“A lot of times the students are receiving a lot of their meals at school but in the summer months that primarily falls on the parent,” said Maya Rashad, nutrition program coordinator at Cook Children’s Health Care System.

According to data from the Cook Children’s Center for Community Health 2024 Community Health Needs Assessment, about 390,100 children from birth to 17 years old live in households that sometimes or often couldn’t afford nutritious meals. 

To help address those needs Cook Children’s Health Care System's Nourishing Communities program partners with R.E.D. Mobile Market, the Good for You Healthy Hub, and other Texas Health Resources Healthy Hubs to fight food insecurity and continue expanding community partnerships.

Free Summer Meals for Kids

Healthy breakfast, lunch, or to-go meals are available to children 18 and under all summer long.

• Fort Worth ISD Summer Food Program: Schedules and school locations
• USDA Summer Meals Site Finder: Find local distribution sites near you

“Healthy diet is the foundation of a healthy life,” said Rashad.

To put those words into action, Rashad hosts cooking classes twice a week at the Las Vegas Trail Neighborhood Health Center focusing on eating healthy while on a budget.

Lily Han, M.D., a pediatrician at Cook Children’s Windhaven and Rashad share practical tips families can use to stay healthy during the summer without breaking the bank.

“The summer is a great time to introduce new fresh, colorful and fun foods,” said Dr. Han.   

 One key strategy is choosing seasonal produce. Look for fruits and vegetables at their peak, like berries, avocados, watermelons and tomatoes.

Balancing Energy and Hydration

Nutrition during the hot summer months is also about maintaining proper hydration. With children constantly on the move between sports clinics, day camps, pool days and play dates, structured eating can easily slide.

Dr. Han said it is important for families to aim for three meals a day and two to three snacks to keep energy levels stable.

“Keep in mind you are fueling for both energy and hydration,” said Dr. Han.

Experts recommend keeping easy, ready-to-eat items on hand to curb hunger, stabilize blood sugar levels and provide sustained energy throughout long days of play.

Smart on-the-go snack options include:

• Trail mix
• Nut butter and whole grain crackers
• Frozen yogurt tubes
• Veggie sticks and fresh fruit
• Granola and cheese sticks

Related Stories:

• Texas Summer Safety for Kids: Hydration, Heat Illness Signs and Sun Protection Tips
• Bridging the Gap: How Cook Children’s Health Plan is Transforming Las Vegas Trail
• From Our Kitchen to Yours: Inside the Demonstration Kitchen at the new neighborhood health center serving the Las Vegas Trail Area

As pediatric experts, Cook Children’s Health Care System know that protecting a child's health is about preventing emergency room visits just as much as treating illness. Ahead of the major soccer tournament, the system launched "World Cup Wednesday," a weekly healthcare series providing local and international visitors with essential resources on injury prevention, heat safety, water safety and guidance on when to utilize urgent care versus the emergency department.

The hottest time of the year in Texas is here, with temperatures regularly ranging from 80-100 degrees between June and August. Medical experts from Cook Children’s Health Care System advise caregivers and parents on what to know before attending outdoor activities or fan watch parties.

“Children can't cool off the body as well as adults,” said Monica Herrera, M.D., a pediatrician at Cook Children’s Pediatrics Windhaven, “it's important that we keep them hydrated.”

Dr. Herrera emphasizes that hydration is key during these months, as well as protecting children's skin from the sun and mosquitoes.

Learn the signs of heat-related illnesses

Spending too much time in the heat without proper hydration can lead to heat exhaustion and heatstroke. Dr. Herrera said learning the signs for heat-related illness is important, so caregivers know when to seek medical attention.

Symptoms include:

• Feeling faint or confused: A child may begin acting disoriented.
• Walking unsteadily and losing coordination.
• Headache
• Abnormally warm skin: Feels hot to the touch.
• Lack of urination: No wet diapers or bathroom use in eight hours.
• Nauseous and vomiting
• Shallow breathes: The body uses shallow breathing to try to shed excess heat.
• Muscle cramps: A child may complain that their legs hurt.
• Numbness

If a child exhibits these symptoms, seek immediate medical attention.

Preparedness is the number one way to avoid heat-related illness and Dr. Herrera says it starts with hydration.

Hydration Tips

Babies under 6 months old should generally be kept indoors. However, if an infant is outside, Dr. Herrera recommends they stay hydrated with formula or breastmilk. Babies under 6 months should not be given water.

“The breast milk has everything that the baby needs as does formula,” said Dr. Herrera. “If you're outside for a prolonged period they really need to be drinking every 20 minutes.”

As children get older water becomes the priority for hydration, but there are other tricks if your little one isn’t fond of H20. While water is best, other caffeine-free fluids and water-rich foods can help count toward hydration.

“Fluids don’t always come in the form of liquid,” said Dr. Herrera.

Alternative hydration sources:

• Ice cream
• Popsicles
• Snow cones
• Crushed Ice
• Fruits (Watermelon, grapes and cantaloupe) are an excellent source of hydration
• Soft liquids (such as yogurt, applesauce)

How do you know if your child is hydrated?

Check their urine. Urine is the best indicator of hydration status for both children and adults. A well-hydrated child's or adult’s urine should be clear to a light yellow, similar to a light lemonade color. If the urine is dark yellow or tea-colored, dark orange, more fluids are needed.

Sun protection

While hydration is critical, protecting a child’s skin is a close second. Dr. Herrera explained that children’s skin is sensitive and can burn when exposed to the sun for a prolonged period. While sunblock Sun Protection Factor (SPF) ratings range in coverage from SPF 10 to 80, Dr. Herrera recommends choosing products with two active ingredients: zinc oxide or titanium dioxide and use a sunblock of SPF 30.

Babies under 6 months of age should not have sunblock applied. Instead, keep them in the shade and dress them in a wide-brimmed hat.

Sunblock recommendations for 6 months and older:

• Choose a mineral-based sunscreen.
• Use SPF 30
• Apply 15 to 30 minutes prior to going outside.
• Reapply every two hours.
• Avoid sunscreens containing oxybenzone.
• Choose lotions over aerosol sprays to ensure total skin coverage.

Staying Cool in the Sun

• Dress children in light-colored, loose-fitting clothing.
• Choose breathable, absorbent materials.
• Avoid sitting directly in the sun. Seek shade when possible.
• Use cool mist sprays for quick relief.

Mosquitos

Summer heat in Texas also brings mosquitoes, which thrive around stagnant water and in hot, humid climates.

“Mosquitoes, as we know, can carry viruses which can cause severe infections and serious complications,” said Dr. Herrera. “We want to avoid mosquito bites if at all possible.”

The most effective line of defense is insect repellent.

Finding the best repellent:

• DEET is the most effective option.
• For infants up to 2 years of age, use a maximum of 10% DEET.
• For children older than 2, a maximum of 30% DEET.
• Apply repellent only to exposed skin or on top of clothing. Do not apply it underneath clothing.
• If concerned about applying directly on the skin, apply repellent on clothing instead.

RELATED STORIES:

• Cook Children’s Provides Innovative Care for Family From Mexico

• Big Game, Big Responsibility: Water Safety

• Navigating Pediatric Emergency and Urgent Care During the Tournament

The American Academy of Pediatrics (AAP) recommends starting children in swim lessons as young as 12 months old to reduce the risk of drowning. The AAP says always keep in mind that swim lessons are just one of several important layers of protection needed to help prevent drowning.

“You are never too old to learn how to swim,” said Jillian Mitchell, community health program coordinator at Cook Children’s Health Care System. “There are instructors who specialize in teaching adults or co-teach adults and children.”

The National Drowning Prevention Alliance (NDPA) provides parents with a printable questionnaire to help identify the right swim program for their children. They suggest some questions for the program you are looking at, including asking for information about the instructor’s experience, swim lesson curriculum, length and frequency of classes. 

“Choosing the swim instruction style is a personal choice, and it should be an informed one,” Mitchell said.

Before choosing a program, the AAP recommends keeping your child’s emotional maturity, physical and developmental abilities and limitations, and comfort level in the water in mind.

“It is important to consider what unique needs your child has in addition to visiting a school, asking questions about their curriculum or teaching philosophy,” Mitchell said.

Swimming lessons teach the basics of swimming and, for toddlers, it introduce them to get them comfortable with water, teaching them physical movements in the water like kicks and “ice cream scoops” with their hands. It also shows them how to get in and out of the water. Infant Swimming Resource (ISR) teaches infants and toddlers how to roll in the water in emergencies.

When should you sign up a child for swimming lessons?

The AAP says most children are ready for swim lessons by age 4. However, parents of younger children should look into classes that allow a parent or caregiver and child to be in the water together with an instructor, whether swimming lessons or ISR. The AAP explains that by age 4, children can usually learn basic water survival skills such as floating, treading water, and getting to an exit point.

What is Infant Swimming Resource (ISR)?

Parents may feel their child is ready to learn as young as 6 months old. ISR instructors are unique in that they work specifically with infants. ISR focuses on teaching children to roll onto their backs, float, and rest. It is designed to give children instinctive reactions to emergencies if they find themselves in the water unexpectedly. Children learn how to “float, swim, float” until they reach the edge and can exit safely or be pulled out of the pool by an adult.

Cook Children’s recommends asking questions and choosing an instructor/school that fits families’ budget, schedule, and child’s unique needs.

Summer has begun, which means more outdoor activities and finding ways to cool down. Cook Children's Health Care System experts share tips for parents on how to keep children safe and prepared for the heat, from cooling down at the pool to summer travel safety.

As the 4^th of July approaches, we are sharing the latest drowning data from Cook Children’s Health Care System. As of January 1 to June 18, there were 20 drownings treated at Cook Children’s, two of which were fatal. Most of these patients have been in the 5-year-old and under age group.

So far in 2025, there has been a decrease with 18 drownings and two fatalities. Most drownings in 2025 have occurred in a swimming pool or spa, second highest were bathtub-related.

While most drowning encounters were not fatal, drowning injuries can result in severe effects, especially on a child’s brain development. Drownings can happen silently and quickly. A submerged person might not attract attention or appear to be in danger.

Cool Down: Water safety and drowning prevention

Drowning is the leading cause of unintentional injury and death for children ages 1 to 4 and the second leading cause for kids 5-14 in Texas.  Eighty-eight percent of drownings occur with at least one adult present. 

• Wear swimsuits with bright colors that are easily detectable in water.
• Designate an adult Water Watcher to ensure constant visual supervision of children in and around water.
• Implement 15-minute shifts for Water Watchers.
• No Distractions: The Water Watcher must have no distractions, including conversations, phones, reading, or consuming alcohol.
• Communication is key: Talk with all caregivers (family and friends) about your child’s swim ability or water competency skills.
• Never assume that adults will be watching, but rather verbally confirm it before leaving your child in their care.
• Barriers: Locks, alarms, and pool fences can help keep unsupervised young children from entering swimming pools.

Fun in the Sun: Boating Safety

The risk of drowning in open water triples at age 15. Setting safety expectations with the whole family ahead of time is paramount. Most drowning fatalities in natural water are not related to boating. Texas law requires that all children 13 and under wear a life jacket while on a boat. Cook Children's Health Care System supports over 60 Loaner Life Jacket Stations in North Texas lakes, rivers, and reservoirs. The goal is to make sure no child or adult drowns at a public lake because they did not have access to a life jacket.

• Make sure life jacket usage is mandatory, along with adult supervision.
• Toe In/Vest On Policy: If a toe is in the water, a life jacket goes on.
• Life Jackets: Must be U.S. Coast Guard-approved.
• When your life jacket is on, ensure that it is buckled on your child as directed.  Always. 
• Know water conditions before getting into open water. Water conditions in lakes and oceans can vary daily.  

Heat Safety

Spending too much time in the heat can lead to heat-related illnesses, including heat exhaustion and heatstroke.

• Stay hydrated: Water is best, but other fluids count if they do not include caffeine.
• Hot car danger: Make a habit of double-checking your backseat each time you get out of the car.
• Watch out for hot buckles on car seats, as these can cause burns on your child’s skin.
• Be aware of heat illness. Know the difference between heat exhaustion and heat stroke.

Sun’s Out, Fun’s On

When it comes to sunburn, prevention is key. 

• Use a zinc oxide-based sunscreen with a minimum SPF of 30.
• Cover skin with SPF clothing.
• Apply sunscreen generously and frequently, 15 minutes prior to sun exposure.
• Reapply sunscreen every two hours and after swimming.
• For infants: Keep them out of direct sunlight, especially during peak hours of 10 a.m. and 4 p.m. Keep their skin covered with lightweight pants, a lightweight, long-sleeved shirt, and a wide-brimmed hat. 
• Wear sunglasses: Look for sunglasses that protect your child’s eyes from at least 97% of the UV rays. 
• If you are worried about any burn, even if it seems minor, consult your child’s pediatrician.

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

• The safest way to enjoy fireworks is at a professional display.
• If setting off fireworks at home, adults should only set them off in a “kid-free” zone.
• Adults should not hold fireworks in their hands or keep any part of their body over them while lighting.
• Avoid accidental burns: keep children away from bonfires and grills.

“Hiding a gun under a mattress, in the closet, or on a high shelf is not safe storage,” Gonzalez explains. “Guns must be stored unloaded and locked away outside the reach of a child or teen.”

Gonzalez adds that safe storage can greatly contribute to reducing unauthorized use of firearms and gun violence among our youth.   

Cook Children’s Medical Center-Fort Worth treated 40 gun-related injuries in fiscal year 2025 (October–September). During the fiscal year 2024, Cook Children treated 62 gun-related injuries.

June 6 marks National Gun Violence Awareness Day and the beginning of Wear Orange Weekend, a time dedicated to raising awareness about gun violence prevention and honoring victims.

“Summer especially is a great time to practice the 3 T’s of gun safety: Talk, Teach, and Take Action,” Gonzalez said.

Gonzalez and Dan Guzman, M.D., a pediatric emergency medicine physician and Medical Director of the Aim For Safety® program, work together to educate the community, primarily focusing on preventing unintentional gun injuries by encouraging safe gun storage. Dr. Guzman has seen and treated an unfortunate number of children injured or killed due to firearms. As a gun owner and parent, he understands the importance of safely securing firearms.

