Our hearts go out to the children and families affected by the recent floods in Central Texas, especially those at Camp Mystic and beyond. We understand many parents and loved ones are struggling to find the right words to explain this tragedy and console their children during this difficult time.

Kristen Pyrc, M.D., a mother and medical director of outpatient psychiatry at Cook Children’s, feels the weight of this weekend’s events both as a mother and as a psychiatrist. Dr. Pyrc shares her wisdom on how to navigate these difficult, heavy conversations with your children.

By Kristen Pyrc, M.D., medical director of outpatient psychiatry at Cook Children’s and mom of two sweet daughters

Yesterday was hard. I dropped off my daughter, Linden, at sleepaway camp with her bravest cousin, Evelyn. In light of the tragedy at Camp Mystic, there were many conversations and tears about whether to attend camp this week. Ultimately, both girls decided to attend. I am so proud of their strength and courage. I would have been equally proud of their self-awareness & honesty if they decided not to go. Many parents will have to navigate difficult conversations with our kids in the coming days so I put together some tips that will hopefully lighten your load a bit.

If you are concerned about how they will take the news, you should tell them. Other kids will be talking about it, and you want your kids to learn the news at home where they are safe to cry if they need to and ask questions. It is also important to impress upon them the sensitive nature of the matter. Encourage them to talk to an adult and not another child if they need to chat when they are away from you.

• Be factual when explaining what happened but shield them from harrowing details, wall-to-wall news coverage, or imagining what the kids went through. Their minds may go there on their own though.
• Survivor’s guilt is sneaky. Lots of kids will wonder about why this happened to other children and not them. Younger kids sometimes think they did something wrong to cause a tragedy to happen. In a few weeks, it may be good to check in about it (“Sometimes kids wonder why this happened to other kids and not them. Have you been thinking about that?”). Hopefully, it hasn’t come up for them, but it would be good to talk through if it has.
•  If they are grieving, give them something to do with their grief. I know this helps me. Could they pray, raise money, write letters, etc?
• Watch out for nightmares & intrusive thoughts. Sometimes kids tell me they can’t get thoughts out of their head, and it is very distressing to them.
• Reach out early to your pediatrician or mental health professional if you notice your kid is having trouble sleeping, not experiencing joy, spending a lot of time in their room, or just can’t turn their brain off. It is so incredibly hard to watch our babies suffer. I promise we want to help.
• I wish I had some magic words to take away our kids’ worries and sadness, but I don’t. The important thing is they have you, a parent who loves them beyond comprehension & is trying their best. I promise you that is good enough.

In March 2024, the Texas Health & Human Services Commission (HHSC) announced plans to deny contract renewals to several Medicaid providers, including three non-profit, Texas-based children’s hospital plans: Cook Children’s Health Plan (CCHP), Texas Children’s Health Plan, and Driscoll Children’s Health Plan. Despite their combined 60+ years of proven, high-quality care, HHSC intends to award the multi-billion-dollar Medicaid STAR/CHIP contracts primarily to publicly-traded insurers beholden to out-of-state shareholders.

On June 2, 2025, the clock will run out on the Texas Legislature to prevent the largest Medicaid upheaval in state history, costing Texans nearly 2,000 jobs and millions in tax dollars. Without immediate legislative action, at-risk families may lose access to pediatric specialists, leading to the loss of hundreds of local jobs. Furthermore, taxpayers might bear the burden of increased ER overcrowding and higher uncompensated care costs resulting from coverage gaps due to this disruption.

What’s at stake

•  1.8 million children and pregnant women across Texas would be forced to change health insurance plans if HHSC’s current award stands.
• 125,000 North Texas children, including as many as 10,000 medically complex kids who count on Cook Children’s Health Plan (CCHP) today. 
  •  Includes 170 children on ventilators who cannot afford a lapse in care and more than 1,700 children dependent on wheelchairs.
•  Texas stands to lose billions in taxpayers’ dollars if Medicaid and CHIP funding are redirected to out-of-state, for-profit corporations. This change will shift profits to shareholders across America, and away from reinvestments in local non-profit children's health plans based health care programs and access points throughout Texas. Don’t let these dollars leave Texas!
•  Three children’s hospital plans at risk: Cook Children’s, Texas Children’s, and Driscoll Children’s non-profit Health Plans swapped in favor of for-profit insurance companies, most of whom are out of state.

Economic Impact

Why non-profit children's health plans outperform for-profit insurance companies

• Texas-based, non-profit children's health plans pour their resources and earnings back into the communities they serve. These reinvestments build and strengthen communities across Texas.
• 107-year local legacy: Cook Children’s reinvests more than $200 million back into the community every year through community benefits and uncompensated care, not Wall Street dividends. 
• Nine neighborhood health centers (two opening this year) are placed in high-need ZIP codes at no additional cost to taxpayers. This keeps families out of emergency rooms for primary care needs. Cook Children’s funds $1 million annually for each center (total $9 million). Checkup Newsroom
•  Top-tier member satisfaction and quality metrics HHSC failed to consider in scoring the 2024 bids, prompting bipartisan criticism of a “subjective and unsound” procurement. AP News

The Solution:

Several bills have been filed in Austin, and officials are actively shepherding this cause.  We are hopeful there will be legislation finalized prior to June 2.

What’s the benefit of Texas-based, non-profit children's health plans?

• Local control of taxpayer dollars. Funds stay in Texas communities, not out-of-state shareholders.
• Free-market competition. Offers more consumer choice instead of narrowing it.
• Fiscal stewardship and ensures quality care. Maintains a proven, nonprofit plan with an integrated health system and a proven quality track record vs. paying corporate margins.
• Family values & self-reliance. Protects parents’ ability to choose trusted doctors and keeps medically fragile kids out of crisis care that drives up costs.

Additional Fast Fact:

• Cook Children’s Healthy Homes Asthma Program significantly improves the quality of life for families by remediating homes to eliminate asthma triggers and providing essential resources like cleaning supplies. To date, we have improved the home environments of 760 children living with asthma, including 314 health plan members.

SaveCookChildrensHealthPlan.com is a valuable resource packed with facts, articles, timelines, photos, member/patient stories, and more. Visit the website here.

