediatrician is not available, then you have the option to request a visit with the next available pediatrician by selecting the “Video Visit Now” tab in MyChart. Urgent Care doctors are available to see these visits from 11 a.m. to 9 p.m. every day. Once selecting the "Video Visit Now" button, patients are put in line for the next available provider.

In addition to telemedicine visits, Cook Children’s pediatricians are actively working to help keep patients safe by direct messaging with patient families and providing phone visits when video is not an option. Messages can include a picture or video and can be sent through the MyChart “Messages” tab.

For more on this, view the following:

• Primary Care Video Visits
• Urgent Care Virtual Visits
• Zoom: https://cookchildrens.org/mychart/Pages/video-visits.aspx
• My Chart: https://cookchildrens.org/mychart

Should we plan on making baseball practice?

Are we prepared if the storm hits our home or while we are driving?

What can I do to ease the fears of my child who is afraid of storms?

First, your outdoor plans may need to be put on hold. According to the National Weather Service, you should start paying attention to the weather around 4 p.m. today. Storms will increase in coverage during the evening and overnight hours.

Next, have a plan for your family’s safety. Kaysey Pollan, Environmental Safety and Emergency Management officer at Cook Children’s, says everyone should know where they are going to go during severe weather.

“If you don’t have access to underground shelter, move to the interior room or hallway on the lowest floor and get under a sturdy piece of furniture,” Pollan says. “If you live in a mobile home, get out and find secure shelter.”

In addition to knowing where to seek shelter, families should have a designated meeting place away from home (a neighbor’s house or a street corner in the neighborhood) where you would gather if you were separated during an emergency. Make sure everyone in your family knows where the meeting place is located.

If you are driving during a storm, stay in your car and try to find shelter (but not under an overpass). The only exception is if there’s a tornado coming toward you. If you can’t find shelter, get out of the car and find the most low-lying area (ditch, ravine, etc.). Lay flat on your stomach and cover your head with your hands. If it’s hailing, stop driving and find a place to park like inside a garage, under a carwash or a service station awning. If you have small children with you, put them under you and cover their eyes.

Whether or not your child is afraid of storms, it’s important for parents to stay calm during severe weather. Children are quick to pick up on their parents’ fears and anxieties and during an emergency and they will look to you for safety and reassurance.

“Parents should do their best to manage their own anxiety. If parents are calm it will help calm their children,” said Kristi Mannon, Ph.D., psychologist at Cook Children’s Medical Center. “Parents should do their best to avoid watching news coverage in front of their children. Parents can check on weather updates on their phone or a device away from their children in order to stay informed.”

Dr. Mannon also advises parents not to dismiss their child’s feelings or to scold them.

“If a parent needs to complete a task such as preparing dinner and their child is expressing fear, they can take a break for a few seconds, make eye-contact with their child, acknowledge their fear, and tell them they will talk about it as soon as dinner is ready,” she said.

“You can help your child stay calm not only by managing your own fears, but by having a supply kit ready to go,” said Justin Smith, M.D., pediatrician at Cook Children’s Pediatrics Trophy Club. “Make sure you have snacks and something for your child to drink in case you have to remain under shelter for an extended period of time.”

Also, don’t let darkness become an added fear. Dr. Smith advises parents to have flashlights in a place that is easily accessible, and not just the one on your smartphone.

“You don’t want to run the risk of your phone dying and losing your flashlight too. It’s always a good idea to have a real flashlight handy,” he said.

Another tip – distraction can go a long way with children.

“Have a box of items that don’t rely on electricity such as coloring books, board games, a deck of cards or a favorite stuffed animal,” he said. “This can help during the storm and if you have to leave your house during a disaster.”

It is also important to be honest with children about what’s going on. However, make sure the amount of information and detail you share is appropriate for their age level.

It’s also a good idea to know the difference between a Watch and a Warning.

A Watch means conditions are favorable for severe weather to occur over the next several hours. The National Weather Service advises you to continue activities as normal, but monitor the weather and be ready to act if a Warning is issued.

A Warning means head for cover! This is an indication that severe weather is imminent or already occurring at your location. Seek shelter on the lowest floor of a sturdy building and stay away from windows.