“I don't want to watch another child die as a result of a firearm,” Dr. Guzman said.

He emphasizes that the initiative is not about advocating for or against gun ownership; the focus is on providing people with the tools and resources to be safe around guns.

The Aim For Safety® program has provided education and resources to thousands across the Dallas-Fort Worth Metroplex.

“We highlight how safe storage greatly reduces the risk of unintentional injuries, as well as how it contributes to keeping children safe during mental health crises and reducing the risk of use for gun violence,” Gonzalez said.

Between October 2024 and April 2025 alone, the program provided 252 gun safes and 206 gun cable locks to the community. This is in addition to almost 1,000 gun cable locks provided to families in the emergency department over the last year.

“That’s a total of 458 families which now have tools to keep their families safe,” Gonzalez said.

Gonzalez explains that safety extends beyond firearms such as handguns and also includes air-powered guns such as BB, pellet, and paintball guns.

“Guns should never be used without a guardian’s permission and should only be used while an adult is supervising,” Gonzalez said.

Open Dialogue: Talking to Other Parents about Gun Safety

• Keep the conversation focused on safety, not on whether someone should or should not own a gun.
• Simply ask if there are firearms in the home and if so, are they properly stored (unloaded and locked with a cable lock or in a gun safe).
  • If not, visit the Cook Children’s Aim For Safety website for tips on how to keep guns safely stored or for resources that we can offer to assist in safely storing the gun.

Aim for Safety in the Community

Aim for Safety will be out in the community throughout the summer:

• Defenderpalooza on July 12
• Fort Worth’s Premier Gun Show on August 23-24
• Scheels Great Outdoor Expo September 6-7
• If anyone is interested in a presentation, please reach out to  eric.gonzalez@cookchildrens.org

Lives Impacted by Gun-Related Injuries and Prevention Efforts at Cook Children's

• In FY 2025, Cook Children’s Medical Center-Fort Worth has treated 40 gun-related injuries
• In FY 2024, Cook Children’s Medical Center-Fort Worth treated 62 gun-related injuries
• Most non-fatal injuries were caused by air-powered guns (BB guns, airsoft guns, paintball guns, etc.), while most severe or fatal injuries were caused by handguns.
• Between October 2024 and April 2025 alone, we provided 252 gun safes and 206 gun cable locks to the community through various events.

Sophia Price, with Cook Children's Trauma and Injury Prevention says Cook Children's Medical Center in Fort Worth reported its first snakebites of the season in late April and early May, including its first copperhead bite in May. In 2024, the Cook Children's Health Care System treated 30 snakebites, with the first reported in March.

Jay Pearson, P.A., a physician assistant with Cook Children’s Trauma Services, offers crucial advice for parents on keeping children safe from snakebites. Price recommends avoiding walking in tall grass and wearing protective boots. She also warns that at night, snakes may rest on warm surfaces like driveways or sidewalks. Price emphasizes that individuals should never attempt to touch or handle a snake, even if it appears dead.

North Texas is home to three species of pit vipers:

• Copperheads
• Cottonmouths (also known as water moccasins)
• Rattlesnakes

A snakebite can cause localized pain and swelling that may spread as venom progresses. Other symptoms can include nausea, vomiting, and an increased heart rate. In severe cases, patients may experience difficulty breathing, low blood pressure, or bleeding disorders.

If a snake bites a child, seek immediate medical attention at the closest emergency department.

What to do if bitten by a snake:

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

How snakebites are treated at Cook Children's:

Once at the hospital, patients with moderate to severe envenomation may receive antivenom, which is readily available at Cook Children’s Medical Center.

Patients are closely monitored for symptom progression and may require hospital admission for observation and supportive care. 

The first outbreak-related cases were reported on May 13 in Collin and Rockwall counties. Alice Phillips, M.D., director of ambulatory quality and safety, advises parents to be aware but not alarmed.

“These cases remain small in our region. If your children are vaccinated, nothing about activities needs to change,” Dr. Phillips said.

Cook Children’s Health Care System continues to work with local public health departments on any report of measles cases. The Texas Department of State Health Services in April recommended that children between 6 months to 11 months traveling to or living in an area with an active measles outbreak receive a vaccination.

Dr. Phillips explained that the best way to protect a child from measles is the MMR vaccine. One dose offers 93% protection, and two doses provide 97% protection against the virus.

DSHS has designated these counties as outbreak areas: Cochran, Dawson, Gaines, Lamar, Lubbock, Terry, and Yoakum.

Currently, the Tarrant and Denton County health departments, where Cook Children’s Medical Center – Fort Worth and Prosper are located, have not issued this recommendation.

“If that changes due to a rise in cases, we will update,” said Dr. Phillips.

However, Dr. Phillips noted that families planning to travel outside of the United States, should be aware of regions where the MMR and/or Hepatitis A, vaccine is recommended for infants between 6 and 12 months.  She encourages parents to check with their pediatrician.

“If your kids are vaccinated, they are safe and protected,” said Dr. Phillips.

“While we are ecstatic that children are finding ways to get exercise and enjoy being outside, we want to remind parents to make sure that kids are protected while having fun,” said Kara Starnes, D.O., medical director of Urgent Care at Cook Children's.

Helmets are a Must for Fun on Wheels

ATV and dirt bike crashes are a common occurrence during summer. Over Memorial Day Weekend, the emergency department in Fort Worth saw 10 injuries related to motorcycles, dirt bikes, ATVs and skating.

Always ensure your child wears a properly fitted helmet to avoid head injuries. Adult supervision is essential when a child is riding any motorized vehicle, and children should never ride on ATVs or dirt bikes designed for adults.

“Please supervise your children on motorized vehicles,” Taylor Louden, M.D., medical director of Pediatric Emergency Medicine at Cook Children’s Medical Center – Fort Worth said. “They should always be wearing their seat belt and appropriate safety gear. The start of summer is a great time to check your kids’ safety gear and make sure helmets fit appropriately and are in good condition.”

A helmet that fits correctly will feel snug but not uncomfortable. 

A few other key points:

• Helmets that passed federal safety standards in testing will say “U.S. Consumer Product Safety Commission certified” on the label.
• Helmets should be worn in a level position just above the eyebrows.
• If the helmet rocks backward and forward or side to side, adjust the straps. No more than two fingers should fit under the buckled chin strap.    
• Never ride without a helmet.

Water Safety: A Constant Vigilance

Drowning is the leading cause of accidental death for children ages 1 to 4, and the second leading cause for kids 1-14 in Texas. Drownings can happen silently and quickly. A submerged person might not attract attention or appear to be in danger. These tragedies highlight the importance of constant supervision around water.

Sharon Evans, trauma injury prevention coordinator at Cook Children's, emphasizes, "There's no off-season for drownings. A moment of inattention can be devastating."

Unplanned swim time is a major culprit, with roughly 70% of drownings at Cook Children's occurring when parents weren't expecting their child to be near water.

Layers of Protection: Keeping Curious Toddlers Safe

Multiple safety measures, known as "layers of protection," can significantly reduce drowning risks. Fencing around pools with self-latching gates, preferably 5-feet high, is crucial. Door and window alarms can alert you if a child exits the house unsupervised. Remember, young children are naturally curious, so removing pool toys and floats when not in use minimizes temptation. For above-ground pools, make sure to remove the ladder when the pool is unsupervised. Consider using a pool surface alarm for added security.

Cook Children's has developed the "Lifeguard Your Child" campaign to raise awareness about childhood injury prevention. Through this initiative, you can find resources like free swim lessons, safety videos, and loaner life jacket stations at lakes across North Texas. Visit lifeguardyourchild.org for more information.

Sun Safety: Protecting Young Skin

Sunburns are not just uncomfortable; they can increase a child's risk of skin cancer later in life. Zinc oxide-based sunscreen is best whenever your child is outdoors. Covering skin with SPF is another way to protect your child’s skin. Apply sunscreen generously 30 minutes before sun exposure and reapply every two hours, or more often after swimming or sweating. Protective clothing, hats with wide brims, and sunglasses that block UV rays offer additional defense.

Hydration: Keeping Cool and Healthy

Dehydration can lead to nausea, dizziness, headache, or even heat stroke. Encourage frequent sips of water throughout the day, even if your child doesn't feel thirsty. Avoid sugary drinks that can worsen dehydration.

Your child’s urine colors can range from clear to dark yellow to orange, depending on how hydrated they are. To tell if your child is dehydrated, read this article from Celina D. Cepeda, M.D., a nephrologist at Cook Children’s Medical Center – Prosper.

Fishing Fun Without the Hooks

Fishing is a popular summer activity, but fish hooks can pose a safety risk. Teach children to handle hooks with care and supervise them closely while fishing. Consider using barbless hooks to minimize injury if a hook snags on skin.

RELATED:

• A Cautionary Tale: The Misadventures of Summer & Top Injuries Seen at Cook Children’s
• Should My Child Ride ATVs? Cook Children's Experts Weigh In 
• Sunburn Relief at Home, When to See a Pediatrician 
• Pediatrician Shares Top Beach Vacation Health Tips 
• Heads Up: Helmet Tips for Safer Bicycling 
• Teen Driver? What to Know Before They Go This Summer 

A new school year is just around the corner and it’s time for incoming kindergarteners and seventh-graders to get caught up on their routine immunizations.

Vaccines to protect against certain contagious diseases – including measles, polio and chickenpox – are required for students in Texas. Your child or teen might need a few boosters depending on their grade and whether they’re behind on their shot schedule.

Cook Children’s wants parents to know that vaccines for school are safe and proven tools to prevent diseases from spreading through the classroom and beyond.

“These vaccines have been around for a long time. There's nothing new to these vaccines, and they're as safe as they've ever been,” said Erin Bridgewater, M.D. at Cook Children’s Pediatrics in Celina.

The 2023-2024 Texas Minimum State Vaccine Requirements lists the number of doses that students need. If an incoming kindergartener has missed out on vaccines normally given at age 4, these additional vaccines are due now:

• MMR (measles, mumps and rubella)
• DTaP (diphtheria, tetanus and pertussis)
•  IPV (inactivated poliovirus)
•  Varicella (chickenpox)

And between the ages of 11-12 years, these additional vaccines are due:

• MCV4 (meningitis)
• Tdap (tetanus, diphtheria and pertussis)

About 7% of seventh-graders statewide either submitted exemptions or were delinquent in their meningitis and Tdap vaccines in the 2022-2023 school year. The concern is that a decline in the vaccination rate makes the general population more vulnerable to a disease catching hold.

“These illnesses are still very much present and could possibly cause serious illness in our children, especially if we don't continue to vaccinate and keep that high level of herd immunity that keeps these things from spreading,” Dr. Bridgewater said.

For example, a pediatric patient in June 2023 was diagnosed with the first confirmed measles case in Texas since 2019. And in New York in 2022 an adult was diagnosed with the first case of polio identified in the United States in nearly a decade.

Making an Appointment

If your child or teen needs an up-to-date shot record before school starts in August, it’s best not to put it off. Schedule your child's appointment earlier in the summer to get what you need for the school year. A spike in appointments and rush for vaccinations and school physicals can cause delays at Cook Children’s pediatrics offices. You can make an appointment at any Cook Children’s neighborhood clinics or pediatric office, including the site in Celina, which opened in April.

Dr. Bridgewater understands that it’s easy to lose track of checkups and shots -- especially for families in transition, like the influx of residents moving into the fast-growing area around Celina and Cook Children’s Medical Center - Prosper.

“A lot of parents meant to come in,” she said. “Things got busy and so they just kind of forgot. We certainly want to help people in those situations.”

The boosters required for kindergarten and for seventh grade can usually be administered in one visit to the clinic or office.  If the patient needs a checkup, it’s an appointment with the doctor. If the patient needs vaccinations only, it’s an appointment with the nurse.

How do vaccines work? The needle injects a portion of a pathogen into the body so that the immune system learns to recognize the virus or bacteria, Dr. Bridgewater said. Vaccines don’t cause infection.

“It's kind of like we're giving their immune system a snapshot of the most important piece of the puzzle so that if their immune system sees that piece again, they already know how to respond,” Dr. Bridgewater said.

She explains to her patients that it’s better to get one preventive poke than to catch a disease that might put them in the hospital. She welcomes any questions they or their parents want to ask so that they can feel confident and informed. Dr. Bridgewater wants to dispel any myths and misinformation that might be a stumbling block.

Dr. Bridgewater believes in vaccines not just as a pediatrician, but as a mom. She points out that her own two kids in recent years got the shots they needed for school.

“I want other parents to have the same reassurance that I have,” she said. “If they've heard anything at all that makes them concerned, I really encourage them to reach out and ask those questions instead of living in fear and then maybe avoiding something that could truly be lifesaving for their children.”

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

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

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

DROWNING PREVENTION

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

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

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

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

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

Parents can put barriers in place to help prevent a child from accessing the water or make it more difficult to access when an adult is not present. Barriers – such as locks, alarms and fencing – can help keep unsupervised young children from getting into swimming pools.

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

HEAT SAFETY

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

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

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

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

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

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

FIREWORKS

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

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

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

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

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

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

ATV SAFETY

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

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

ATV Safety:

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

RELATED

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

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

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

My girls are just beginning to experience the downtime of summer. My early-risers are finally trying to sleep in longer. They are no longer allowed to start their days with their iPads because it immediately affects their attitudes. But that means that the dining room table is covered in crafts and unfinished projects to keep little hands busy.

This is the season of yelling “CLOSE THE DOOR!” a million times a day, and for the next few months, I will be a short-order cook rotating between their desires for grilled cheese, quesadillas, mini-pizzas, chicken nuggets and everything in between. It’s so fun, but it takes us a good chunk of time to really get into our summer rhythm.

Summertime is long awaited for many kids and teens, but unfortunately, summer can bring about depression in children and teens similar to the cold days of winter. Often in the emergency room, we start to see kids begin to struggle during the last weeks of school and then again in the last weeks of summer. The number of kids struggling with their mental health rises during these times. We know that transitions can be difficult and surrounded by anxiety for kids and parents alike. 