“I knew about Cook Children’s, but I thought it was just for babies. I didn’t know they had a plan actually to prepare mothers,” Evans said. 

CCHP covers the health care of pregnant mothers and offers additional services. Chrystal Bryant, a high-risk maternity case manager at CCHP, calls Evans monthly to check in. Under the health plan, each high-risk pregnancy is assigned a case manager. 

“We ensure they have adequate prenatal care, that they’re going to their doctor’s appointments, and that they have their prenatal vitamins,” Bryant said. 

At four months pregnant, Evans was told her baby was measuring small. Doctors informed her that her daughter might need to spend time in the neonatal intensive care unit (NICU) at Cook Children’s Medical Center-Fort Worth. Although concerned, Bryant and her medical team helped put her at ease. 

“I have a whole dedicated team for her. It’s amazing,” Evans said. 

Maternal and infant mortality is a concern in Tarrant County. In 2024, the Tarrant County Maternal and Infant Health Coalition presented the city of Fort Worth with data showing Tarrant County had the second-highest maternal mortality rate among Black women in the state. 

“Cook Children’s Health Plan is committed to ensuring that all children in our community are safe and healthy, and that begins at conception,” Bryant said. 

CCHP understands this and focuses on ensuring mothers and children’s medical and essential needs are met. 

Members can earn gift cards, a car seat, and a portable crib by attending their prenatal and postpartum appointments and classes. 

“Cook Children’s Health Plan is unique because we are embedded in the community as a community plan,” Bryant explained. 

A former labor and delivery nurse, Bryant provides mothers with an added resource as she is able to answer questions and direct patients to the appropriate resources, such as transportation vouchers, rental assistance and food delivery. 

Evans said it makes a difference. 

“They make sure the baby has everything she needs to grow,” Evans said. As her nutritional needs increased, Bryant helped Evans get food boxes delivered to her home every two weeks. 

CCHP case managers are embedded in the community, enabling them to form relationships with organizations to help meet members’ needs. 

Meeting for the First Time 

Evans and Bryant, who had spoken on the phone for months, met in person for the first time in March. They shared a hug and began conversing as if they had known each other for years. 

Bryant asked Evans about her medical appointments and her mood. 

In December, Evans's mother died. Bryant became more than a caseworker; but a shoulder to lean on and encourage her. 

"Not only did she become my caseworker, but she also became my mental health caseworker," Evans said. Bryant helped her navigate her emotions. 

During the meeting, Evans shared that her daughter would be named Hazel, after her mother. She expressed her excitement about meeting her daughter. 

Evans showed Bryant a 3-D sonogram of Hazel, noting her resemblance to Evans’s fiancé. 

Bryant took notes as Evans discussed her recent doctor's appointment. Bryant accessed Evans's medical records to answer questions. 

They discussed nutrition, ensuring Evans was receiving nourishing foods. 

"She's concerned about the baby, but she's also concerned about me as well," Evans said. 

They also discussed baby items that Evans could get through classes.  

Chrystal let Evans know she could receive a bassinet for completing a Safe Sleep class hosted by Cook Children's Center for Community Health. 

Through other classes, she could earn a car seat and a gift card for other baby items. 

"They [CCHP] have a team of people willing to help me with a lot of things," Evans said. "They are helping me in the process of helping the baby grow." 

What’s at Stake 

CCHP helped Evans thrive during her pregnancy. She may not have received the support and resources under a different insurance plan, like the ones the state plans to fund instead.  

The current CCHP STAR and CHIP contracts will remain active through Aug. 31, 2025. At that time, families enrolled in CCHP will be forced to choose a new plan from four national, for-profit insurance companies – Aetna, Blue Cross Blue Shield of Texas, Molina, and UnitedHealthcare – three of which have no experience in our local market.  

Until then, CCHP will continue to appeal against the state’s flawed decision and work with all stakeholders to ensure that its members continue to receive the best possible care.  

For more information, including key facts, videos, photos, and recent media coverage, please visit SaveCookChildrensHealthPlan.com.  

In Texas, the partial eclipse will begin at 12:23 p.m. and end at 3:02 p.m. Totality will begin at 1:40 p.m. and last a total of four minutes, ending at 1:44 p.m. According to NASA, people should never gaze directly at the sun during a solar eclipse, even when it is partly or mostly covered by the moon.

We asked Cook Children’s experts how to best prepare for this historic event. Osaretin Aimuyo M.D., pediatrician at Cook Children’s Pediatrics Arlington and Michael G. Hunt M.D., Research and Education Director of Ophthalmology at Cook Children’s, advise parents on how to protect their family and their eyes.

"A total solar eclipse can be very exciting because it doesn't happen often and is a great opportunity to get kids excited about natural phenomena,” says Aimuyo. “It is possible to look directly at the eclipse, but it must be done with proper eye protection to prevent blindness or permanent ‘stamps’ of the sun on the eye. There are glasses with specialized filters designed specifically for viewing an eclipse. The American Astronomical Society publishes a list of vendors who sell ISO-certified eclipse glasses.”

Wearing solar eclipse glasses

Hunt explains that solar eclipse glasses are worn the same way you wear regular sunglasses. They can be worn directly over your regular glasses or contact lenses. However, Hunt emphasizes that you should not put them on or take them off while you are looking at the sun. “The simple order for using solar eclipse glasses is this: look away, put them on, watch the eclipse, look away, take them off.”

Hunt shares the safest way to use a pair of solar eclipse glasses:

1. Prepare your glasses by folding them into the correct configuration if needed.
2. While holding the glasses, stand with your body toward the sun, but look down.
3. Still looking down, put the eclipse glasses on.
4. Raise your head and look up at the sun - enjoy the eclipse.
5. Don’t remove your solar eclipse glasses if you are still watching the eclipse.

When can solar eclipse glasses be removed?

1. There is one situation where the glasses can be removed: during the totality phase of a total solar eclipse. This is when the moon has completely blocked out the sun and the sky is dark.
   1. With young children, it could be hard to have them remove and replace the glasses at just the right time. It is best to have them keep the glasses on the entire time they look toward the sun.
   2. With infants, it is safest for them to remain inside during the eclipse. If they are small enough to fit in a car seat or stroller with a canopy, you can safely have them outside. Be sure the canopy is drawn so they do not get direct sunlight to their eyes. 
2. Be prepared to put your solar eclipse glasses back on before totality ends and the partial phase reappears.
3. To remove the glasses, look away from the sun and remove the glasses.