One easy way to prepare for severe weather is to download the tornado app created by The American Red Cross. It provides alerts, watches, warnings, and plan-ahead lists right to your phone.

The American Academy of Pediatrics also has compiled a thorough list if wants to prepare for a disaster. You can find it here. 

Ear pain can be caused by many different factors. Often kids just play with or point to their ears. If the child is otherwise cranky, sick or not sleeping well, parents will assume there is an ear infection. However, a study from 1998 showed that parents only identified 70 percent of their children with ear infections and when they suspected an ear infection, it was only present 50 percent of the time. (Translation-they could have just flipped a coin rather than trying to guess.)

This is why getting an antibiotic called in when your child has ear pain is a bad idea - whether it is from your doctor or from one of the new insurance nurse lines that many people are using. Every exposure to antibiotics is a potential risk for allergy or side effects. Unnecessary exposure is not worth it.

2. All ear infections have fever.

Studies are all over the place about what percentage of ear infections have fever. They generally fall between 1-2 out of 3. Regardless, that means a lot of kids with ear infections won’t have fever.

3. Having your child in the wind or under water causes ear infections.

The location of an ear infection is behind the ear drum way back in the inner ear. External exposure like wind and water don’t affect that area. Grandma will have to come up with another reason for their grandbaby to put on a hat when it is cold outside.

What are risk factors?

• Age (6 months-2 years)
• Family history
• Day care
• Not breastfeeding
• Smoke exposure
• Pacifier use (small effect)

4. You can’t go swimming if you have an ear infection.

Related to the previous myth, there is no reason to avoid swimming if you have an ear infection. Unless the ear drum has ruptured the space where the ear infection is located is walled off from the water. Don’t skip the swim party! If the child feels discomfort or pain while swimming, they can play in the shallow end or just have a snow-cone.

5. All ear infections need antibiotics.

Many children with ear infections will get better without antibiotic treatment. The latest treatment guidelines give the following advice for treating ear infections:

• Children of any age with severe pain, fever or ear drainage should receive antibiotics.
• Children 6 months-2 years with both ears infected should receive treatment.
• Children 6 months and up with 1 ear infected and with mild symptoms can be watched for 2-3 days to see if symptoms improve or worsen prior to starting antibiotics.

6. Amoxicillin is not strong enough for ear infections.

Many studies have looked to compare different antibiotic treatments for ear infections. The bottom line is this, there is nothing better at getting rid of infections than amoxicillin. Other antibiotics may work as well, but they are typically more broad spectrum - meaning they cover more different types of infections that those that typically cause ear infections. Because of this, we should reserve those antibiotics for those situations in which they are necessary. Amoxcillin is cheap, well tolerated by most kids and effective. Therefore, except in penicillin allergic patients, it should be used unless the child has been on the medication in the last 30 days.

7. If your child gets tubes, their ear infections are guaranteed to stop.

After a few ear infections, some parents are eager to move forward with placement of tubes. Tubes can be a life saver with kids who have had multiple ear infections and can prevent recurrence of ear infections, but they aren’t perfect. They are a surgical procedure and the inherent risk associated with anesthesia need to be fully explained to a parent. Continued ear infections occur in about 20 percent of children even after they have had tubes placed.

Watch the video below for five key facts about diarrhea that every parent needs to know in only a minute. 

In today's video, Doc Smitty explains:

1. What are the common causes?
2. How long can it last?
3. When are the symptoms more than a stomach bug?
4. When do you call your pediatrician?
5. What are the biggest risks?

Learn the answers to these questions. It only takes a minute.

When people think of homelessness, they commonly think of someone living in a park or on the street with no structure to sleep under but the effects of homelessness are felt by many in less dire circumstances. There are various classifications of homelessness which include homelessness without shelter but also include the following:

1. Homelessness with shelter - Living in a supervised private or public shelter.
2. Imminent homelessness - A chance that the primary residence will be lost in 14 days.
3. Youth/family instability

In survey data from 2012, the Cook Children’s Center for Children’s Health show than 7.5 out of 1000 kids in Tarrant and the surrounding counties had spent the night in an emergency shelter or with family/friends due to homelessness. Because of the nature of the study, my suspicion is that this number is likely understated. Despite the fact that it is more common in low socioeconomic areas, it is not restricted there. An example of this might include a child who is kicked out of the home for various reasons.