As much as kids love the idea of not being tied down to schoolwork and getting a break from the grind, the routine and expectations of school coupled with time with friends and activities, can make summer feel chaotic, dull, and ultimately lonely. Many parents still have to work full-time jobs while their kids are out of school, which can mean a lot of unsupervised time for kids.

It is easy for kids to get their schedules completely flipped – sleeping all day and staying up all night. They begin to spend hours in front of their screens including video games, social media and hours of endless scrolling. Once the summer is in full swing, it can be easy to miss the signs of summer blues that your kids may be experiencing. There are a few things that you can do as a parent or caregiver to help with these blues and maybe prevent some of them.

Establish a Summertime Routine

Kids are immediately out of routine. They finally get to sleep in and have no real time constraints on their day. They have zero rhythm to their days and little expectation.

Years ago, I realized this was not going to work for my kids for the whole summer. To keep some peace in my home and give my girls the best chance for transitions back into school, we needed to have at the very least a loose schedule for the summer. For us that has looked like some quiet activities in the morning. This could be reading, crafts, or play time. iPads do not turn on before 10 am.

I ask them to get dressed, brush their teeth and get ready for the day. We make beds in our home, so we keep that up even in the summertime. They are in charge of their own breakfasts, but sometime before noon. When their iPads turn on at 10 am, they have a limited amount of time on them, so they have to manage when they use their time. We have lunch a little after noon, then they can do some outside activities. Sometimes we go on a bike ride, swim or they play with neighbors or friends.

When they were younger, we had another quiet time in the afternoon that was no screen time.  Around 4 pm, we do a clean-up time to get ready for dinner and then plan to spend time together as a family after dinner. Not every day looks exactly like this, but it has been so, so helpful to have a rhythm. This lets them know what to expect.

Many times, when we plan to go somewhere, I try to do that in the morning before lunch so that we can have some rhythm to our afternoon. For my school-aged girls and pre-teen, this rhythm is so important for their brains and emotions throughout the day.

Limit screen time

Limiting screen time is so important. It is so easy for all of us to fall into hours of screen time and not get anything done all day. I am guilty of this as an adult, and we know the damage it is having on our kids and teens. Hours of scrolling are not beneficial to their developing brains.

Our girls’ iPads have a filter on them that I control from my phone. This has been an important investment for us. I can control the time their iPads come “on” and the time that they are able to be on them in a day. I also can see EVERYTHING that they search or look at in a day while also blocking and filtering the content that they can see. I can do this from work, which is super helpful. There are many options for this, but I highly encourage this.

The level at which our kids are being exposed to developmentally inappropriate content along with engaging in dangerous material is astounding. The effects of screen time on children’s brains and development are proven to be detrimental in many ways.

We are seeing the mental health of our kids and teens suffer the more they scroll. My kids have screen time limited to 2 hours during the week and 3 hours on the weekend during the summer months. They are only able to have about 30 minutes on weekdays during the school year to talk with friends and then 3 hours on the weekend. My girls are school-age and preteen. I know that some of these limits will need to change as my girls get older. I also find, like I mentioned before, that our days go much better when my kids do not start their day or end their days with screen time. We try to keep screen time sandwiched in between other activities.

Set Aside Time to Connect with Your Kids

This is something that can be challenging especially if you are working full-time. This quality time is important in the summer as well as the school year. I find, though, that summertime is a great opportunity to reconnect in different ways with your kids without the intensity of school schedules and activities getting in the way.

I try to do bike rides, plan a special outing, read a book with my girls, play a game, etc. Any time that I can get with them one-on-one time with them is even better. Our kids are looking to connect and belong. We want to be the first place that they belong. Prioritizing this time will be one of the best things you do all summer for your kids!

Say YES Where You Can

Lastly, this is the challenge for the parents. We can help our kids by saying yes where we can. Say yes to the walk, to the game, or to friends coming over. If you are the stay-at-home mom, say yes to being the house where the kids can hang out for the afternoon. Say yes to water balloon fights and water play. Say yes to the mess when you can. Say “yes” and “sure” when your margin allows. Our yes is often the bright part of the day for our kids and the things they remember the most.

Summers can be a time when memories are made and the best moments are ingrained in our kids’ minds. So, while the summertime blues can pop up, with a little bit of intentionality and a few yeses, we can combat them and help our kids have some bright summer days!

Ahh, summer. It’s full of adventure. Or, if your kids are anything like mine — misadventure.

Barely two weeks into our summer break this year I made a visit to urgent care with my 14-year-old to have a fish hook removed from his hand. Totally worth it, he says, since he caught a bass. (Insert my motherly eyeroll and exasperated sigh.)

The summer months can be busy ones in pediatric emergency departments, urgent care centers and pediatrician offices. With kids out of school and looking for fun, they sometimes find trouble that results in injury. Tragically, some of those injuries can be serious, life-altering or even fatal.

“In the summer, kids have all day and night to be able to get into trouble, which is what kids are supposed to do. They're just learning,” said Daniel Guzman, M.D., a pediatric emergency medicine physician at Cook Children’s Medical Center. “As parents, we're just trying to manage the chaos so they don’t make any tragic mistakes.”

Drownings top the list of summertime injuries and causes of death at Cook Children’s, according to Sharon Evans, trauma injury prevention coordinator. In fact, it tops the list nationally. Drowning is the leading cause of accidental death in children ages 1 to 4. For teens, it is the second leading cause of death.

The Center for Community Health, led by Cook Children’s, offers parents and kids water safety and drowning prevention education guides and resources like water-watcher tags and life jackets through its Lifeguard Your Child program. Through this program, anyone can learn how to choose and properly fit a life jacket, how to build a water safety plan, what type of physical barriers should be in place to secure backyard pools and tips for a safe and fun swim time. 

After drownings, the top sources of summertime injuries sending kids to Cook Children’s Emergency Department include:

• Motor vehicle collisions
• All-terrain vehicle (ATV) accidents
• Dog bites
• Falls on playground equipment and trampolines

Dr. Guzman says car and ATV accident injuries are often the most tragic.

An estimated four kids are seen in U.S. emergency departments every hour for injuries related to ATV accidents, according to the American Academy of Pediatrics. From 2017 to 2022, more than 700 North Texas children, most between the ages of 10 to 14, were treated at Cook Children’s Medical Center for serious injuries involving accidents with off-road motorized vehicles.

“The most critical injuries we see from these vehicles are head injuries from kids not wearing a helmet and being ejected,” Dr. Guzman said.

Golf carts can be particularly dangerous.

“With individual ATVs, people tend to put more of the safety equipment on their children, but with a golf cart people feel more secure and protected and less threatened,” he said. “They usually are not wearing a helmet or a seatbelt, so we see these ejections. When you are riding on pavement and it’s head versus pavement, the pavement always wins.”

While common summertime injuries seen at Cook Children’s Urgent Care Centers are more minor in nature than those in the Emergency Department, the sources of injury are often similar.

“We see lots of trampoline and bicycle injuries," said Kara Starnes, D.O, medical director of Cook Children’s Urgent Care Services. “Kids get outside, they're more active and they're more likely to break things. Bicycles, hoverboards, skateboards and trampolines are a big source of fractures or sprains. Fish hooks are more common in the summer, as are lacerations because kids are playing outside more. They get more cuts and things that need to be sewn up in the summertime.”

The primary care pediatrician’s summer risk list looks a little different given their focus on non-emergency care. When temperatures rise, pediatricians see more:

• Infected bug bites
• Sunburn
• Dehydration
• Poison ivy
• Swimmer’s ear infections
• Leg fractures

“Believe it or not, I see lots of leg fractures in little kids from sliding down a slide while sitting in their parent’s lap, because their leg gets caught between the parent and the side of the slide,” said Diane Arnaout, M.D., a pediatrician at Cook Children’s Pediatric Forest Park. “It’s a really dangerous thing to do.”

Pediatricians and Their Own Kids

Given these common injuries, we asked a few Cook Children’s physicians to weigh in on what they never allow their own children to do, or never let their kids leave the house without in the summer. It’s important to note these physicians are not afraid of fun, they just see the negative outcomes of these thrill-seeking activities on a daily basis. For them, the dangers associated with some of these risky behaviors outweigh the entertainment.

Here’s what they had to say:

Dr. Guzman:

“Trampolines are a big thing that I despise. We see so many injuries from those. You get multiple kids on a trampoline and that really becomes a problem. Another thing for me is golf carts. Until kids can drive, they probably shouldn't be in the golf cart unless mom or dad is in there with them. You wouldn't let your kid drive your car. Why would you let them drive a golf cart, ATV or other off-road motorized vehicle at a young age without any experience? They just don't understand the gravity of the responsibility or have the physical dexterity to maintain a vehicle.”

Dr. Starnes:

“I would never let my kids ride their bikes without a helmet because we see some pretty severe head injuries from bike accidents. ATVs are an absolute hard no for me. Also, kids go barefoot a lot in the summer, so we'll see things get stuck in their feet more often, like glass or gravel. To avoid this, I would recommend they at least wear flip flops or some sort of shoe while playing outside.”

Dr. Arnaout:

“I never let my kids leave the house without a water bottle in the summer. We don’t do trampolines without safety nets or bikes without helmets. And ATVs are a no-go for me.”

Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Pediatrics Haslet

“Insect repellant, sunscreen and big hats for scalp protection are a must for my kiddos. Water safety is my No. 1 topic in the summer and must be the No. 1 focus of parents when their kids are in or near bodies of water.”

RELATED:

• Should My Child Ride ATVs? Cook Children's Experts Weigh In (checkupnewsroom.com)
• Sunburn Relief at Home, When to See a Pediatrician (checkupnewsroom.com)
• Pediatrician Shares Top Beach Vacation Health Tips (checkupnewsroom.com)
• Heads Up: Helmet Tips for Safer Bicycling (checkupnewsroom.com)
• Teen Driver? What to Know Before They Go This Summer (checkupnewsroom.com)

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

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

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

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

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

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

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

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

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

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

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

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

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

Warning Signs of Heatstroke:

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

Sunshine, outdoor adventure, new experiences, camaraderie and memories — it’s the stuff summer camp is made of.

Each summer, more than 14 million kids and adults attend a camp. Doing so can contribute to a child’s love for nature, their willingness to try new things, social awareness, independence and resilience, according to the American Camp Association (ACA).

“Camp really provides kids an opportunity for independence and to be exposed to things they don’t get exposed to during a traditional school year,” said Katie Campbell, Child Life manager and Camps for Kids coordinator at Cook Children’s Medical Center. “It’s an opportunity to challenge themselves to try something new, to make new friends and to establish community with their cabin.”

But sending your child off to camp can be scary. How do you know it’s a safe place for them physically, mentally and emotionally? Are the people you are trusting to care for your child at camp qualified?

Choosing a Camp

The ACA is a good place to start when determining what to look for in a camp, according to Megan White, camp director of Camp John Marc, a residential Dallas-Fort Worth-based camp serving children and families living with a chronic illness and physical challenges, and a Cook Children’s Camps for Kids partner. The ACA is an accrediting body for camps and is considered the industry’s gold standard for best practices when it comes to safety, staff training and risk management.

“It's a resource that is intended to be used for any parent at any stage to learn about the camping industry,” White said. “I would definitely encourage parents to read up on and learn about our best practices in the camping industry and to find out the qualifications and accreditations of the camp before you send your children to one.”

What makes a good camp? According to a study commissioned by the ACA, campers who experience a sense of belonging, supportive youth-staff relationships and learning that is both experiential and reflective report the most positive attitudes and outcomes from camp.

But safety should be a top priority, too, White says.

“The two most important things that I would say are what are their abuse prevention and camper safety protocols as it relates to mitigating risks at camp.” White said. “One thing that we always say here at Camp John Marc is we can have the best camp cookies, the most comfortable camp beds or the coolest camp store, but if our campers aren't safe, then we’re not doing our job to the best of our abilities.”

While some of this information can be found on a camp’s website, White says to never be afraid to pick up the phone and talk directly to the camp director about their protocols and policies.

“Sometimes this will give you a more honest read on how important these things really are to the camp than what you can get from a manicured website,” White said.

Tips for Parents

If you are preparing to send your child off to camp, be it sleep away or just for the day, White and Campbell share the following tips for making the experience a positive one for you and your camper. 

●       Don’t be afraid to ask questions about certifications, camper-to-counselor ratio, staff training, camp schedule, etc.

“Communication is key. Ask questions about the schedule the camp follows, where they get their staff and the ratio in regards to campers and counselors. That's important information that needs to be pretty easy to get and for families to inquire about. Don’t assume that it's a popular camp so it will be safe, but make sure that, for those things that are important to you around your child's safety or knowing who will be taking care of them, you get an answer.” – Katie Campbell

“I encourage parents not to get distracted by all of the cool amenities but to focus on the two most important things of how do they train their staff as it relates to preventing child abuse, and what are they doing to ensure a culture of safety. What does that look like for all of their employees, including their kitchen and housekeeping staff and their facilities team? What is their camp culture of safety? These are questions any camp director should easily be able and willing to answer.” – Megan White

●       Make sure your child understands personal boundaries and how to ask for help if they feel uncomfortable.

“I really think that parents should have a conversation with their kids at any age about appropriate and inappropriate touch. We teach that a camper should never be touched anywhere that their swimsuit would cover. For males and females alike, that is a good benchmark for their physical safety. I also encourage parents to have a conversation with their kids about asking for help and give their children permission to tell someone they are uncomfortable — whether that's someone in my cabin is making me uncomfortable or an adult that is in the area is making me uncomfortable. Give your children the permission and language to find another adult they trust and ask for help.” – Megan White

●       Include your child in the process of choosing and preparing for camp.

“Camp is good for everyone, but not every camp is good for every child. You have to find the right camp for your son or daughter to make sure it's meeting their needs or their interests.” – Megan White

“I think it’s important to involve kids in the whole process of shopping or gathering what is needed for camp and allow them to help pack their bags so that they understand the packing system you are using. This makes them more confident about the new experience.” – Katie Campbell

●       Be prepared for outdoor activities and weather changes. 