Learn more about the "Great American Eclipse" by visiting the Fort Worth Museum of Science and History's site. View a schedule of events at the museum and explore solar eclipses on the site.

The state-of-the-art facility was built with everything for the child in mind, including what they'll see and experience as they make their way through the facility. Spaces are bathed in every color of the rainbow. Storybook murals meant to capture and stoke the imaginations of children define many spaces.

In the main entrance, guests are welcomed by a Sistine Chapel-like painting of flying cows — a nod to Cook Children's Cowtown roots — a massive video wall and a tile motif of a tree whose color-coded falling leaves guide visitors to the emergency department in one direction and outpatient services in the other.

“This is an extraordinary time in our almost 105-year history in North Texas,” said Rick W. Merrill, President and CEO of Cook Children’s Health Care System. “Families in this fast-growing region can take comfort in knowing there’s no need to drive long distances to see board-certified pediatricians, specialists, intensivists, hospitalists, and emergency medical doctors. Their child’s medical needs can be met right here by our outstanding team in Prosper.”

Cook Children’s Medical Center – Prosper includes an emergency department, operating and procedure rooms, pediatric ICU, medical/surgical unit, outpatient infusion center, imaging services, retail pharmacy, laboratory services, and pharmacy services.

With thousands of families moving to this area of North Texas each month, the need for quality pediatric health care is evident. Cook Children’s has already served more than 260,000 children through its 17 primary-care clinics located in this booming region, which includes Prosper, Aubrey, Plano, McKinney, Allen, Denton, Celina, Frisco, Little Elm, Flower Mound, and Carrollton.

“Cook Children’s is more than a health care system. We strive to be an extension of your family, growing with your child from their first steps to adulthood,” said Kevin Greene, Vice President and Administrator at Cook Children’s Medical Center – Prosper. “When your child needs world-class pediatric care, we’re here – whether it’s primary, urgent or emergency care, or treatment for a chronic condition. You can trust our team to take care of you and your child’s every need.”

The ribbon-cutting ceremony for Cook Children’s Medical Center – Prosper coincides with a new look for the health care system. This month, Cook Children’s unveiled a new logo and a culture platform to reinforce its commitment to its patients and community. Patient families in the Prosper area can expect to experience the same culture of kindness, safety, and compassion they’ve come to know from Cook Children’s.

Cook Children’s has long been recognized as a leader in pediatric health. In fact, US News & World Report has ranked Cook Children’s among the best children’s hospitals in the United States every year for the past 15 years. In 2022, Cook Children’s earned recognition for cancer treatment, cardiology and heart surgery, diabetes and endocrinology, neurology and neurosurgery, orthopedics, and pulmonology.

Many of these medical specialties are currently available at Cook Children’s Prosper campus, which opened in 2019 with urgent care and primary care services. A medical office building was added in 2020 providing access to 14 specialties including:

• Cardiology
• Ear, Nose and Throat
• Endocrinology
• Gastroenterology
• Hematology and Oncology
• Nephrology
• Neurosurgery
• Psychology
• Sleep Medicine
• Urology
• Neurology
• Pediatric Surgery
• Pulmonology
• Sports Medicine

An ambulatory surgery center for outpatient procedures, outpatient lab, and retail pharmacy are also located in the medical office building. By the end of the year, 549 medical professionals and ancillary staff will work at the Prosper medical campus. 

“Cook Children’s is known nationally and internationally for its world class patient care, leading clinical research and medical advancements,” said Tony Anani, M.D., MPH, MBA, gastroenterologist and Medical Director of Clinical Specialties at Cook Children’s Medical Center – Prosper. “I’m proud to be part of this incredible organization that truly embodies the motto, “Everything for the child.”

Cook Children’s Medical Center – Prosper also showcases the best available medical technology including features directly related to patient satisfaction. For example, if a patient in the hospital needs to see a specialist at Cook Children’s Fort Worth campus, they can visit virtually through the in-room TV.

In addition, the MyCookChildrens app provides patient families access to wayfinding, information about their care team, and daily schedule, to name a few. Another perk of the Prosper campus is Peaks Tech Zone. Similar to Apple’s Genius Bar, Peaks Tech Zone provides families access to health technology advocates who can assist with setup and support for their child’s medical device and/or MyCookChildren’s account.

Cook Children’s Medical Center – Prosper marks the first hospital Cook Children’s has built outside of the flagship medical campus in Fort Worth.

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

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

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

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

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

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

Opportunities for Improvement

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Progress and Strengths

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

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

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

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

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

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

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

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

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

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

This week, SMA was added to the list of required medical screenings every baby in Texas receives at birth. Without newborn screening, many children escape the diagnosis until after permanent neuromuscular damage has occurred. Early recognition and treatment can mean the difference between a near normal life or suffering many skeletal deformities and being unable to breathe without a ventilator.

“The hope and thought is that it’s going to change the lives of patients and their families,” said Stephanie Acord, M.D., a pediatric neurologist at Cook Children’s Jane and John Justin Neurosciences Center. “Without treatment, these kids and those who care for them are significantly affected. The earlier you treat SMA, the better.”

Dr. Acord directs the multi-disciplinary Muscular Dystrophy Association (MDA) Clinic at Cook Children’s Jane and John Justin Neurosciences Center where she and Warren Marks, M.D., medical director of movement disorders at the center, specialize in the treatment of SMA. Dr. Acord shared with us what every expectant parent needs to know about the disorder and the new screening.

What is SMA?

Spinal muscular atrophy is a genetic disorder in which the nerves within the brainstem and spinal cord, called alpha motor neurons, break down and lose the ability to send signals from the brain to the muscles. Without those signals, the muscles grow weak from lack of use and affect a baby’s ability to hold up and control their head, sit up, crawl, walk, swallow, speak and breathe. If left untreated, a child will eventually require a feeding tube and respiratory support, such as a ventilator. Untreated SMA is among the leading genetic causes of death of infants and children.