What are the effects of homelessness youth and children?

1. 97 percent have moved more than once in the last year.
2. Interrupted or ineffective school participation
3. 22 percent have been witnesses to domestic violence
4. 50 percent of homeless teenagers have depression or anxiety
5. More likely to have severe asthma, malnutrition, ear infections, exposure to toxins
6. More likely to have mental health and substance abuse issues
7. More like to engage in dangerous sexual activity leading to STDs and unintended pregnancies
8. 7 times more likely to be victims of violent crime

All of these issues can be categorized under the heading “toxic stress.” Toxic stress occurs when a child experiences strong, frequent and prolonged adversity. Studies show that these experiences can have significant effects on the development of the brain and other organs which can lead to increased risk for negative mental and physical health outcomes. These problems can persist well into the adult years, even when the stressful situations have resolved.

What can you do?

1. Be aware - One of the biggest problems with addressing homelessness is that many people are not aware that it is even an issue in their area.
2. Donate time - There are many programs available in our area where you can serve as a mentor to children in schools. Children going through toxic stress benefit greatly from having an adult who spends time with them and with whom they can process their experiences.
3. Donate financial resources - Many homeless shelters struggle to survive financially. They have a hard time providing healthy nutritional options and, certain times of year, even enough beds to house all those in need.

Learn more about homeless in Tarrant County here. 

The numerous health benefits of breastfeeding cannot be denied. Some of them might be overstated at times but, all in all, I believe that breastfeeding is best.

I know there are times when, for whatever reason, moms cannot or choose not to breastfeed. Fortunately, we have come a long way from the old days of evaporated milk formulas of the 1920s to where formula feeding is a very reasonable alternative for those moms. I believe that families should be properly educated and supported in their feeding decision no matter what it is.

If you chose to formula feed or plan to, you can stop reading now. This is not one of those articles meant to shame someone for their choice. This post is a message in support of moms and families who choose to breastfeed and need a little help to determine if everything is going OK.

“Seven percent is average, over 10 percent I start to get worried.”

Most moms know (or read or were taught) that babies lose weight in their first few days of life. If not, that one week checkup is pretty emotional when they place their babies on the scale and the number is lower than their birth weight. Think about it, a 10-pound baby can drop to as low as 9 pounds and still be considered normal weight loss, but you would certainly worry from the time the baby was weighed until I came in the room to tell you everything is OK.

I have been quoting this 7 percent/10 percent mantra since I started practice. It’s partially wrong, at least for breast fed babies. Why? They can actually lose more and still be normal.

A study released in Pediatrics in December showed that breastfed babies could lose more than 10 percent and still be normal, especially babies born via caesarean section. The graphs enable a pediatrician to look at a baby’s weight loss day-by-day and determine if the weight loss is excessive. The bottoms of the weight loss peak occur on day six for both vaginal and c-section but the peaks occur at 11 percent and 12 percent respectively.

Why does this matter?

Any mom who has had trouble getting their baby to grow on breastmilk knows the pressure to start formula that can be applied by doctor, nurses or family members. While, I don’t believe that having mom give formula when appropriate ruins her chances of breastfeeding, I certainly don’t want to be pushing families to supplement when it isn’t necessary. Therefore, I plan to start implementing these guidelines into my practice so that I can best support breastfeeding moms in their effort to breastfeed.

If you are having a baby and are planning to breastfeed, it might be helpful for you to be aware of them as well.

Sweat was dripping off my shirt and I could not escape that feeling of needing to throw up, almost wishing I could, but not actually vomiting. It doesn’t sound all that inviting, but I was really interested in coming back the next day to try it all again.

Why?

Because my nurses had invited me.

Because they were getting up for their 6 a.m. boot camp every morning.

Because they were loving every minute of it and sticking with something to better their health (despite the fact that the schedule was crazy and the workouts demanding).

I would think that most people do not want to get up and work out at 6 a.m. (I think there was even a 5 a.m.class but…I’m not that crazy!). Those that do love it, could probably get up and work out on their own by running or lifting weights by themselves.

Why are programs like boot camps and Crossfit so successful?