“One minute it could be hot and 100 degrees and the next it could be storming. Make sure that your child has everything they might need for the week, even if it seems random. We don't necessarily always need a rain poncho in Texas in July, but just having it and other little things like a flashlight might turn out to be really useful.” – Katie Campbell

“Pack plenty of sunscreen and a water bottle. We always recommend closed-toe shoes so that you don't stub a toe or get a splinter in your foot.” – Megan White

●       Send them with things that will make them feel more at home.

“If there are things from home that help kids feel safe — a stuffed animal, a favorite blanket or something like that — make sure those things are included.” – Katie Campbell

“I encourage parents to send their child with a journal or give them a place or a tool to help them reflect and write about their experience. A Polaroid camera can be great for this, too. A lot of times children get home and parents ask about camp and their campers are too tired or can't remember what happened. So give them at least some tools to record their memories and experiences.” – Megan White

Heat illness during sports practice or competition is among the leading causes of death in the U.S. for high school athletes, according to the Centers for Disease Control and Prevention (CDC). Scorching summer sun and high temperatures put athletes at increased risk for heat illness, no matter their fitness level. 

Coaches and directors of marching bands are currently conducting practices, rehearsals and scrimmages ahead of football season. This summer, North Texas experienced lengthy stretches of triple-digit temperatures and drought. Rainy days have tampered down the heat, but the humidity is still high.

Students’ primary preparation begins with hydration – not just during and after practice. Drinking water and clear liquids must begin hours, even a day, before the exercise and exertion, said Jason Terk, M.D. of Cook Children’s Pediatrics Keller Parkway.

“If you're not dealing with a full tank, you are not going to be able to catch up or keep up,” Dr. Terk said. “Those leading the practices must also build in enough breaks for rest, shade and hydration.”

Keeping pace with science and research, the University Interscholastic League (UIL) sets guidelines around heat stress and athletic participation for high schools. Their recommendations follow research from the American Academy of Pediatrics Committee on Sports Medicine. UIL now recommends water availability for athletes in unlimited quantities. Cold water is best. Additionally, practice schedules should include 10-minute water breaks for every 20-30 minutes of exercise in the heat.

Dr. Terk is a self-proclaimed marching band nerd and is an unofficial chaperone for Keller High School’s marching band.

Guidelines Make Sense

“In 15 years of doing this, the last nine of them at Keller High School, I have no reported heat-related emergencies,” said Ryan Heath, director of the marching band.

There are two parts to Heath’s preparation for marching season, the music-only rehearsals indoors and the music-plus-marching outside.

“Our district has great guidelines related to temperatures and that dictates what our hours are,” Heath said. “We work to schedule the outdoor part in early morning or in the evening before sundown.”  

Keller Independent School District bases decisions on the National Weather Service’s Wet Bulb Globe Temperature Forecast. Its measurements can help manage workload in direct sunlight and capture temperature, humidity, wind speed, sun angle, and cloud cover (solar radiation). Many of us are more familiar with the “heat index” that only measures temperature and humidity, and does so in the shade.  

Heath starts the discussion with his students in the spring, about summer training for the fall marching band season. When rehearsals get underway, he expects students to have done enough summer activity so they can complete a one-mile run in 10 minutes. Heath says the measurement ensures band students have the cardiovascular endurance required, to play an instrument successfully and march simultaneously. He came up with it after consulting medical professionals and other  experts.

“We don’t have a certain training regimen,” Heath said. “But this is an athletic activity as much as sports and my expectation of participants is they maintain good physical health and stay hydrated.”

For safety precautions, he requires students to have a hat, sunglasses, a gallon of water, and sunscreen when they report for outdoor marching rehearsals. Without those, they cannot participate. He also says, during the first weeks of marching practice many parents show up with extra pop-up tents, ice packs and more water to help monitor students’ response to the heat. Many of the parents are doctors, nurses, nurse practitioners and others with professional expertise.   

Ease Into Practice  

“I played high school football and we practiced for three hours with one water break,” said Daniel Guzman, M.D., pediatric emergency medicine physician with Cook Children’s Medical Center. “I’m happy to see that we have advanced from the archaic ‘it will toughen you up’ to water breaks are important for players’ safety.”

Dr. Guzman’s youth sports career included summer practices in South Texas. He knows now just how dangerous it was and how preventable heat emergencies are.

“Exertional heat illness is one of the leading causes of death each year. Parents need to be aware and informed about their children’s practice schedules and the team’s policy on modifications of practice depending on the level of heat that day,” Dr. Guzman said. “At what temperatures do we modify our practice schedule?  It is within a parents’ right to know what these policies are and what are children being taught about rest and hydration to keep them safe.”

Dr. Guzman says coaches and band directors can help student athletes by acclimatizing to heat during the first seven to 14 days of practice. He says athletes can become more heat tolerant, but are never out of danger. Coaches should be careful and watch closely, while athletes need to self-restrict activity if they begin feeling badly – the sooner the better – to avoid emergencies.

“It’s important to be careful when pushing these young athletes to their limit and be mindful that most kids won’t say they feel bad or need to stop,” Dr. Guzman said.

Early Warnings

What are the earliest signs of heat illness? Dr. Guzman says it usually begins with muscle cramps, lightheadedness, headache, abdominal cramps and nausea. If you ignore these early signs, your condition could become emergent quickly. If you are too sweaty and looking pale, Dr. Guzman says that means it is time to get in the shade and drink something with electrolytes, like a chilled sports drink, to replace salts. It’s really important to treat the symptoms quickly, especially if the athlete is confused.

The color of urine is a good monitor for sufficient hydration. Dr. Guzman says it should be clear and not dark. If urine begins to look brown, red or tea-colored, there could be serious issues underway, like the medical condition called rhabdomyolysis (rhabdo). Rhabdo occurs when injured muscle tissue breaks down rapidly and releases proteins and electrolytes into the bloodstream. In large amounts, the substances can damage kidneys and other organs, cause rapid heart rate and even death.  

“The process makes the blood sluggish. Everything just aches and patients often say it’s too painful to move, they have achiness everywhere, flu-like discomfort,” Dr. Guzman said. “Kids can complain of feeling sluggish and weak. They should skip practice if this occurs and seek medical attention.”

Athletes that have dark-colored urine with or without any other symptoms should consider it a significant cause for concern. Blood tests can measure the level of substances released into the blood stream to diagnose rhabdo. One measurement important to Dr. Guzman is creatine kinase (CK). Normal ranges can vary among patient populations. Generally, he wants to see it under 300-350 micrograms per liter (mg/L). In the emergency department, he has seen patients whose CK is 1,000-2,000 mg/L range and he recalls one athlete with over 10,000 mg/L.

“The treatment is to continue IV hydration two times the normal amount until the patient feels better and the creatine kinase begins to decrease to normal levels,” Dr. Guzman said “Big muscular kids are the ones that concern us the most. Working out vigorously can break down all that muscle and create a dangerous situation.”

Avoiding heat illness among sport and marching-band athletes is a group effort among coaches, band directors, parents and kids. Respecting any outdoor activity for the possibilities and concerns related to heat stress is vital to the safety of student participants. Be cool this summer – literally!

Early Signs of Heat Stress

• Muscle cramps
• Lightheadedness
• Headache
• Abdominal cramps
• Nausea

Reminders for Athletes and Parents

• Monitor your body’s need for water or cooling breaks.
• Avoid worrying about being the ‘weak link.’
• It is okay to say, “I can't go anymore.”

RELATED: The Facts About Fainting in Children (checkupnewsroom.com)

Parents and caregivers should ensure that a home swimming pool has an effective swim safety plan and extra layers of protection. Most drownings seen at Cook Children’s happen in a swimming pool during the least expected moments. Drowning is the leading cause of accidental death among children ages 1 to 4 and the second leading cause for kids 1 to 14 in Texas.  

Commonly, during unplanned swim time, children sneak off unnoticed, curious and looking for adventure, and that’s when drowning most often occurs. It’s vital never to lose sight of your child when you are in or around a swimming pool.

Drownings are preventable - more often than not, parents do not hear their children drowning; this is why children must be given undivided attention at or near the swimming pool. 

Don’t be the person to think, “It won’t happen to me.” Drowning can happen to anybody in a split second, not just neglectful parents not watching or paying enough attention to their children, and not just children who can’t swim. 

A parent’s water safety job is not over when their child learns to swim. Even experienced swimmers are susceptible to drowning and should still be watched, or wear a life vest at all times.

When choosing a life vest for your child, always check the label. If it does not read “US Coast Guard Approved” or “USCG Approved”, do not use it - assume it is not safe and untrustworthy. As your child grows, the lifejacket needs to meet their new weight. Get a new lifejacket if there are rips and tears or fraying of the straps.

Sharon Evans, trauma injury prevention coordinator at Cook Children's, shared tips and insight on safety at the pool. 

What are some tips you have for parents this summer while they’re at their home pools?

The biggest thing is  keeping your eyes or hands on your kids at all times. The large majority of our drownings we see at Cook Children’s are in backyard pools. It’s not always the homeowner's child - a lot of times they’ve gone to somebody else’s house for a barbecue or party. 

When you have a pool party for example, the more people you have at a pool, the higher the risk a child will drown because everyone assumes someone else is watching the kids. Wear a Water Watcher tag for 15 minutes, while you wear it, you cannot eat, drink or talk to anyone else- you’re strictly just watching the kids in the pool. Then, pass the tag onto someone else.

What are common incidents seen at Cook Children’s?

We see similar stories every time: The child will be in the pool, swimming with a life vest on, and then they get out of the pool to go to the bathroom or get something to eat and the parents will take the life vest off and somehow they get back into the pool. Drownings are always silent, not like in the movies where we see the kid thrashing and screaming. We’ve had parents sitting on the edge of the pool on their phones, unaware that their kid is drowning because it is so silent. 

Are life vests the safest option for children?

Anything that is Coast Guard approved is safe. We see a lot of parents using puddle jumpers and those are safe too, as long as they are Coast Guard approved and are not inflatable. Blow- up floaties or anything that’s inflatable can deflate at any moment.

Does drowning prevention differ from age to age?

Generally, drowning prevention is the same for all ages. We’ve had older adolescents/early teenagers go to the pool and they get tired and are unable to swim. You should always be watching, even if they’re a great swimmer, that doesn’t mean you can take your eyes off them. 

Pool Safety Checklist:

Choose a Water Watcher

• A child must have constant supervision while near or in a swimming pool. Decide on a designated Water Watcher and make sure they have no distractions. 
• If more than one adult is present, switch water watching jobs every 10 minutes. 
• Put your phone or other possible distractions away.

Install fences around home pools

• Proper fencing around pools could prevent 50% to 90% of childhood drowning incidents. 
• Four-sided isolation fencing should be around your home pool. 
• Fences around pools should be at least 4 feet tall.
• Self-latching/self-latching gates that only open outwards.
• Gates with childproof locks should remain locked at all times if the pool is unattended. 

Be aware of pool drains

• Teach your children to stay away from pool drains or any equipment with strong suction that hair or clothing can get caught in. 
• Make sure any swimming pool your child is at has compliant, working drain covers.

Use pool/door/child alarm

• An alarm can give you crucial seconds that could save a child's life.

Empty inflatable or portable pool immediately after use 

• Even shallow pools are a drowning risk.
• Store them upside down so they cannot collect water.

 Know what to do in an emergency

• Take family CPR lessons. 
• The adult should call 911 immediately and then begin CPR while EMS is on the way.
• Schedule water safety and swim lessons. 

For more information and resources, go to LifeguardyourChild.org.

With the temperature reaching 104 the other day, I was shocked to see a toddler by himself in the car outside of a restaurant. I rushed inside and found his mom, who waited in line for her to go order. As soon as the mom unlocked the car and I knew the child was safe, I left but could not get this scenario out of my mind.

“There is no amount of time that is safe to leave a child in the car,” said Sharon Evans, RN, BSN, CPN, CPSTI, trauma injury prevention coordinator at Cook Children’s. “It’s not worth the risk to run into a restaurant because before you know it five or 10 minutes have gone by, and the temperature could have reached a dangerous level. If a child is left in the car and something happens, there is no way to justify it.”

Since May 1, MedStar emergency medical crews have responded to nine incidents where a child was left in a hot car. All were under 6 years old.

Only 20 states have laws that make it illegal to leave a child unattended in a vehicle – Texas being one of them. In only 10 minutes, a car’s temperature rises 19 degrees, and cracking windows has no effect. Since 1998, 920 children are known to have died in the U.S. of pediatric vehicular heatstroke (PVH), 13 of those deaths happening this year. Texas leads all states with 137 pediatric vehicular heatstroke deaths.

“When a core body temperature of 107 degrees or greater is reached, cells are damaged and internal organs begin to shut down,” Evans said. “A child’s thermoregulatory system is not as efficient as an adult’s and the body temperature warms at a rate three to five times faster.”

Sharon became part of the Texas Heatstroke Task Force which formed in 2011 after a Safe Kids Worldwide meeting. The Task Force provides heatstroke prevention education.

“Our goal is to provide awareness about pediatric vehicular heatstroke to prevent these deaths from happening,” said Johnny Humphreys, Texas Heatstroke Task Force Chair.

How Everyone Can Help Prevent Pediatric Vehicular Heatstroke Deaths 

Evans says that everyone needs to be aware of locking their car doors, because some kids, especially those with special needs, think of the car as their safe haven.

“Some children with autism find comfort from the vibration of the car, so they may escape to an unlocked vehicle,” Evans said. “The problem is that sometimes they can get into the car but not out of it.”

Besides locking doors, everyone can be on the lookout for children left in cars. The Texas Good Samaritan Law allows you to rescue a child in a hot car if five conditions are met.

Tips for Parents and Caregivers of Young Children

Research shows the majority of people are in overdrive and functioning on autopilot. Be on alert if there is a change in routine such as dad dropping off the child at daycare instead of mom and proactively plan for it. Leave an important belonging such as a shoe or purse in the backseat by the child so you automatically go there before walking away from the car.

“I know some couples who text each other every morning after dropping off their child at daycare,” Humphreys said. “That way if one parent doesn’t receive their daily text, they can double check to be sure the child is OK.”