Spinal muscular atrophy can be passed to a child if both parents have a defective survival motor neuron (SMN1) gene. Parents do not have the disease or signs of the disease and do not usually know they carry an abnormal gene. The faulty gene inhibits the production of the protein that fuels these motor neurons and, without it, the nerves die. There is a back-up copy, the SMN2 gene, but it doesn’t work as well as the SMN1 gene.

It is estimated that about 100 children born in Texas each year have the disorder. Many newborns will not show signs of SMA for months. By that point, you’ve lost valuable treatment time and the ability to give a child with SMA a better life. This is why newborn screening is so important.

What are the signs and symptoms of SMA?

There are several types of SMA. Symptoms vary depending on the type, but muscle weakness and loss of muscle control that worsens over time are general indicators. It is important to note that SMA is not a cognitive disorder, but a muscular one.

Type 0 is the rarest and most severe form of the disorder. Babies born with Type 0 SMA have breathing problems very early on and typically do not survive.

Type 1 is the most common form of SMA and also considered severe. Infants will begin showing signs within six months of life. They have poor head control, do not sit independently and have difficulty sucking and swallowing. Even though cognitively they are normal, they are unable to speak due to weakness. Without treatment they will need assistance with breathing, feeding, communicating, sitting and walking.

Type 2 is a more moderate form of the disorder. Symptoms will become evident between six months to 18 months of life. Infants with Type 2 will have difficulty controlling their lower limbs. They may be able to sit independently and crawl but struggle with walking.

Type 3 is a milder form of SMA. Symptoms such as mild muscle weakness, difficulty walking or frequent respiratory illness do not appear until after 18 months of life. Some people may not experience symptoms until early adulthood.

Type 4 is adult onset SMA. It is rare, progresses slowly and typically doesn’t appear until the early 30s. Most people maintain mobility and are able to manage their symptoms without much interruption to their lives.

What treatment is available for SMA?

The Federal Drug Administration (FDA) approved the first treatment for SMA in December 2016.

“It used to be a diagnosis in which there was very little treatment and little hope,” Dr. Acord said. “But the treatment now available for these patients is completely different than it was just five years ago.”

Today, there are three FDA-approved treatments. Two—Spinraza® and Evrysdi®—are drug therapies that help stimulate the production of a more functional SMN2 protein. These two treatments require ongoing administration of medication at various time intervals. The other—Zolgensma®—is a gene-replacement therapy administered once through an IV that delivers a normal functioning copy of the SMN1 gene.

The treatments have varying degrees of success, but all work to improve the strength and function of muscles through healthier neurons. They help to prolong the amount of time a child can live without additional support such as equipment to help them breathe more comfortably, as well as increase their ability to speak with their voice and to eat to some extent by mouth. The most critical part of any of the treatments is to start as soon as possible following diagnosis.

How will my newborn be screened for SMA?

As of June 1, 2021, SMA is one of 55 disorders on Texas’ list of required newborn screenings. It does not require an additional test. It’s simply bundled into the routine screenings already performed on newborns via blood test.

What happens if my newborn is positive for SMA?

If your newborn’s screening is positive for SMA, it is recommended that they be referred to a specialist, either a pediatric neurologist or a pediatric neurogeneticist, within 24 hours. A specialist will most likely conduct additional testing to confirm the diagnosis and develop a treatment plan.

“Parents need to advocate getting their child to a specialist as quickly as possible,” Dr. Acord said about receiving a positive SMA screen.

Pediatric neurologists at Cook Children’s Medical Center are able to conduct many SMA assessments virtually via telemedicine, which is helping parents and children in parts of the state without specialists get access to care from the comfort of their home.

Click here to learn more about the Muscular Dystrophy Association Clinic at Cook Children’s and for contact information for clinic staff.

Despite a recognized need, the majority of families at Cook Children’s are unable to access legal services. Social workers at the medical center are often contacted by patient families who have been unsuccessful in qualifying for public benefits, obtaining a guardianship for their incapacitated adult child or communicating with their landlord to remediate unsafe housing issues. These social, economic and environmental factors have a direct impact on a child’s health.

“The health and wellbeing of our patients is impacted by so many factors beyond the scope of traditional medical care,” said Vida Amin, M.D., medical director of Cook Children’s Neighborhood Clinics. “Having an accessible, dedicated resource for our families to turn to for assistance in navigating their legal challenges will be an invaluable addition to the family-centered care we strive to provide every day.”

The medical-legal partnership allows law students the opportunity to develop and apply their skills on behalf of clients who cannot afford legal representation.

“We are giving these children and their families a chance of success by increasing their quality of life by decreasing their unresolved legal needs,” said Robert B. Ahdieh, dean of Texas A&M School of Law.

The collaboration, which officially launched in March 2020, has already assisted dozens of patient families. Felicia Carey is one of the program’s first clients. She was referred to the TAMU Law after her sister passed away, leaving her to care for three teenagers, including a niece diagnosed with spina bifida.

“At first it was very difficult because I lost the paperwork that allowed me guardianship so I could take the children to the doctor,” said Carey. “A social worker at Cook Children’s referred me to the program and it’s been phenomenal. They made a process, which was unbearable, extremely easy.”

Since finalizing her guardianship issues, Carey is now working with TAMU Law on an adult adoption, veterans benefits and developing her will. The program also provides patients and families with access to legal services in family law, housing and public benefits.

“Our job is to prepare compassionate lawyers who will advocate tirelessly for their clients. That’s what sets Texas A&M Law a part from other law schools. We embody our core values, especially selfless service,” said Ahdieh.

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

Learn more on our website.

Surgery teams from the two hospitals joined together in Lubbock on Monday to perform two cardiothoracic procedures on pediatric patients. The partnership is part of an initiative to make treatment more convenient for patients and families in Lubbock and surrounding areas.

“Cook Children’s and Covenant Children’s developed a partnership, which allowed Cook Children’s to come to Covenant and perform procedures on a recurring basis,” said David Gray, D.O., chief medical officer of Covenant Children’s.