I believe it is because of one main reason: they are SOCIAL CLUBS.

(Wait Crossfitters, don’t get mad yet.)

I certainly don’t mean that the people going to these workouts are sitting around drinking coffee and chatting. I’ve done a few of each type of workouts and I can guarantee they are working hard.

What is a social club?

1. People gathering around a common interest.
2. People attending to better themselves or increase their knowledge.
3. People encouraging one another.

People who gather together and workout get many benefits besides simply getting their workout in. They are motivated to show up because they provide accountability. “Where were you this morning?” They are encouraged to continue working even when things are hard. “Come on, just one more, you can do it.”

Unfortunately, there are not as many opportunities for our teens to have this type of experience, which is why I am advocating that we bring this mindset into our homes.

Here are some comments I frequently hear during my teenager visits:

“I try to get them outside but they just don’t want to.”

“All they want to do is sit around and watch TV.”

Yep, that’s right, that may be all they want to do. That is probably all they will do unless you make exercise social for them.

One of the major contributors to children’s physical activity is whether their friends are active. Friendships are often centered around shared goals or activities. If those shared interests are active, it is more likely that your child will be active. If those shared interest are passive, getting your child to be active may be more difficult. A study from 2012 in Pediatrics showed that even children as young as 5-12 years would increase their physical activity by 10 percent to match their friends.

But, it’s not just friends that influence your child’s activity level. Parents' activity level, but more importantly their encouragement, also have big effects on their child’s activity levels.

Here are some ways you could possibly make this work for you teenager:

1. Find a common activity the whole family enjoys- Maybe it’s just getting out and kicking a soccer ball around or playing catch. Maybe it’s something more intense, it doesn’t matter just do something together.
2. Set a family goal- Make it a goal to do something physical as a family 6 days a week. If you accomplish that goal, have a family cheat day where you get to watch a movie and have a special treat (or whatever reward would motivate your kids).
3. Run a 5K as a family- Set a goal to run a 5K sometime in the next 3 months. Find the race, sign up and start trying. There are plenty of Apps and online programs you can use to help work your way up to the distance. There is no goal for time or speed, just that everyone finishes.

I’ve made a decision that I’m no longer able to accept this:

“They just won’t get out and exercise.”

Without this:

“Are you getting up to do it too?”

One of the biggest stories centers around the suspension of Luis Suarez for biting an Italian defender.  It’s not the first time he has done it either.

I usually tell families that their kids will outgrow this problem, but I guess if you’re a world-class soccer player, that’s not always true.

What do we do when our child is the biter?

First off, this happens ALL THE TIME…

Your child is not the first child who has bitten and won’t be the last so let’s be calm.

There’s really just a few things you can and need to do in these situations …

When the bite has already happened

Separate biter and the bitten child.  This helps the “victim” feel safer and diffuses whatever frustration caused the biting in the first place.

Try to talk it out.  Often you are dealing with a pre-verbal child, but it is still important to try and talk about the situation that led up to the biting.  Usually the child who bit is just as scared as the child who was bitten.  You are typically dealing with young toddlers with limited verbal skills, but talking with them about their frustration/anger that led up to the biting can help them understand that there is a better way to express these emotions.

Preventing the Problem

The ultimate goal in helping with biting is to prevent the situation that leads to biting in the first place.  The key to this is: distraction, distraction and distraction.  Keep the frequent biters from their trigger situations or be prepared to intervene quickly before the frustration levels begin to rise.

Or, Just Bite Them Back

Of course, everyone has had a family member or someone tell them that this is the best way to get a biter to stop and while it may have worked for them in the past, I feel that this strategy is simply modeling the behavior you are trying to extinguish.  Toddlers learn best through seeing their parents’ actions and having your parent bite you only makes you think that is appropriate behavior.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his three young children, exercising, reading and writing about parenting and pediatric health issues.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.

I hope everyone had a great Father’s Day. I'm sure there were no fights between fathers and their teenage children.

Maybe, you had barbecue and ugly ties mixed with good feelings and love all around. But now back to reality.

Because of that, you can consider this a post for all the other weeks of the year when there might be more "disagreements" between fathers and teenagers. Most of you might be able to file this away under the Common Sense tab of your brain but I think it is a good reminder.