ACT – Prevention Method

Avoid heatstroke-related injury by never leaving a child alone in a car, not even during a quick trip into a store. Always lock your doors and trunks — including in your driveway or garage. If a child is missing, check the pool and water sources first, then check vehicles, including trunks.

Create reminders. Keep a stuffed animal or other mementos in your child's seat when it's empty and move it to the front seat as a visual reminder when your child is in the back seat. Or place and secure your phone, briefcase or purse in the backseat when traveling.

“One kind of memory is based on repetitive actions,” Humphreys said. “By using one of these methods every time you drive the car, it will become a habit.”

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

More info:

Good Samaritan Law in Texas for removing certain persons from a vehicle (texas.gov)

Burns are common during the hot summer days because the sun and its UV rays are a common source of sunburn that can develop quickly on exposed skin that is not protected by clothes or sunscreen.

Sun exposure is not the only source of burns in children, other culprits include thermal heat from hot appliances, stoves or hot liquids among others. Knowing the different types of burns that can occur can help determine the kind of care that is necessary.

• 1st-degree burns occur when skin turns red/pink but there is NO blistering. An example is a mild sunburn.
• 2nd-degree burns are when the outer layer of skin is burned and some of the dermis (deeper layer of skin) is damaged. This burn usually causes blistering and is painful.
• 3rd-degree burns are when skin appears charred or white. Both the epidermis and dermis layers are damaged usually with irreversible damage.

For minor burns care at home including the following is appropriate:

• Cool the burn by using cool water over the burn for a few minutes. Do not put ice directly over the burn and do not rub or break blistering as this can increase the risk of infection and worsen the injury.
• Cover the burned area with a clean bandage that will not stick to the burned skin. Do not apply anything to the burn site before discussing this with your pediatrician.

If a burn is blistered and swollen or covers a large portion of skin (larger than the size of a child’s hand) or involves the skin of the hand, feet, genitals or over a joint (elbow/knee/ankle) then a child should be seen by their pediatrician or in the emergency room.

When it comes to sunburns, prevention is key. Zinc oxide-based sunscreen is best for exposed skin and re-application if outside and exposed to the sun for a prolonged time is usually the best way to prevent sunburn. Covering skin with SPF clothes is another way to protect your child’s skin.

If you are worried about any burn, even if it seems minor then consulting your child’s pediatrician is always a good idea. 

As your family travels to the beach this summer, remember to include health and safety measures to ensure you and your children have the best vacation possible. 

Sunscreen often comes to mind, however, there are some other precautions to consider. Cook Children’s Medical Advisor for Digital Health, Dr. Diane Arnaout, M.D., shared helpful tips when preparing for the beach. She sees a variety of beach-related medical conditions each year and offers tips to avoid trouble.

Dr. Arnaout reminds us it only takes 15-20 minutes for a sunburn to form. Hence, it’s essential to apply and reapply sunscreen routinely and ensure all body parts are covered.

“Don’t forget the top of the ears -- that’s where I tend to see the most sun damage, especially in boys because they don’t have that hair covering their ears. I see lots of freckling and burned skin here,” Dr. Arnaout said.

Dr. Arnaout also talked about using shade and clothing, such as longer swim shorts and shirts to avoid harmful, cancer-causing ultraviolet (UV) rays. By doing so, we can protect our kids from day one. 

“Try to keep kids, especially under 6 months, completely covered with an umbrella or some kind of shade because they can burn much more easily,” she said. Parents should know, according to Dr. Arnaout, that you CAN put sunscreen on your child at that age, but doctors prefer an umbrella, with exceptions for their feet. 

Lifejackets & Riptides

When taking your child to the lake, lifejackets are commonly used for children. However, Dr. Arnaout observed that many parents do not think to bring a lifejacket to the beach.

“When we go to the beach, people will assume the kids will be playing in the sand without any danger, but kids can wander off and get swept into the water very easily,” Dr. Arnaout said.

Although riptides are not ordinary on the Texas coast, it is important to keep them in mind. Dr. Arnaout shares some tips in the event your child runs into riptides. 

“Especially older kids, if it’s dragging them, do not fight it, but let it take you in the direction it needs to,” Dr. Arnaout said. “You can tire out easily trying to fight a riptide.”

Skincare & Jellyfish Stings

We’ve all seen it in the movies, TV shows or heard stories of someone peeing on a jellyfish sting, so surely that’s the way to cure one, right? Contrary to popular belief, that is false, according to Dr. Arnaout. 

Dr. Arnaout shares that peeing on a jellyfish sting is only a myth. It might make the sting worse. The most effective treatment is vinegar. However, there are other things you can do if your child is stung by a jellyfish. 

“The tentacles of jellyfish have these little stingers that can get stuck in your skin. One of the best and immediate things you can do is go back in the water and a lot of them will wash off. You don’t want to rub it off, but you can take a credit card and gently scrape the stingers off, ” she added. 

Last but not least, it’s time to talk about skincare and gentle clothing at the beach. Be aware of mesh lining and life vest straps, which they can harm the skin.  Dr. Arnaout says she has seen many instances where the mesh lining or buckles from lifejackets irritate private parts, especially for boys. It is important to be aware of the materials inside your children’s swimsuits. 

“I think it’s not well known that the mesh lining of these suits or even the straps that go down in that area can be super abrasive and can cause a lot of chafing and a lot of pain,” Dr. Arnaout explained.

While you’re having fun by the pool this summer, ensure your pool safety plan includes a Water Watcher: an adult who is designated to watch children around the pool at all times. Drowning is silent, so it’s vital to designate a Water Watcher when children are around all bodies of water - swimming pools, kiddie pools, lakes, or the beach. Kids can drown in just 2 inches of water.

Cook Children’s created a wearable Water Watcher tag to ensure that the adult wearing the tag is in charge of watching the children in or near water. Fifteen-minute shifts are recommended for the Water Watchers. During that time, the designated Water Watcher should have no distractions, this means no phone, magazines, books, eating, alcohol or conversing with friends. The only time a phone should be used is during an emergency to call 911. After 15 minutes, pass the tag to the next adult in charge.

Cook Children’s Medical Advisor for Digital Health, Diane Arnaout, M.D., explained the importance of having an assigned adult at all times, especially now that summer is in full swing and social gatherings are held around bodies of water.

“I have a pool myself and we love to have friends over," Dr. Arnaout said. “It’s so easy to talk yourself into thinking your children are being watched when you’re in a group of 12 people because six adults certainly seem like more than two adults watching the kids, so certainly it’s more secure. But the problem is it’s actually less secure.”

Dr. Arnaout also noted that it does not have to be the official Cook Children’s tag, yet the rules remain the same. People can use a rubber band, bracelet or a hair tie as a substitute.

“By using the Water Watcher tags, it basically says the wearer of this does not play on their phone, does not drink, does not talk to other friends at the time - their sole job is to watch children at all times,” Dr. Arnaout said. 

Water Watchers add an extra layer of protection to prevent children from drowning. Swimming lessons are just one layer of protection and do not guarantee safety. Even strong swimmers can drown, so always designate a Water Watcher.

Other extra layers of protection include maintaining barriers to and around the pool, keeping pools clear of toys attractive to little ones when not in use, having a designated water watcher and wearing a life jacket.

A Water Watcher tag can be found in many of Cook Children’s pediatrician offices. Call your pediatrician to get one to use next time you're at the pool. You can also reach out to the Lifeguard Your Child department and one will be mailed.

When wearing the Water Watcher tag, you have one job and one job only - Lifeguard Your Child. 

To get a Water Watcher tag of your own, send an email to safe.kids@cookchildrens.org or follow this link: Water Safety Product Order (jotform.com)

It’s never too early to teach children to be safe around water. After all, if a baby can crawl, they can make their way to a pool or open body of water. Any number of things can lure them there — a floating toy or sheer curiosity as they naturally explore the world around them. Whatever the reason, the result could be deadly. 

The American Academy of Pediatrics says children as young as 1 year old can benefit from water competency training, which is teaching kids to understand the danger water poses, how to avoid it and how to survive should they find themselves in water alone.

“I think the No. 1 thing that water competency gives a young child is confidence,” said Jillian Mitchell, a community health program specialist at Cook Children’s Medical Center. “If a child falls in unexpectedly they are in a situation that might induce panic, but being water-competent is having the confidence to know what to do to survive.”

While most toddlers aren’t coordinated enough to learn traditional swim strokes, they can learn basic survival skills like surfacing, turning onto their backs to float with their head above water and reaching for the wall of the pool.  

Kelsey Strieby calls it aquatic problem-solving. She is a Certified Infant Swimming Resource (ISR) Self-Rescue® instructor and has taught hundreds of children water survival and self-rescue skills. 

“There are two components to this,” Strieby said. “It's the roll-back-to-float program and the swim-float-swim program. But the first priority is being able to float to survive.”

Survival Becomes Second Nature

As an ISR instructor, Strieby teaches infants and children to roll onto their backs and float if they fall into the water. After the child has been walking for a few months, they’ll advance to learn to swim, then roll onto their back and float, and swim again until they can grab the side of the pool. If they are in a larger body of water and cannot get to the side, Strieby teaches kids to survive by floating on their backs until help arrives. 

Her students don’t learn a specific swim stroke or even to tread water, but to use their natural movement, like when they are crawling or walking, to bring themselves to the surface. 

“Self-rescue is taught using muscle memory and each child’s unique muscle movement,” Strieby said. “So the kids actually simulate like they're walking or crawling through the water. We don't teach a specific movement of the hand or leg. We will guide them through how to move effectively in the water and reinforce that moving their arms is great, but how that arm moves or how that leg moves is specific to that child.”

Just like riding a bike, consistency and repetition with these skills promote muscle memory and competence. If the unthinkable happens, those trained responses kick in, giving little ones a chance to survive.

“We want their survival response in water to become second nature,” Mitchell said.

Children with special health, developmental and learning needs benefit from this approach, too, especially if traditional swim lessons are not a good fit for them or learning specific swim strokes is outside of their developmental abilities. Every one of Strieby’s students undergoes a health assessment that is reviewed by a nursing team before beginning lessons, so she can tailor her teaching to their particular needs. 

Choose Wisely

When it comes to finding the right water competency program for your child, Strieby encourages parents to do their research. A quick social media search of infant swim lessons will return all kinds of videos of very young children, even babies, seemingly learning to swim, but Strieby cautions that not all of these approaches are practical or safe. 

“We don't throw babies into the water and let them sink or swim,” she said. “Programs that claim they teach survival and show videos of them chunking children into the water—that should never ever happen in an ISR self-rescue lesson. It should be a guided, safe and gentle approach. I always tell people, if you are going to commit to doing a survival swim program, please do your homework and make sure it's a program with a certified instructor who has had quality training and that the program has safety protocols in place.”

Strieby’s lessons do include simulations of situations in which a child may fall into the water. They even practice survival skills in diapers as well as summer, fall and winter clothing because many drownings occur when kids are fully clothed and not expected to be near water. In 2021, over 60% of patients brought to Cook Children’s following a drowning incident were from accidents that occurred during an unplanned swim time.

Respect the Danger

Water competency and rescue skills also teach kids to have a healthy fear of water as they are introduced to the natural consequences of going into the water alone, like not being able to breathe and the hard work it takes to stay afloat. 

“Kids who learn to self-rescue learn that if they fall into that water and mom is not right there, they are going to be responsible for their own lives and getting their own air,” Strieby said. “As silly as it sounds, this creates a healthy boundary for many kids, because they don't want to have to do that hard work. They don’t want to have to use their skills unnecessarily.”

The majority of Strieby’s students are under the age of 4, but she does teach self-rescue to children up to six years of age. Once they master survival and self-rescue skills, some kids go on to traditional lessons with other programs to learn specific swim strokes. Either way, children who learn water competency and rescue skills from an early age are better equipped to survive a water-related accident. 

Even so, Mitchell cautions that swim and self-rescue lessons are not a replacement for the layers of protection needed to prevent children from drowning. Maintaining barriers to and around the pool, keeping pools clear of toys attractive to little ones when not in use, having a designated water watcher and wearing a life jacket are all important components of water safety, whether a child does or does not know how to swim. 

Violet Gomez admits she didn’t know much about water safety and drowning prevention when she had her first child nine years ago. It wasn’t until after the birth of her second child that she began to take the dangers of water seriously, thanks to a Cook Children’s Health Care System program she joined called the Water Safety Club.

“I never knew safety precautions and the steps to introduce my first son to water,” Gomez said. “I would just say, ‘Oh, he'll be fine.’ I would never really take him to a pool. So I really didn’t know what kind of safety steps I would have to take.”

The Water Safety Club is a drowning prevention program of Safe Kids North Texas - Fort Worth, led by Cook Children’s. It’s open to all and free to join. 

Now a mother of four, Gomez was introduced to the Water Safety Club through her kids’ Head Start program with Child Care Associates, a community partner of Safe Kids North Texas - Fort Worth. During a Head Start meeting that Gomez attended, a Safe Kids North Texas - Fort Worth representative talked about the club, the importance of water safety and how to prevent drowning.

After the presentation, Gomez signed up to learn more about how to keep her kids safe in and around water. She shared what she learned with her children and says they are now as aware of water dangers as their mother.

“For me, it's helped so much, and it's helped my son because he didn’t know at a younger age,” Gomez said. “I learned myself to be able to teach them what safety steps they have to do before even going in the water. I have learned how to introduce them to the pool.”

The club exists to generate awareness and ongoing conversations about water safety and how to prevent drowning.

“We want to make sure children are educated, and that parents are talking to their kids about having a healthy fear and an awareness of the water,” said Jillian Mitchell, a community health specialist at Cook Children’s. “Because if we're not talking about it, then kids don't understand what's OK and what's not OK”

Drownings are the No. 1 cause of death in children ages 1 to 4. Already this year, more than 50 children have been treated at Cook Children’s for drowning injuries. This is a significantly higher number than in recent past years during the same time period.

“Not all drowning incidents are fatal, but non-fatal incidents can also be devastating,” Mitchell said. “That's why we want to have these conversations over and over to help build awareness.”