Vincent Tam, M.D., medical director of cardiothoracic surgery at Cook Children’s, performed both surgeries at Covenant Children’s. He traveled to Lubbock this week, along with seven other members of the Cook Children’s team. With the help of the surgical team from Covenant Children’s, Dr. Tam repaired the hearts of two children, including that of four-year-old Adrian Rosalez. Adrian was born with a vascular ring, a malformation of the aortic arch in the main blood vessel leading from the heart that partly or completely encircle the trachea or esophagus. Thanks to the collaboration between Cook Children’s and Covenant Children’s, Adrian is now recovering at home in Lubbock.

“Heart surgery is not a simple thing, I can’t take my suitcase of instruments, come to West Texas and do surgery," Dr. Tam said at a press conference at Covenant Children’s on Tuesday. "Heart surgery requires a large team of people, it requires a significant collaborative effort.”

Without this partnership, Adrian and his family would have had to travel to Dallas/Fort Worth, or another major medical hub to receive his surgery.

Covenant Children’s and Cook Children’s formed the joint partnership between the two hospitals in 2018. The plan allows Cook Children’s surgery team to perform cardiothoracic procedures on pediatric patients at Covenant Children’s once every quarter.

More than 500 people spanning 20 states have been diagnosed with measles this year already. According to the Texas Department of State Health Services, 15 of those cases were in Texas.

For the rare remaining physicians who have treated measles, the news is like déjà vu.

“We learned a lot from the 1989 measles epidemic,” said Deborah Susan Hucaby, M.D., an emergency room physician at Cook Children’s Medical Center. “We got to a point where anyone who came into the pediatric emergency room or clinics with a fever was presumed to have measles until proven otherwise.”

Dr. Hucaby was a resident at Ben Taub Hospital in Houston in 1989 when the worst measles outbreak in recent history occurred. That year, 17,850 measles cases were reported in 47 states with 3,201 of those in Texas.

“At the time, the MMR vaccine was recommended for children at 15 months,” Dr. Hucaby explained. “Due to the high number of unprotected children we were seeing with measles, that recommendation was lowered to 12 months of age. We also started giving the single measles vaccine at 6 months of age.”

For this reason, Dr. Hucaby says a doorbell was installed outside of the pediatric clinic where she worked during the outbreak.

“Parents were asked to ring the bell if their child had a fever, with or without other symptoms,” she said. “A nurse would go out into the hallway to look at the patient. If they appeared to have a risk factor for measles, we would take them straight into an exam room. We didn’t sit them in the waiting room.”

In Houston alone that year, 1,434 children under the age of 5 were diagnosed with measles. Dr. Hucaby says it’s frustrating to interact with parents today who refuse to vaccinate their children against diseases such as measles, mumps and rubella.

“So many of these parents have never seen these diseases. I’m 40 years older than most of them and I have. I have seen kids die from them,” she exclaimed.

Dr. Hucaby says there’s one child she will never forget. The little girl was only 6 months old when she arrived at the hospital with measles and pneumonia. She was too young to have been immunized and died as a result.

“Parents who decide they are OK with their children becoming infected with diseases probably frustrate me the most,” added Dr. Hucaby. “We didn’t see that during the Houston epidemic. Truly, people were willing to vaccinate their children. I don’t remember a single parent saying ‘no’ to a vaccine.”

She said in the 1980s, children often weren’t up to date on their immunizations mostly because parents didn’t see the importance or they had difficulties with transportation or finances. Today, vaccines are more accessible than ever in the U.S. with programs providing low-cost vaccines in every state.

“Every place I worked before Cook Children’s had an infectious disease ward where patients could be isolated,” said Dr. Nelson. “But as infectious diseases became better controlled, particularly the ones that are so contagious like chicken pox and measles, we didn’t need to have a special ward anymore.”

The reason for the decline in such quarantined areas is simply vaccines.

“I have lived through the era where I’ve seen vaccines come and save children’s lives. I have stood in line to get the polio vaccine,” Dr. Nelson explained. “I grew up with a great deal of anxiety about all of these diseases. That’s the piece that is missing in our society now, no one is anxious about these diseases.”

Dr. Nelson had good reason to be anxious. Not only did he know people who fell ill with polio, he himself lived through infections of measles, mumps and chicken pox.

“I had measles when I was a little boy, before I even started school. I remember having to stay in a dark room for four days because they thought light might increase your chances of losing your vision, which was not true, but that was the belief back then,” he said. “I didn’t want to eat. I didn’t want to do anything. I just wanted to die. It was that horrible.”

“As a physician, I’ve seen a ton of children die when there was nothing I could do about it. There was nothing anyone could do about it. So it does make me incensed that a parent would put a child at risk for a disease that could kill them based on emotion,” he said. “A parent that has never lost a child doesn’t understand the emotion that they are going to feel if they do.”

Read More About Measles and Vaccines

Resources Available at Cook Children's

There's so much misinformation on the Internet and television about the dangers and risks of immunizations, that it can be hard for a parent to separate the facts from the fears. Visit our website to learn more about our recommmendations regarding vaccines and how to make the best decision for your family. 

According to the National Conference of State Legislatures, Texas is among 18 states that allow families to opt out of vaccines for personal or moral beliefs. The Morning News reports that Plano, Fort Worth, Austin and Houston all ranked among the 15 U.S. metro areas with the most such conscientious exemptions for kindergartners. Each had more than 400 kindergartners exempted from vaccines.

Fifteen years ago, about 2,300 students opted out of at least one vaccine. Today, that number has grown to 56,737 kindergarten through 12th grade students.

This has many doctors, including myself, worried about more measles outbreaks in Texas.

"Populations who choose to not follow the recommended vaccine schedule for themselves and for their children are actually setting up the perfect conditions for the diseases they are unvaccinated for to erupt into an outbreak. It is really not a question of whether these outbreaks will occur but when," Jason Terk, M.D., a Cook Children's pediatrician in Keller.

News about vaccine preventable diseases is important for us to share, but it brings up many strong opinions.

Here’s how the debate usually goes:

“Please vaccinate your children.”

“If your child is vaccinated and vaccines are such a good thing, why do you care if my child gets vaccinated?”

Most people don’t have a good answer for it so it tends to be a good trump card.

So why do I care?

There are two reasons.