What is the best way for a teenager to resolve a fight with his/her dad?

Find someone else to support them through dealing with the conflict in a healthy way.

Jeff Cookston from San Francisco State University studied almost 400 families asking them questions about how they handled father-child conflict. He released a study in the March edition of the Journal of Research on Adolescence.  

The most common people that teenagers talked to were mothers, then friends and occasionally a stepfather or father (if conflict is with stepdad).

The study compared two positive ways the support person could discuss the problem with the teenager: giving an explanation for dad's behavior and assigning responsibility for the conflict.

So, to make the adolescent happy, just take his or her side and assign all the blame to the father, right? Actually, you may be surprised to learn that’s not true.

In fact, a real discussion about the reasons for dad's opinion and a fair assessment of the responsibility of the conflict left children feeling better about themselves and their fathers in the long run.

So, how does this play out in a real life situation?

Conflict #1:

"But, dad, I really want to go to this party and it won't even get started going strong until 11!"

"Sorry, it's just not going to happen this week."

Bad support:

"That's just how your dad is, he's always been overprotective."

Good support:

"I'm sure your dad is just concerned about you being safe and remember what happened the last time you went to a party and came home hours after your curfew."

Conflict #2:

“But, dad you can’t take away my Xbox!”

Bad support: 

“He’s just being dumb.  You can always play after he goes to bed.  I’ll try to convince him to give it back.”

Good support:

“I think he’s concerned because we’ve noticed that your grades have been dropping and you are having a hard time getting out of bed in the morning.  Maybe if you show him that you can show more responsibility, we can talk about getting it back.”

Give the father in your life the best gift you can give them this year, support your teenager in a way that helps them feel better about themselves and their Dad. (The ugly ties can wait until next year.)

Stop screaming in the car!

That's enough!

Just stop!

I'm the “out-of-home” worker in our family, while my wife is able to do her job mainly from the house. Therefore, I usually have:

1. brief periods of time alone with the 3 kids.
2. time at home when the duties are shared between my wife and me.

Because of Mother's Day Weekend, I got to spend more time alone with the 3 littles this weekend (all under 5).

As the weekend wore on, there were more moments of frustration.  I'd like to think they were just particularly crazy this weekend but I'm sure that would just be lying to myself and trying to justify my frustration.

Finally, on the way to get some tortillas for dinner Sunday night, after repeated attempts to get my kids in the car, listening to them scream at each other and seeing my 3 year old more or less punch my 5 year old in the face....

"Stop screaming in the car!

That's enough!

Just stop!"

I didn't REALLY yell at them. They weren't physically threatened. But, there were three pair of scared eyes looking back at me in the rear-view mirror.

Fortunately, a week before, I'd listened to Michael Hyatt's Podcast: 4 Difficult Sentences for Leaders.

In it, he outlines a four-sentence method for apologizing:

Sentence #1: I am sorry.

Sentence #2: I know that hurt.

Sentence #3: I was wrong.

Sentence #4: Will you please forgive me?

He also reminds us to avoid using terms like if and but...

So, I had the 5 minute drive home to think about it. The kids were quiet by now. They had either forgotten about it, they were too terrified to speak or Thomas the Tank Engine^™ just got much more interesting.

But when we got home, here's how it went:

"Guys, I'm sorry I yelled at you. I know that was scary. I should not have done that. Will you please forgive me?"

Some tips:

1. Apologize specifically for what you did, recognize how they felt, apologize again and ask forgiveness.
2. Don't use ifs or buts.  It was very tempting to say, "I'm sorry I yelled at you guys, but you should have come quicker and you shouldn't have been screaming and you shouldn't..."  But, then I'm not truly acknowledging the fact that I shouldn't have raised my voice.

There has been talk in the media and blogging world lately about how forcing your kids to apologize doesn’t actually teach them to apologize. I’ve seen this to be true in my family, they barely get the “I’m sorry” out before they are running off to do something else and very likely to come back and do the same thing two minutes later.