Community partnerships, like the one with Child Care Associates, help spread the message of the Water Safety Club and provide membership access. Currently, there are about 2,000 members and some from as far away as Alabama.

In addition to education and information, Water Safety Club members also gain access to free or reduced-cost safety resources such as life jackets, bathtub kneelers, swim goggles, water safety lessons and CPR instruction. For her membership, Gomez received free life jackets for her children.

“Whenever we have gone to any pool I tell them to make sure you put your life jacket on first,” Gomez said. “They're like, ‘Can I go in the water? I'm just gonna put my legs in there.’ I'm like, ‘Nope. If your legs are in, you have to put on your life jacket because you don't know what can happen.’”

Gomez says she’ll continue to teach her children what she learns as a club member. She also encourages her family members and friends to join.

“I find it amazing because they've learned so much, and I want them to continue to learn so much,” she said. ‘I have invited other moms, friends of my daughter and my sons. I'm like, ‘Hey, you should learn more about this program. It helps you know what to do in case something happens or how to prepare before even taking your children to the pool.’”

Joining the Water Safety Club is easy. Click here to become a member, to view current membership incentives, to identify community partners, and to learn more about how to lifeguard your child. 

The Fourth of July is a time for celebration and getting together with family and friends. Cook Children’s experts are sharing safety tips and information to remember as people gather this weekend. Keep in mind that drowning is the leading threat for children, especially during the Fourth of July holiday.

In the emergency room, drowning patients are seen the most frequently and drownings most often lead to fatal outcomes, said Corwin Warmink, M.D., medical director of Cook Children’s Emergency Department.

“Keep a close eye on your child any time there is water nearby,” Dr. Warmink said. “People are often in large groups and let down their guard thinking that someone else is watching the kids in or around the water. They should identify an official Water Watcher who is responsible for keeping track of everyone.”

DROWNINGS

In June 2022, there were 19 drownings treated at Cook Children’s, none were fatal. Seventeen of those children were 5 years old and under.

• In June 2021, there were 22 drownings, one was fatal.
• In June 2020, there were 8 drownings.
• In June 2019, there were 13 drownings.
• In June 2018, there were 16 drownings. Three were fatal.

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

Many of the drownings so far in 2022 have occurred during unplanned swim time. This is when parents didn’t expect their child to be in or around the water.

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

Drownings can occur even with many adults present. When there are children around water, always designate a Water Watcher, an adult who is in charge of watching all children without any distractions.

Drownings on July 3 and 4:

• 2018: one drowning on July 3 and two on July 4
• 2019: four drownings on July 3
• 2020: one drowning on July 4
• 2021: one drowning on July 3 and one drowning on July 4

None of these drownings listed above were fatal, but parents and caregivers must remain vigilant.

Parents can also put barriers in place to help prevent a child from accessing the water or make it more difficult to access when an adult is not present. Barriers – such as locks, alarms and fencing – can help keep unsupervised young children from getting into swimming pools.

For more information and resource, including Water Watcher tags, visit: LifeguardYourChild.org

HEAT SAFETY

There are other threats during the Fourth of July holiday that can lead to severe injuries.

“Boating, jet ski and watercraft accidents are very frequent and often very tragic injuries. Burns from fireworks and cookouts are also very common,” Dr. Warmink said. “Snake bites and other bites are also common because a lot of people are outdoors along with very severe sunburns and heat exhaustion.” 

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

“Sunscreen is important and it should be reapplied every few hours. Drinking plenty of water and hydrating drinks throughout the day,” Dr. Warmink said.

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

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

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

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

FIREWORKS

Severe injuries from fireworks can be harmful and painful to a child. Even sparklers can heat up to more than 1,200 degrees and are dangerous for young children.

“Kids should not shoot off fireworks and they should be shot off in a ‘kid-free’ zone," Dr. Warmink said. "Keep kids away from grills and bonfires also.”

ATV SAFETY

Though often thrilling for children, off-road motorized vehicles — including all-terrain vehicles (ATVs), ATV mules, go-karts, and even golf carts — can be extremely dangerous for them to ride, especially if they don’t use safety measures once they get on board.

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

ATV Safety:

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

Whether your child is a beginner on training wheels or an expert on the stunt ramps, every bicyclist should consistently wear a helmet that fits snugly and buckles securely.

That’s according to the safety experts at Cook Children’s, where 81 patients were treated for traumatic injuries to the head or body from bike accidents in 2021. Another 93 patients were treated last year for traumatic injuries on scooters, skateboards, skates and hoverboards. Most reported they weren’t wearing a helmet.

National data show bicycle injuries tend to spike in June. The most at-risk population? Boys in the 10- to 24-year age group. More than any other sport or recreational activity, bicycling accounts for the highest number of visits to the emergency department for traumatic brain injuries, according to the U.S. Centers for Disease Control and Prevention.

Sharon Evans, trauma injury prevention coordinator at Cook Children’s, hears a variety of excuses from helmet resisters. Teens and children often don’t wear helmets because their parents don’t enforce the rule, she said. Or they think they’re invincible and won’t ever fall.   

“It goes back to ‘It won’t happen to me,’” she said. “For the most part, there are way more broken bones. But when they have a head injury, it’s bad.”

As director of Neurotrauma at Cook Children’s, Daniel Hansen, M.D. has seen skull fractures, severe concussions, brain bruising, and bleeding in and around the brain in bicycle riders who crashed without the protection of a helmet.

“These injuries very often involve kids going downhill and flipping over the handlebar and hitting their heads,” Dr. Hansen said. “We do have the unfortunate instance where we have some auto versus bicycle accidents, but it’s usually children getting out of control going down a hill that was a little bit bigger than their skill level.”

Dr. Hansen pointed out that helmets are designed to absorb the force of impact when a cyclist’s head hits the pavement or other hard surface. If the helmet breaks in a bad fall, he said, it worked as intended.  

Helmets should be replaced if they’re damaged or if they’ve been in an accident, which could cause the interior foam to shift.

Cook Children’s is spreading the message, “Falls are Brutal. Protect your Noodle,” to educate North Texans about the importance of wearing the right-sized helmet. A helmet that fits correctly will feel snug but not uncomfortable.  A few other key points:

• Helmets that passed federal safety standards in testing will say “U.S. Consumer Product Safety Commission certified” on the label.
• Helmets should be worn in a level position just above the eyebrows.
• If the helmet rocks backward and forward or side to side, adjust the straps. No more than two fingers should fit under the buckled chin strap.    
• Never ride without a helmet.

Dr. Hansen said his three children have been trained in the helmet habit.  

“Start your kids off early with the idea that it’s just part of what you do when you’re on a bike, and it’s not an option. It’s not an accessory. A helmet is part of the bike,” he said.

“Helmets might seem at times like an inconvenience, especially in the hot Texas summers. They might sometimes seem like an unnecessary expense,” he said. “But when you’re thinking about the value of a child’s life or the expense of a hospital admission or the inconvenience of recovering from a bad head injury, it’s really a very small price to pay to keep someone you love safe.” 

If a child takes a bad fall, Dr. Hansen said, parents should watch for signs of head trauma. The child might be inconsolable from pain; unable to move normally or to say what happened; lose consciousness or appear to have a seizure. Call 911 if you’re concerned.  

Most patients recover well from head injuries after bicycle accidents, he said. But lingering effects can include restrictions on sports activities, weakness, memory problems and speech difficulty. 

“We certainly see a couple of kids a year who are pretty devastated from their falls,” he said.

Evans hopes helmet use someday becomes as automatic and widespread as seatbelts. Cook Children’s has given away more than 250 free helmets to hospitalized patients and at community events in collaboration with the Fort Worth Fire Department and Fort Worth Firefighter Charities.

For more information, go to Bicycle Safety (cookchildrens.org)

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

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

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

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

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

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

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

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

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

2022 Hot Car Deaths | KidsandCars.org

But what about during summer break, when there’s no recess or PE teacher to organize their workouts? How can parents motivate kids of all ages to stay physically active during the hottest months of the year?  

The experts at Cook Children’s recommend making exercise a routine part of the day for the whole family. Aim for a variety of fun and simple ways to get everybody up and moving. Games that involve physical exertion – anything from playing tag, to jumping rope, or throwing a baseball – can strengthen the body and boost the mood.

At every well-child visit, Christina Sherrod, M.D. talks with her patients at Cook Children’s Pediatrics Southlake about the importance of physical activity for improving sleep, protecting against heart disease, preventing obesity and other health benefits. Dr. Sherrod encourages parents to be especially intentional about making exercise a priority during the months when school is out.  

The best strategy to get children and teens off the couch, she said, is to do sports or other activities together. Go outside during the cooler morning and evening hours.

“Join in with your kid doing physical activity in a way that’s fun, and they don’t even realize they’re getting exercise while they’re doing it,” Dr. Sherrod said.

As a mom to 9 and 7-year-olds, Dr. Sherrod speaks with experience about favorite ways to burn energy with kids in the summer. Her family likes to swim, throw water balloons, run through the sprinkler, and kick around the soccer ball. Do what you enjoy, she advises.

“For people who didn’t care for P.E. class, when they think of physical activity it sounds like a negative,” she said. If going for a 30-minute run doesn’t sound appealing, she suggests to her adolescent patients that they walk the dog, stroll around the mall, go on a hike, sign up for a dance class, or try yoga.

Dr. Sherrod wants parents to know that their own example of regular exercise can inspire their children and teens. Also, screen time should be limited. Too much TV, computer games and scrolling on social media contribute to a habit of sedentary choices.

The American Academy of Pediatrics (AAP) recommends 60 minutes or more of exercise for children and adolescents each day. Benefits of regular physical activity include building strength in muscles and bone density, more flexibility, improved coordination, leaner body mass and increased stamina. Physical activity also helps promote self-esteem and psychological well-being.

The AAP provides this exercise guidance:

• The emphasis for preschoolers should be on play. Motor skills such as hopping, climbing and skipping help young children develop coordination and balance. “Engaging young children in structured and unstructured play promotes the joy of movement, a sense of control and the ability to navigate the body through space.”
• For older children and teens, include moderate or vigorous aerobic physical activities such as dancing, bicycling and basketball. Focus on skill development more than the competition.
• Encourage children with special health concerns to participate as much as they’re able, allowing for adaptations that create a positive experience. 
• Guard against sunburn, heat exhaustion and dehydration by taking precautions outdoors in the summer. Use sunscreen. Drink lots of fluids.

Todd Johnson, M.D. at Cook Children’s Pediatrics Allen highlighted the role of exercise in developing resilience, mindfulness and the ability to manage stress. Physical activity can also build self-confidence and social interaction with peers, Dr. Johnson said.    

He points out that exercise can be incorporated into everyday life, including chores and responsibilities around the house. 

“Sometimes we think physical activity is something that has to be structured and complex, and there are too many moving parts, and we get discouraged,” Dr. Johnson said. “But it can be as simple as planting flowers together, pulling weeds, riding bikes.” 

The recommended 60 minutes can occur throughout the day in smaller increments. Eating and sleeping habits tend to improve when children and adolescents get regular exercise, he said. 

“It helps teenagers with their energy levels. It spaces out eating so that they have better hunger cues. They’re better at drinking water when they’re out and active in the summertime, and it’s easier to structure a normal bedtime.”

The father of seven children – ages 21, 18, 15, 12, 10, 6, and 3 – Dr. Johnson sees a wide range of interest and ability when it comes to physical fitness. His older children prefer team sports and camps while the younger ones enjoy parks and zoos. As a general rule in the Johnson household, everyone goes outdoors to kick balls, shoot baskets, swim or do other activities before they get on their electronic devices.  

Dr. Johnson urges families to explore local parks, museums and hiking trails not only as an exercise outing but to create happy memories and traditions. His own kids made a bucket list that includes kite flying and miniature golf.  

The bottom line is to help students stay in shape over the summer … play active games, aim for an hour daily, and set boundaries on phone/computer use. Dr. Sherrod emphasized the fun factor and simplicity of hide-and-seek or soccer in the yard.

“Parents tend to know the importance of exercise, and kids seem to be aware as well. But all of us need reminders to stay on track and continue healthy habits,” she said. 

With the beginning of summer well underway, I have seen many kiddos in the office with a very typical summer rash. It’s a rash that usually appears on the hands, feet, and around the mouth, giving it the name Hand, Foot, and Mouth Disease (HFMD). It’s caused by a group of enteroviruses that are common in the summer months. While this big group of viruses can cause more serious illnesses, this presentation of illness is typically mild and commonly infects infants and toddlers. While it can affect older children and adults, it is less common and these individuals typically have milder symptoms of the disease, if any. 

The most common symptom of HFMD is the rash for which the disease is named. The rash usually begins as tiny little red dots that get bigger and then look like small blisters. The areas that are typically affected include the skin around the mouth, mucous membranes inside the mouth (including tongue/back of throat), hands (including the palms) and feet (including the soles), as well as buttock and diaper area.

Other symptoms of HFMD include fever, runny nose and sore throat. Like all other viruses, treatment involves supportive care and caring for symptoms, including the use of fever-reducing medications as well as pain control. While rash is typically not bothersome or painful, the lesions in the mouth can cause sore throat or mouth pain. There is no particular treatment necessary for the rash, as it will typically self-resolve within two weeks. It is important to watch for any spots that look like they are oozing or not healing well because secondary bacterial infections can occur. If you have any worries, call your pediatrician as we can usually diagnose this by examining your child and getting a history of the symptoms. 

The family of Michael Stuyvesant knows he beat the odds on a hot June day six years ago when he survived being accidentally left in the mini-van parked outside their Garland home.

Michael, 3 years old at the time, experienced brain swelling, seizures and other trauma caused when his body overheated. He was hospitalized for 10 days – three of them in intensive care – and then spent almost a month in a rehabilitation facility. Michael had to relearn skills such as walking, eating and playing.

His father says Michael still deals with short-term memory loss. But the Stuyvesants count themselves lucky that he didn’t die in the accident. On average, 39 children in the United States suffer fatal injuries every year from what’s known as pediatric vehicular heatstroke, a tragic and preventable danger. Four children have died so far in 2021 as of mid-June.