1. I care about your child. I firmly believe that vaccination is the right thing to do. I vaccinate my children on time and on purpose. I would not want any child to receive less care than I would provide my own children.

2. Vaccines sometimes do not provide complete protection. Most provide protection in the 90-percent plus area (some nearly 100, some lower). Because of this, even a vaccinated child can contract the disease. I will go into this in more detail below, but the more children who are vaccinated for a disease the less likely it is that any child will contract that disease. This occurs through a process known as community, or herd, immunity.

Many people will stop reading right here because they have already decided or have read somewhere that herd immunity is not a real thing. Here are some of the arguments against herd immunity I come across from time to time:

• It’s not based on a science, but on epidemiology. Epidemiology is the study of the way diseases spread. It is a very complicated field, involves tons of statistics and research and IS science. To say that it is not science is a false comparison.
• We still have outbreaks even in areas where there are high vaccination rates. This is most definitely true, but does not prove that herd immunity is not real.

How does it work?

Since it's most timely, let’s use measles as an example. First, you need to know some things about measles…

Measles has an attack rate of a susceptible individual at 75 percent. This means that 75 percent of people exposed to measles who are not protected will contract the disease. I’ll use 70 percent to keep my numbers round and err on the side of people who would disagree with me.

Measles vaccination has a 95-100 percent protection rate. Again, I will use 95 percent so that I am not cherry picking the best results to prove my point.

There are two scenarios below. The first scenario has a case of measles in a classroom where everyone else is vaccinated. The second scenario is a case of measles in a class with one child who is not vaccinated.

Scenario No.1:

Scenario No. 2:

In scenario No. 1, all the children are vaccinated which means they have a 5 percent chance of catching measles. If that child goes to another class or event where all children are vaccinated, each of those children have much less than a 5 percent chance because the child doesn’t likely have the disease and they only have a 5 percent chance of catching the disease even if he did.

In scenario No. 2, one child in the classroom is unvaccinated. He thus has a 75 percent chance of catching the disease. He’s going to go to other locations with other children, even if those children are all vaccinated, we have potentially opened up a whole second circle of exposed children. Not to mention that the children in the first class have now potentially been exposed twice.

So, in scenario No. 2:

• If I gave you a choice, would you want your child in group A or B?

• Does it matter if your child is vaccinated or not?

• What if you also have a baby in your house who cannot be vaccinated?

• What if you child is in class B, but has a disease for which they cannot receive the MMR vaccine?

The answer is no, none of these things matter. Logically, we should all want our child in room A because it decreases the odds of our child being exposed. Is it 100 percent? No, but it doesn’t matter. Are you more likely to be angry about a measles outbreak if your child cannot be vaccinated? Yes, and I understand that.

For one last thought, consider this … a  study in Pediatrics described geographic clusters of people who choose not to vaccinate at all or to under-vaccinate their children. I suspect that is true across our area as well, but I also suspect that there is clustering according to other factors as well: socioeconomic status, church/religious affiliation, etc. Populations where there are multiple families who choose not to vaccinate would be particularly susceptible in an outbreak situation. Let’s pray we don’t get there.

This is herd immunity and why the question, “If your child is vaccinated and they are such a good thing, why do you care if my child gets vaccinated?” doesn’t end the conversation.

Aug. 29th marks the “angelversary” of the passing of then 7-year-old Kyle Gracin Lewis. Kyle spent the week being the outdoorsy little boy he was – swimming, fishing, boating and camping in Lake Granbury and the Paluxy River near Glen Rose, Texas. A perfect family week right before school started.

The Lewis family clings on to those moments now before their little boy became ill and passing at Cook Children’s Medical Center from Primary Amoebic Meningoencephalitis (PAM), which was caused by the water-born amoeba Naegleria fowleri.

Since Kyle’s passing, his parents and his sister Peyton have become passionate advocates to make people aware of brain-eating parasites that are common in fresh, warm water. In 2010 the Lewis family started the Kyle Lewis Amoeba Awareness Foundation, aka Kyle Cares, with the goal of informing families of the potential dangers which exist in most freshwater.

In 2016, the family helped to make Cook Children's the first hospital in the nation to house a life-saving investigational drug called miltefosine. Timing is so critical when it comes to this amoeba and trying to save a life and Kyle Cares was instrumental in getting that potential life-saving drug into many hospitals around the country in hope that when the need arises, that medication could be more readily available.

“It’s always difficult this time of year, especially when you hear of more cases,” Jeremy Lewis, Kyle's dad, said. “Those reports hurt. It’s like the wounds are open again.”

“We hope that we can help other families not go through what we did with the passing of Kyle,” Julie Lewis, Kyle's mom, said. “We simply didn’t know the dangers. Our hope is we can save other families from going through the heartache that we went through then and continue to do so now.”

Just this past May, Kyle’s sister Peyton graduated from high school and in August she will be off to Tarleton State University to begin her journey to become a Child Life Specialist and it’s all because of the wonderful Child Life Specialists at Cook Children’s that cared for her and her brother during those days back in 2010. “We were grateful then for the care that was poured into our children by these wonderful ladies and they made such an impact on our daughter that we are all looking forward to her pursuing this certification, so she can be that special person to many children” states Julie.

For many Texas kids, the summer means time for fun activities such as fishing, swimming and water skiing. Unfortunately, those staples of summer could also lead to serious health complications, such as PAM.

According to the CDC, “only 4 people in the US out of 143 (diagnosed) have survived infection from 1962 to 2016. Signs and symptoms of Naegleria fowleri infection are clinically similar to bacterial meningitis, which lowers the chances of initially diagnosing PAM”.

Texas health officials say:

• From 1984-2013 (30 years) there were 28 cases of PAM reported to the Texas Department of State Health Services, just under one case per year.
• Most cases occurred in young males, 9-12 years of age, with a history of recent exposure to freshwater lakes, ponds and rivers during the warm summer months.

Mary Suzanne Whitworth, medical director of Infectious Diseases at Cook Children’s, says that children who spend time in still water run the greatest risk of the life-threatening parasite, entering their bodies. The dangerous amoebas are usually found in warm freshwater, such as lakes and rivers, but they could be in any standing body of water, including creeks or even puddles.