However, there are many reasons to apologize to your kids. First, modeling that one should apologize when they are wrong is a better method of teaching your children the power of apology. Another benefit is what it does for you. After apologizing, I was back in the right frame of mind to go back inside and parent more positively and with more patience rather than continuing to be angry and letting my kids suffer the ongoing consequences. It sure didn’t hurt that I heard this in return:  

5 yo: Of course, we forgive you.

3 yo: Yeah, we wuv you dad.

Almost 2 yo: Go, go; pway, pway; hungy!!

Well, 2 out of 3 isn't so bad.

"My mom used to say, 'When God closes a door, He always opens a window.' I have found that to be true many times in my life. My life as a pediatrician is a result of crawling through an open window when the door I thought I was supposed to walk through was closed to me."

Jason Terk, M.D., Keller, Keller Parkway

"Florinda Peak, the most amazing Mommy in the world, to 5 year old Dr Sandra Peak who did not want to practice reading… 'You have to learn how to read…because when you do the whole world opens up to you!'”

Sandra Peak, M.D., Lewisville

"The best advice my mother ever gave me was to give to others without expecting anything in return. (She also told me to never go outside with wet hair because I’d catch a cold, but medical school later disproved that. Sorry mom.)"

Diane Arnaout, M.D., Willow Park

"The best advice my mother ever gave me was, “never miss the chance to use a perfectly good bathroom” when you are out of the house."

Audrey Rogers, M.D., Fort Worth, Forest Park

Nicole Wineriter, M.D., Keller, HeritageTrace

"My mom told me to respect (be nice) to the nurses because they can either make or break your day."

Samuel Sheng, M.D., Arlington Neighborhood Clinic

"Encourage others. She always wrote notes to people for accomplishments, during sad times and just because."

Justin Smith, M.D., Lewisville

And finally, our favorite advice ...

"Marry Joan."

Tom Rogers, M.D., Forest Park. Dr. Rogers and his wife Joan have been married 59 years and today, she is a proud mother. "Joan worked to pay my way through medical school, gave me two great kids who are both pediatricians, and has allowed me to work without having to pay attention to small things like finances, maintenance of our house and yardwork. I couldn't be where I am today without her," Dr. Rogers said.

Happy Mother's Day from all of us at Cook Children's ...

It’s that inevitable time of year where I see news story after news story where children are rewarded Oprah-style for their awesome record of perfect attendance:

“You get a bike and you get a bike and you get a bike.”

Yeah!!  It’s pretty heart-warming and exciting, right?

There are kids (and families) that blew their perfect attendance the first week of school and didn’t think twice about it, but there are some that are holding out hope that maybe this year will be their year to win the drawing for $100 or an iPad or a trip to Hawaii (I haven’t actually seen this one, but I want my kids to go to that school) or whatever their school dreams up.

I do have a question though. Is perfect attendance really the point?

You need to be at school to learn. I get that. Missing school for frivolous reasons is harmful to the student and the school. So incentives to get kids to school make sense from that standpoint. But, at what cost?

There is a tension going on right now in the minds of parents throughout our community. It might go something like this:

“He’s only coughing a little bit.  He did get a few hours sleep last night. His fever is only 101 and if I give him Tylenol® maybe he won’t have fever at school.”

Does this sound right?

Has this line of thought ever happened in your house?

Do you think it really happens at other houses?

I can assure you it does. Parents say something like this all the time, “Well, he was having fever last night, but I gave him some Motrin® this morning so he hopefully wouldn’t have one at school. But sure enough, he did and the nurse called me to pick him up.”

This clearly misunderstands the whole point of not wanting your child at school if he has fever. Not having fever is not the goal. Keeping your child away from others when they are sick is the goal. Whether your child’s fever is masked by medicine or not doesn’t make them less contagious.

What can we do about it?

What if we changed the goal from perfect attendance to responsible attendance?

Perfect attendance implies that you go to school no matter what.

Responsible attendance implies that you go to school when it is appropriate and don’t when it isn’t.

Perfect attendance puts your child’s classmates health at risk.

Responsible attendance puts your child’s and their classmate’s health above another goal.

I am an optimist, but not unrealistic. I’m pretty sure that we can’t change the school’s policies regarding perfect attendance awards.  Besides, how would you reward responsible attendance anyway?  But, we can make a decision to practice responsible attendance with our kids and teach them to do the same.