Eric Stuyvesant wishes his vehicle had been equipped with a device to remind him that Michael was asleep in the car seat that day in 2015. Some type of alarm “would have saved a lot of anguish, tears and heartache,” he said.

Legislation introduced last month in the U.S. Congress would require automakers to install technology that detects a backseat occupant, and then alerts the driver. The Hot Cars Act would make the technology a standard safety feature in every new passenger vehicle. The legislation calls for sensors and warning systems in an effort to protect unattended children and pets.

Here’s an example, a rear-seat reminder: If someone opens and closes a car’s back door within 10 minutes of starting the ignition, an alert will activate later whenever the vehicle shuts off. The alert chimes and a message on the instrument panel tell the driver to check for backseat riders. Supporters of the Hot Cars Act draw comparisons to other technology mandated over the years for auto safety, such as seatbelt reminders and levers for emergency release in trunks.

Chad Hamner, M.D., pediatric surgeon and trauma medical director at Cook Children’s, believes in the potential benefit of such devices whenever parents and caregivers unintentionally leave their little passengers behind.

 “It’s not a sign that you’re an unintelligent person or forgetful. It just happens,” Dr. Hamner said. “We get in a routine or we’re thinking about other things. It’s natural human behavior.”

When it comes to excessive heat, infants and young children are particularly at risk. Their bodies heat up five times faster than an adult in the same environment as a result of a larger surface area relative to body mass for heat exchange with their surroundings. Infants are at exceptional risk as they also have an immature temperature regulatory system.

What happens during heatstroke? Dr. Hamner said profuse sweating leads to loss of water and electrolytes, which can rapidly produce dehydration. A severely dehydrated child can’t maintain adequate blood pressure to support the delivery of oxygen and nutrients to their vital organs. According to Dr. Hamner, eventually heat stroke results in cardiovascular collapse and damage to muscles, the kidneys, the intestines and the brain. In the emergency department, the staff works fast to bring down the body temperature and replace lost fluids and lost electrolytes.

 Symptoms of hyperthermia include rapid pulse, shallow breathing, flushed skin, high fever, vomiting, dizziness, confusion and loss of consciousness. Organs start shutting down when the body core temperature reaches 104 degrees, said Sharon Evans, trauma injury prevention coordinator at Cook Children’s.

“Usually by the time the child is found (in a hot car), they‘re dead. They rarely even make it to the hospital,” she said.

Texas leads the nation in the most fatalities, with 132 since 1998, including five last year. Evans said public awareness campaigns in the state have made a difference. But she also favors the implementation of more technology, such as devices that detect motion or breathing in the back seat. She supports the Hot Cars Act.

Experts want caregivers and bystanders to know: 

1. Never leave a child unattended in a vehicle, not even for a second, even with the windows cracked and the air conditioning on.
2. Create a habit of checking the back and front seats before you walk away from the vehicle.
3. As a reminder, place something essential -- your purse, briefcase, shoe or other personal items -- next to the child during the drive.
4. Teach your children that a vehicle is not a play area. Keep the doors locked, even if the car is in the garage. Keep the keys out of reach.
5. If you see a child alone in a car, try to get him out. Call 911.

State law in Texas gives liability protection to anyone who forcibly enters a locked vehicle (by breaking a window, for instance) to reach a vulnerable person inside who faces imminent harm. State law also protects the confidentiality of anyone who calls to report suspected child abuse or neglect.

Statistics kept by the advocacy groups KidsandCars.org show July as the deadliest month for pediatric heatstroke. Even in milder weather, the temperatures inside a vehicle can quickly climb to a hazardous level. Studies found that in just 10 minutes a car’s internal temperature rises 19 degrees. To put it another way … 80 degrees outside, but a sweltering 99 degrees for anyone inside the vehicle.

KidsandCars.org keeps track of pediatric vehicular heatstroke in three main categories: A caregiver forgets the child (55% of cases), the child gets into the car on his or her own (26%), and someone leaves the child in the car deliberately (14%). A common thread in many instances is a deviation in the family’s routine on the day of the accident.

That’s what happened to the Stuyvesants on June 10, 2015. Eric Stuyvesant normally dropped off Michael at daycare and then drove his wife Michelle to work. But this particular day, to get Michelle to work earlier, he drove her to the office first with the intention of stopping off at daycare on the way back. But the phone rang, autopilot kicked in, and he forgot about Michael.

“I drove down to my regular exit, drove home, finished my phone call, went in the house and cooked my breakfast,” Stuyvesant said. “About 45 minutes later I remembered we hadn’t been to the babysitter.” He found his son “barely hanging on.”

He rushed Michael into a cold shower, gave him mouth-to-mouth resuscitation and put an ice pack on his carotid artery while waiting on paramedics to arrive. At the hospital, doctors put the boy into a coma to reduce swelling in his brain. Recovery wasn’t easy.

Stuyvesant and others emphasize that heatstroke accidents can happen to anyone. Because of what his family went through, Stuyvesant now makes the case for all new cars to come equipped with the features that the Hot Cars Act endorses.

“If we have technology in our vehicles that remind us that our cell phone is plugged in, our headlights are on, our turn signal has been blinking for awhile, we ought to have technology that remind us we forgot where we are and we need to turn around and go to the babysitter.”

“You don’t typically have two viral epidemics at the same time,” Dr. Whitworth said. “We’ve never had an RSV outbreak in June.”

Dr. Whitworth says the medical center began to see RSV patients in early May. Over the last few weeks, there has been an increase in RSV patients and the number is rising each week.

“The numbers reflect inpatient and outpatient testing done at the medical center,” Dr. Whitworth explained. “It looks like we could have an RSV season ahead of us at an unexpected time of year.”

According to Dr. Whitworth, RSV is a very common respiratory virus that we all get every one or two years throughout our lifetimes. The first time you get it, you might be sicker and some children require hospitalization, but most do not. In infants younger than six months, RSV infection may result in symptoms of irritability, poor feeding, lethargy, and/or episodes where they stop breathing with or without fever. In older infants and young children, a runny nose and decreased appetite may appear one to three days before cough, often followed by sneezing, fever, and sometimes wheezing. Symptoms in adults are typically consistent with upper respiratory tract infections, including runny nose, sore throat, cough, headache, fatigue, and fever. RSV can be a very serious illness for anyone who is immunocompromised. But for most children, it is a minor upper respiratory infection.

“The virus is spread by respiratory droplets and can be spread from person to person very easily,” Dr. Whitworth said.

If parents begin to see any RSV symptoms in their child, Dr. Whitworth says it is important to keep them well hydrated.

“They can use Tylenol if they have a fever,” she said. “Cough and cold medicines are not routinely recommended for children two years old or younger because of the side effects.”

She says if parents are worried that their child is having difficulty breathing, or if they are concerned that their child is lethargic, not eating or drinking enough, or irritable, they should call their primary care physician.

Dr. Whitworth says the most important thing to stress is, “RSV is common, and most children don’t require any treatment at all.”

This trend at Cook Children’s is a part of a larger RSV outbreak across the South. Late last week, the Centers for Disease Control and Prevention (CDC) issued a Health Advisory Network warning to health care providers to be on alert for the virus.

Important to note:

Cook Children Urgent Care facilities do NOT test for RSV. Please discuss any questions with your child’s medical team.

But, driving to work the last few weeks and seeing all the standing water already starts to make my skin itch. Mosquitos are on the way. And I suspect it’s going to be a terrible year.

Mosquitos can cause a variety of problems:

1. Simple itching and discomfort-small bites which can lead to infection when scratched
2. Large local reactions-which can be very itchy, even quite painful (See more at Skeeter Syndrome).
3. Serious systemic illness such as West Nile Virus, Zika virus or Chikungunya.

But our kids don’t have to suffer. There are great options for preventing mosquito bites and warding off some of these miserable consequences.

DEET

N,N-Diethyl-meta-toluamide sounds like a little bit of a scary name for a chemical we can put on babies as young as two months. But DEET has been extensively studied and consistently shown to the safe and effective as a mosquito repellant in children. Recommended concentrations of 10-30% provide great protection with 30% lasting around five hours.

Picardin or Lemon Eucalyptus Oils

Multiple alternatives to DEET have been tried. Studies have shown that these two alteratives can be as effective as 10% DEET and thus last around two hours. Reapplication will be important if there are plans to be outside longer than two hours.

Here are some important facts about applying insect repellant:

1. Spray a thin layer over clothes and exposed skin. Thick layers do not make it more effective.
2. Use your hands to apply repellant to the face rather than directly spraying.
3. Spray in open areas to avoid ongoing inhalation.
4. Assist young children with application to ensure coverage and safety.
5. Avoid combination sunscreen products because reapplication of sunscreen needs to be done more frequently.

Having a healthy and fun summer should include TONS of outdoor play. Keeping your child safe from mosquitos is one part of making sure nothing spoils the fun.

Read more: 

'Skeeter Syndrome': Is My Kid's Bug Bite Infected?

An Infectious Disease Pediatrician Explains Differences and Similarities between West Nile and COVID-19

Everything You Need To Know About DEET and Protecting Your Kids From Mosquitos

Why Do Mosquitoes Bite Me and Not You?

 Chiggers Myths Parents Need To Know

There were only five juvenile drowning deaths in all of 2017, according to Tarrant County Public Health spokesman Kelly Hanes.

Read the full story here.

As Chief Administrative Officer at Cook Children's, Keith Holtz knows the value of experience in the workforce.

As a father, Holtz understand the importance of that first summer job.

"The first job offers such valuable life lessons for a teen," he said. "It builds confidence, self-esteem and financial independence. It also helps teach fiscal responsibility and the value of being accountable, reliable and dependable. I'm sure we all remember our first bank account and the tremendous sense of pride we had, regardless of the amount we had to spend after that first paycheck."

As your teen, searches for a summer job, ensure he or she considers summer extracurriculur activies too, such as sports, band or dual enrollment college programs. Be sure to discuss the commitment these activities require and decide as a family on your child's summer priorities. All these important activities can impact both the hours your teen can work and the amount of rest he or she can still get.

The first job can be initimidating for a teen. And while the job may eventually help with your child's confidence, Holtz advices parents to support thier kids as they search for work and beyond.

"Your child may look to you for guidance when preparing for their job search," Holtz said. "Help them to create a resume, look for work and guide them through the interview process. But be there too for them throughout the summer too. Ask them how the job is going and ask if they have questions. Then, after the summer job, ask them what they learned and then talk about ways they could improve next time."

But are they ready for the hottest part of the year?

Locally, the National Weather Service has issued a heat advisory that remains in effect until 8 p.m. Saturday. Daily temperatures will range between 94 to 102 degrees, with a heat index between 105 to 109 degrees.

So while you don't want your children to waste their summer vacation away playing video games inside, warm summer temperatures can lead to more than just a sunburn. Being outdoors in the heat for too long can pose a heat-safety risk.

Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children's, says eight kids have been treated in the ED this summer with a chief complain of heat related illness.

"As the outside temperature rises, your family's risk of heat stroke rises right along with it," Dr. Warmink said. "On 100-degree days, it's best to stay inside when it gets that hot. If temperatures exceed 90 degrees, stay in the shade and keep an extra eye on the kids."

Children today are spending increasing amounts of time in air conditioned environments, lured indoors by the constant upkeep of social media accounts and online gaming. One study of nearly 9,000 U.S. children, ages 3 to 5 years old, found that only half were taken outside by their parents on a daily basis to walk or play.

"The more you're out in the heat, the more your body gets used to it, or 'acclimatizes,'" Dr. Warmink said. "Children who are always inside are more prone to heat exhaustion and heatstroke than those who are frequently outdoors and active."

Play it cool

But don't mistake what Dr. Warmink is saying. Too much time out in the heat can cause heat-related illnessess such as heat exhaustion and heatstroke.

Lack of acclimatization has led to an uptick in heat illness among children in recent years, according to Dr. Warmink. Most incidents occur during the first two weeks of school athletics training when kids begin cross country, football, cheerleading or band practice.

"More is being demanded of young athletes during the late summer months," Dr. Warmink said. "Kids who spend all summer indoors and then go out for training in August are setting themselves up for heat illness."

Staying safe

Symptoms of heat exhaustion include flu-like symptoms such as paleness, sweating, nausea and vomiting. Signs of heatstroke include hot, red and dry skin, as well as confusion, vomiting, rapid heart rate, decreased sweating, shortness of breath, decreased urination, increased body temperature (104 to 106 degress Farenheight), or convulsions.

MedStar reminds us that heatstroke and heat exhaustion are common this time of year, but they can be easily prevented:

• Hydrate: Drink plenty of water during the day, especially if you are engaged in any strenuous activity. Sports drinks are a good choice if you're exercising or working in hot conditions, but water is a good way to hydrate as well.
• Ventilate: Stay in a place where there is plenty of air circulating to keep your body cool. If you are indoors and don't have access to air conditioning, open windows and use a fan.
• Cover Up: Wear light-colored and loose-fitting clothing to avoid absorbing the sun's light and trapping heat. Wear a hat to shield yourself from the sun, but once you feel yourself getting warm, remove any items covering your head which can trap heat close to your body.
• Limit Activity: Heatstroke can occur in less than an hour when you are participating in strenuous activity during a hot day. If you feel yourself getting hot or light-headed, stop your activity and rest in a cool place out of the sun. Be sure to drink water or a sports drink before, during, and after any strenuous activity.
• Check on Loved One’s: MedStar reminds families to make sure that your child's grandparents are OK. The elderly are especially vulnerable to heat related emergencies. Many elderly residents are not aware of how hot it may get in their residence. Call on older friends and family members regularly to assure they are doing OK.

About the source

Corwin Warmink, M.D., is the medical director of Emergency Services at Cook Children's. Cook Children's Emergency services are available 24 hours a day, seven days a week. Cook Children's Emergency Department (ED) treats more than 105,000 patients every year. Our ED is the only EMS-designated pediatric trauma center in Tarrant County. 

According to noheatstroke.org, 32 children have died in the U.S. as a result of being left in a car. In all of 2015, 24 kids died.