“Once a child is infected, everything happens very quickly,” Dr. Whitworth said. “We try our best to save the child’s life, but the parasites rarely respond to medications and are very difficult to treat. The infection tragically results in death almost uniformly.”

Use caution when swimming in fresh warmer water, especially in stagnant water. Naegleria fowleri grows best at higher temperatures up to 115 degrees (46 degrees Celsius) and can survive for short periods when the temperature rises even higher.

Do all you can to limit the amount of water going up the nose. Your best option is to keep your head above water, but you can reduce the chance to getting these infections inside the body by wearing nose plugs.

Dr. Whitworth says progress is being made in treating children who are infected by these dangerous parasites. But until a cure has been found, the most important thing is to be extremely careful if you are in fresh, warm water.

Related to this topic:

www.KyleCares.com

New hope in fight against deadly brain-eating amoeba

An average of 132 tornadoes occur in Texas each year.  

At some point, probably in the near future, one of those tornadoes will be in our area. Then what?

First of all, have a plan in place.

Sometimes, it’s just as important to know what you shouldn’t do. Kaysey Pollan, Environmental Safety and Emergency Management officer at Cook Children’s, offers these five things you should never do during a tornado:

1. Be unsure of your safeplace. Whether if it’s at your home or your office, know where you are going to go during severe weather. If you don’t have access to underground shelter, move to the interior room or hallway on the lowest floor and get under a sturdy piece of furniture. If you live in a mobile home, get out and find secure shelter.
2. Turn off your TV or radio. You hear it all the time. People calling in complaining to TV stations because their favorite program was interrupted for the weather. Don’t be that person. Pay attention to the weather forecast.
3. Depend on your fast car. Sorry, you can’t, or shouldn’t want to, outrun a tornado. Find shelter. If you can’t find shelter, get out of the car and find the most low-lying area (ditch, ravine, etc.). Lay flat your stomach and cover your head with your hands.
4. Open the windows. It’s been proven that this serves no benefit whatsoever. All an open window does is allow more wreckage to enter your home. During a severe storm, stay away from windows and keep them closed.
5. Drive underneath an overpass The National Weather Service Forecast Office says, “Seeking shelter under an overpass is more dangerous than standing in an open field while a tornado is approaching." When a tornado passes over an overpass, the wind is funneled under the bridge. In turn, this actually increases its velocity.”

Learn more from the source material for this article at the following sites:

• ready.gov
• knowhat2do.com
• accuweather.com/

From 2012 to present, 91 children have been seen at the medical center for snake bites. The most was in 2014 with 25 and last year staff saw 19 kids.

And as the weather heats up and kids are out of school, the opportunity for kids encountering snakes increases. From 2012 to 2016, 16 bites occurred in May, 26 in June and 23 in July.

Mark Shelton, M.D., an Infectious Disease doctor at Cook Children’s and an Eagle Scout with the Boy Scouts of America, says it’s important to teach respect for snakes.

"If you ignore a snake, more than likely, the snake will avoid you,” Dr. Shelton said. “But kids being kids, that’s sometimes easier said than done. Talk to your children about staying away from the snake. Don’t try to pick it up or kill it. Teach your child not to touch it or walk near it. Children should stand still when they spot a snake, then turn around slowly and walk away. Usually, the snake will crawl away into the bushes.”

Sharon Evans, Trauma/Injury Prevention Outreach Coordinator at Cook Children’s, says it’s not just live snakes that pose a threat either.

We’ve seen bites that occurred after a snake was killed. Often the parents or kids want to get a closer look of the ‘dead’ snake and the head still had the reflex to bite,” Evans said.”

As the warm weather approaches, this is a good opportunity for parents to talk to their children about snake safety.

Here are nine tips to start the conversation with your child:

1. Don't touch a snake.
2. Don't try to kill a snake.
3. Ignore the snake if you see it.
4. Wear closed-toe shoes in wooded areas.
5. Don't put fingers under rocks or crawl under houses or other structures.
6. Don't canoe or boat under limbs on rivers, streams or lakes.
7. Avoid edges of lakes, streams and rivers where vegetation is high.
8. Instruct your children to notify you if they see a snake.
9.  If bitten by a snake, seek medical help immediately. DO NOT open the wound or try to suck out the venom.

 *Data provided by the Trauma Registry of Cook Children's Medical Center, Fort Worth, Texas.

House Bill 2249 would require the Texas Department of State Health Services to provide reports every other year on vaccine-preventable outbreaks and the number of students at public schools who have vaccine exemptions.

“Parents want the choice about where to enroll their children to lessen the chance of their child contracting a vaccine-preventable disease from an unvaccinated child,” J.D. Sheffield, R-Gatesville and the bill’s author, said.

Lisa Pomeroy, a general pediatrician in Lubbock, spoke to the committee about this issue. Her daughter is in remission from leukemia, but remains immunocompromised because of the chemotherapy she must continue to receive.

“I don’t want to put my daughter in a dangerous environment,” said Pomeroy. “I want to keep her safe, and this information will let me decide what school is best for her.”

Jason Terk, M.D., a Cook Children's pediatrician in Keller and on the Committee on Federal Government Affairs for the American Academy of Pediatrics, says current school district information is not specific enough.

"The parent of a child with special needs, such as one with cancer or any disease which makes him or her more vulnerable to infections, needs to know if the school that child may attend is safe," Dr. Terk said.

"Currently the percentage of exemptions per district is available, but that information is not that helpful when you consider that many school districts cover large areas and may have a large number of individual schools," he added.

For example, the Keller ISD has 23 elementary schools, 6 intermediate schools and 4 high schools spread over a very large area.

"Knowing the district level exemption rate is not very helpful when the exemption rates may vary widely across all of the many schools," Dr. Terk said. "Risk is specific to the environment that your child learns in and that is what parents need to know about."

Since 2003, Texas has allowed parents to decline state immunization requirements for “reasons of conscience.” At the time, 3,000 kids were listed as exempt. In the 2015-2016 school year, the Texas Department of State Health Services reports 44,716 children from kindergarten to twelfth grade claimed exemption.