On Sept. 21, 2016, a 7-month-old baby died in a hot car in Huntsville, Ala. The temperature was 94 degrees. The following day, a 4-month-old child died in Geronimo, Okla. The temperature at the time was 96 degrees.

As anyone who lives in a state like Texas can attest, summer-like temperatures can occur even in winter. But it doesn’t take a scorching hot day for a child to be in danger. Heatstroke deaths have been recorded in 11 months of the year in nearly all 50 states.

“It truly doesn’t have to be a ‘hot’ day in Texas for a death to occur,” said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County coordinator. “The temperature inside a vehicle can quickly climb over 20 degrees hotter than outdoor temperature. So even a cool day in Texas can become dangerous very quickly. Since children’s body heat rises three to five times faster than adults, it’s important to know that temperatures can become deadly any time of year.

Heatstroke, also known as hyperthermia, is the leading cause of non-crash, vehicle-related deaths for children. It occurs when the body isn’t able to cool itself quickly enough and the body temperature rises to dangerous levels.

Young children are particularly at risk as their bodies heat up three to five times faster than an adult’s. When a child’s internal temperature gets to 104 degrees, major organs begin to shut down. And when that child’s temperature reaches 107 degrees, the child can die.

Because of this, and because cars heat up so quickly – 19 degrees in 10 minutes – tragedies can happen faster than you think. Symptoms can quickly progress from flushed, dry skin and vomiting to seizures, organ failure and death.

“We still have to get the word out that there’s never a safe time to leave your child in the car,” said Sharon Evans,Trauma/Injury Prevention coordinator at Cook Children’s, said. “We’ve seen children die in February. We hope people will take extra precaution in never leaving a child in the car.”

Safe Kids Worldwide says that heatstroke is the leading cause of non-crash, vehicle related deaths for children and that young children are particularly at risk as their bodies heat up three to five times faster than an adults’.

It’s hard to imagine someone forgetting a child is in the car, but human error, and people make these mistakes during their busy day-to-day lifestyle. Safe Kids recommend the “ACT” method to prevent tragedy to your child or to a child you see left in a car:

• A: Avoid heatstroke-related injury and death by never leaving your child alone in a car, not even for a minute. And make sure to keep your car locked when you’re not in it so kids don’t get in on their own.
• C: Create reminders by putting something in the back of your car next to your child such as a briefcase, a purse or a cell phone that is needed at your final destination. This is especially important if you’re not following your normal routine.
• T: Take action. If you see a child alone in a car, call 911. Emergency personnel want you to call. They are trained to respond to these situations. One call could save a life.

For more information

Cook Children's partners with the community to raise awareness and meet learning needs centered around injury prevention and child safety equipment. Read more about it here.

But whether it’s a long cross country trip in the car, boarding a plane or a day at the pool, soon you will hear tummies rumbling. Snack time! Snacks are meant to fill empty tummies just a little bit so they can make it to their next meal. But, what is a “healthy” snack?

Snacks should be less than 200 calories unless otherwise stated by your doctor or dietitian. They’re small, so make them count! When you pull over at the convenience store, look for nutrition-packed foods that have protein, fiber, and vitamins. This helps keep everyone happy on the road until dinner time, and gives your child nutrients they need to grow.

With all of the snack options out there, it can get confusing! So here is a short list of unhealthy and healthy snacks.

Unhealthy snacks:

1.Snack Cakes or Cookies

Despite their name, “snack” cakes and cookies are desserts, not snacks. These provide “empty” calories from sugar, meaning they provide energy but very little nutrition.

2.Candy or Candy Bars

Don’t be fooled by commercials! Eating a candy bar doesn’t help fill your child’s tummy. The high sugar from these items can make some kids feel sick if they’re eaten on an empty stomach.

3.Ramen Noodles

This includes Cup ‘o Noodles as well. One package of ramen noodles contains two servings, enough calories for a meal, and a day’s worth of salt. Yikes!

4.Chips

Takis, Doritos, and Hot Fries! Oh, my! These little fried chips give a lot of salt and unhealthy fat, but very little nutrition. This means your child is left hungry and going to the pantry for another snack a little while later.

5.Fast Food Meals or Gas Station Fare

Snacks are supposed to be small. Fast food sandwiches, hot dogs, and similar choices are “meal-sized”. These extra calories can lead to unhealthy weight gain in many children. If drive-thru options are all that are available, choose a yogurt parfait, apple slices, or other healthy options instead of a full meal.

*We recommend washing down your snack with water or 1 percent or fat-free milk. Sodas, juices, and other sugary drinks are too high in sugar and don’t give very many nutrients.

Healthy snacks:

Pump up snack time with lots of nutrition! Protein, vitamins, minerals, and fiber all add up to a happy tummy and healthier child.

1.1 small apple with 1 Tablespoon peanut butter

2.Celery or carrot sticks with 2 Tablespoons of hummus or low-fat salad dressing

3.15-20 small pretzels with 1 low-fat cheese stick

4.3 cups of air-popped or 94% fat free popcorn

5.1 slice of whole-wheat bread with 1 piece of low-fat turkey lunch meat and mustard

There are many other healthy options out there as well. Want more information about healthy snacks? Ask your child’s provider or dietitian!

Happy traveling and healthy snacking!

About the author

Lauren Williams is a clinical dietitian at Cook Children's. Through medical nutrition therapy, a Cook Children's pediatric dietitian can help prevent and manage diseases that affect your child's health, fitness and overall well-being.Cook Children's has registered dietitians and dietetic technicians on staff to help with your child's nutritional needs from birth all the way through the teen years. Click here to request an appointment.

The statement from the city says "there is no reason to expect a widespread appearance of rabies, however it is extremely important that anyone exposed be identified and examined right away.If you know of a child who fits this description, please contact Ethel at Animal Services right away at 972.219.3478."

The staff at Cook Children's Infectious Diseases has treated its share of kids for rabies through the years, and bats are a frequent cause for rabies exposure. Infectious Diseases offers these seven helpful tips to protect them:

1. Rabies is a deadly disease. Spread of the disease occurs when the saliva containing the rabies virus is introduced into an opening on the skin, usually via a bit (or possibly a scratch) of a rabid animal.
2. If you have a suspected animal, whether it’s a stray or a family pet, it should be taken to the vet or animal control for a confinement of 10 days. If the person who has been exposed to the animal is immediately treated with the vaccine and the animal does not show signs of rabies, it will not have to be euthanized.
3. Bats are extremely dangerous. Not all bats have rabies, but most human cases of rabies in the U.S. are caused by bat bites.
4. If you aren’t sure you’ve been bitten, go to the doctor immediately. Bats are tiny and can leave tiny bites or scratches that humans may not even notice, until it’s too late. If you come in close contact with a bat, go to the Emergency department immediately.
5. If bitten by an animal, wash the wound with soap and water and seek medical care immediately.
6. Protect your pets and farm animals from rabies by making sure they are vaccinated. Talk to your veterinarian for more information.
7. Cook Children’s is prepared and experienced when it comes to caring for children and rabies. Cook Children’s has been very invested in making sure that the vaccinations are in stock. The caregivers are specialized in treating children, including Child Life specialists who can help the child throughout the process. Adult hospitals may not be equipped to treat pediatric rabies cases.

About the source

Cook Children's Infectious Disease is dedicated to providing excellent, patient-centered care, as well as access to the most up-to-date therapies and leading-edge clinical research.

"If it can accelerate your body, it can injure you," said Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children's. "Vehicular accidents, including boats, ATVs, cars, scooters and bikes are all too common on holiday weekends during the summer."

Another danger Dr. Warmink is concerned about this weekend: broken bones. No one wants to spend Labor Day weekend in the hospital. But Dr. Warmink says many families do, thanks to trampolines and monkey bars.

One of the scariest threats we see all too often is drowning. And yes, it can happen to you. In August alone, 14 children were admitted to Cook Children's Medical Center for drowning-related injuries. Two of those children died.

"We've seen many cases where children took their life preservers off and jumped back into the water," said Magdalena Santillan, Trauma Injury Prevention specialist at Cook Children’s. "Often, parents are getting ready to leave the pool and don't realize their kids have jumped back in."

One of the best ways to protect your child around the pool or lake is to become a Water Watcher. This means adults take turns supervising the water with undistracted attention. You can find more information about the program here, including 5 seldom used tips that could save a child's life.

And Labor Day may mark the unofficial end of summer, but that does not mean an end to the heat. According to Dr. Warmink, heat-related illness also tops the list of Labor Day dangers. "Heat exhaustion, heat stroke, hot cars and sunburns are among the common injuries we see over the Labor Day weekend," said Dr. Warmink. "Parents should make sure their kids drink plenty of water and wear sunscreen, and of course, never leave a child alone in a car."

With your help, we can cut the number of Emergency Department admissions this holiday weekend and ensure a safe celebration for everyone.

But summer doesn’t guarantee complete relief for kids with asthma.

“For most children, asthma tends to be better during the summer. This is mainly because there are less circulating viral infections in the community, which tends to be a big trigger for asthma flares or attacks,” Karen Schultz, M.D., a pulmonologist at Cook Children’s said. “During this time of the year, the biggest triggers are allergies and ozone days with poor air quality. In general, it is recommended that everyone avoids too much activity during orange or red ozone days, but this is particularly important for individuals with asthma or other respiratory conditions.”

Dr. Schultz said it appears that grass and elm pollen are in the medium range in Fort Worth, Texas, this time of year and that may be affecting the allergies of children with asthma. She thinks it’s a good idea for parents to download a weather app on their phone to keep up with the outside conditions.

As the school year gets closer, many kids will be starting activities such as band and/or athletics. Dr. Schultz advices parents and children with asthma to listen closely to their asthma symptoms such as coughing.

“It’s important for people to know asthma can happen during the summer,” Dr. Schultz said. “It’s best for children with asthma to practice or work out earlier in the day if possible. As school starts, more children will be outside with PE and recess. Many kids stay inside during the summer if they do not have structured activities. So they may not be used to the outside conditions. Also, we will start seeing more viral infections not long after school starts, so good hand washing is very important.”

About the source

Karen Schultz, M.D., is a pediatric pulmonologist at Cook Children's. To schedule an appointment with her call 682-885-6299. The Cook Children's Pulmonary team diagnoses and treats children with lung diseases. Our team includes board certified pediatric pulmonologists, clinical nurse specialists, registered nurses, respiratory therapists, Child Life specialists, clinical dieticians and social workers. The professional opinion of each team member, including parents, is considered in developing a plan of care for your child. We place a high value on continuity of care with your primary pulmonologist.

When I came home from the hospital with my new bundle of joy last fall, the first two weeks were filled with the tasks of survival – learning to feed my son, making sure he was growing appropriately, entertaining family and friends who wanted to meet him, catching a snooze here and there, and establishing a routine. After those two weeks ended and I had barely left my house, my next plan of action was: Operation Mama Sanity! I needed to get out!

Everyday in my office I have parents who ask me when they can take their newborn babies out and about, and get into the swing of life with their new child. My answer is always the same: now! But … with a few rules.

From day one it is absolutely fine to get out into the fresh air and go for a walk in the park, or in your neighborhood, if the weather permits.Try not to go out on extremely hot or extremely cold days, and as a rule of thumb, dress your little one in as many layers as you are wearing. Make sure the baby is not exposed to direct sunlight. Most strollers these days come with a nice shade for this purpose, or you can use an umbrella.

If you’d like to go out where there are a lot of people, like a busy restaurant, grocery store, or mall, I always tell parents to try to keep their infant’s seat completely covered by a light blanket.This serves a few purposes. First, a baby’s immune system before age 6-8 weeks is still immature. If someone at the next table sneezes or coughs, its best to have this protective canopy over them so viruses and bacteria are less able to come in contact with her. Also, it keeps the baby hidden as a deterrent to well-intentioned patrons from touching your sweet little one. As nice as that is, it’s best if people don’t touch your baby during those careful first weeks. 

If it’s holiday season and you and your new baby are expected at the family get-together, don’t fret. Just politely ask that everyone wash their hands before they hold her. If you’re too shy to ask them yourself – do what I tell my patients to do – blame me! Say, “My pediatrician says everyone has to wash their hands before holding her!”  This way no one can get their feathers ruffled. Carrying a small bottle of hand sanitizer and offering it to everyone is also a great and easy way to get germy hands cleaned. If someone appears to be sick and you don’t want that person to hold your baby at all, don’t. It’s Ok. You can blame that on your pediatrician too.

Don’t be afraid to go out with your new baby – she and YOU need it! Getting fresh air, exercise and social interaction in those first few months is vital to parents, and happy parents make happy babies. 

Hope my two cents help you muster the courage to venture out! And remember, many pediatricians have slightly differing opinions about these things, so it’s best to speak with yours if you have questions.

About the author:

Dr. Diane Arnaout joined the Cook Children's Willow Park practice in 2011. Dr. Arnaout was born and raised in the Dallas-Fort Worth area. She served as a leader on the medical education committees during her internship and residency in pediatrics at the University of Texas Health Science Center in the Texas Medical Center at Houston, Texas.

I’m sure many of you will take to the road, as those summer road trip plans will be in full force. Have you seen the prices of gas today? The daily average today is $2.59 a gallon and I know you too have felt severe pain at the pump. 

How many of my fellow frugal mom’s shop at Kroger, did you know you could earn fuel points just for buying groceries? When you shop at Kroger and use your Kroger plus card, you’ll accumulate fuel points each time you shop. Kroger matches one fuel point per $1 spent. 

If you redeem your points at Kroger gas stations, you can select the amount of savings you want from 10 cents up to $1 per gallon. You can also redeem fuel points at participating Shell gas stations within the state of Texas. Since grocery shopping is a never ending chore, why not shop at a store where you can spend for your family and receive savings at the same time!

For your convenience, please download a printable brochure from Shell and Kroger. See you on the road. 

http://s02.static-shell.com/content/dam/shell-new/local/country/usa/downloads/grocery/grocery-rewards-kroger-1-dollar-brochure.pdf

Janeen Walls is not affiliated, associated, authorized, endorsed by, or in any way officially connected with Kroger. This blog is meant for entertainment and informational purposes only.