Of the state’s 10 largest school districts, three have vaccine exemption rates higher than the statewide rate of 0.84 percent:

• Austin ISD (Travis) – 1,582 students exempted (2.02 percent exempted)
• Katy ISD (Harris) – 866 students exempted (1.22 percent exempted)
• North East ISD (Bayer) – 657 (0.97 percent exempted)

Dallas ISD is eighth on the list with 497 students and 0.34 percent exempted, followed by Tarrant County as ninth with 197 students and 0.24 percent exempted.

Opponents of the bill say they fear families that opt not to have their children vaccinated will face harassment. Sheffield counters by saying no identifying information would be included in the information.

Keeping vaccination rates relatively high (somewhere around 90-95 percent) helps protect all children (vaccinated or not) from diseases, Justin Smith, M.D., a pediatrician at Cook Children’s, said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

“At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high,” Dr. Smith said. “My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together. What if an outbreak occurs in these schools?”

In the absence of state-led standards, DSHS was tasked with developing criteria for designating levels of neonatal and maternal care. This includes specifying the minimum requirements for each level, one through four. Any NICU in Texas that receives Medicaid reimbursements must undergo this designation process by September 2018 in order to continue collecting Medicaid funds. Cook Children’s NICU was one of the first NICUs in the state to be reviewed.

“While all NICUs help babies who need extra care, Level IV NICUs care for the most critical and vulnerable infants,” said Jonathan Nedrelow, M.D., neonatologist and medical director of the NICU at Cook Children’s Medical Center. “This designation reinforces the fact that Cook Children’s is among the best care centers in Texas for medically-fragile babies.”

• Comprehensive care for infants born at all gestational ages and birth weights with critical illnesses.
• Surgical repair for complex congenital or acquired conditions.
• A full range of pediatric subspecialties and surgical specialists.
• Access to high-risk infant follow-up care through the NEST program once babies are discharged.
• Ability to transport critically-ill babies via aircraft.
• Outreach education to lower-level facilities.
• Single rooms so parents can comfortably stay with their babies.

“Cook Children’s NICU is the only Level IV NICU in Tarrant County,” said Sheralyn Hartline, director of the NICU at Cook Children’s Medical Center. “This recognition is significant because it means families of critically ill babies don’t have to travel far from home to receive the best care available. The physicians and nurses at Cook Children’s NICU provide exceptional care for the some of the sickest babies in Texas and across the United States.”

Find the requirements for a Neonatal Designation Level IV, according to Texas Administrative Code, here. For more information on House Bill 15, please visit the Texas Health and Human Services website.

Learn More About Cook Children's NICU
No one ever wants to think about their newborn being critically ill. But it's good to be as prepared as possible, so if you do have to make such choices, we'll help you be well-informed. Start by asking your doctor about what type of treatment your baby may need. Then ask which NICU has the best equipment and staff to provide that care. You may want to research and learn about the differences between each one. For example, only Cook Children's NICU offers all single rooms, specially designed so that babies can receive the highest level of care and parents can comfortably stay with their babies as much as they like. Your OB/GYN or pediatrician may also be good sources of NICU information. 

Well, first of all don’t wonder to the point of trying the water. Follow the city's advice:

“To ensure destruction of all harmful bacteria and other microbes, water for drinking, cooking and for making ice should be boiled and cooled prior to use. The water should be brought to a vigorous, rolling boil and then boiled for two minutes. In lieu of boiling, you may purchase bottled water or obtain water from some other suitable source.

“When it is no longer necessary to boil the water, the water system officials will notify you that the water is safe for consumption. Instructions to discontinue boiling will be issued in the same manner as this notice.”

And what would happen if you did drink the water?

“If a child were to get sick from drinking the contaminated water, the most likely outcome would be intestinal infections that cause diarrhea,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “Some of these can cause severe diarrhea leading to dehydration such as E. coli (and related bacteria). Others like giardia and cryptosporidium (which are parasites) often lead to chronic diarrhea that can last for weeks."

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

Police continue to investigate the cause of the accident, but young drivers are always at risk any time they are on the road.

In 2015, more than 81,900 drivers ages 15-19 were involved in traffic crashes on Texas roadways. According to the National Highway Traffic Safety Administration, motor vehicle crashes are the leading cause of death in teens, ahead of all other types of injury, disease or violence. The Texas Department of Public Transportation states there are more than 100,000 traffic crashes in Texas each year involving distracted driving.

While the Facebook Live aspect of the story in Pennsylvania has gained the most media attention, the two girls were participating in at least two other activities that Safe Kids Worldwide describes as risky behavior:

• They were driving without adult supervision. When two or more teens ride in a vehicle with a teen driver, the risk of a fatal crash can double or even triple with more passengers in the car.

• They were driving after midnight. The risk of a fatal crash at night can be more than three times higher for teens than adults.

Lonny Haschel, a staff lieutenant for the Texas Department of Public Safety, encourages teens, and all other drivers, to avoid distractions while driving by putting away their phones.

Lt. Haschel says there are steps parents can take before their child gets behind the wheel to help them be safer on the road:

1. Make sure the teen has taken all the Texas DPS suggested driver education courses.
2. Work with insurance companies and take advantage of any programs offered. This may help with insurance rates when the new driver receives his or her license.
3. During the period when the teen has a learners permit, get plenty of practice driving. Driving is like any other skill; the more you practice the better you become.
4. Teach the new driver to be respectful of others on the roadway and be courteous.
5. Make sure your teen is taught how to maintain the vehicle. Each driver needs to know how to check fluid levels and change flat tires.
6. Teach them who to call in an emergency and how to respond in the event they are involved in a crash.
7. Make sure the teen knows that they can always call the parent for guidance, regardless of the situation.

Most importantly, Lt. Haschel says it’s important for parents to establish ground rules when handing the keys over to teen drivers. If you want your teen to drive safely, give them a good model by putting your phone away while driving.

“A parent/teen driving contract can help spell out the guidelines and the consequences if the terms are not followed,” Lt. Haschel said. “They need to address topics such as friends in the car, smart phone use, GPS use, vehicle maintenance and family responsibilities. Many insurance companies have teen driver programs, so we encourage parents to work with their insurance agents.”

Resources For Young Drivers:

• Parent/Child Driver's Agreement from SafeKids 
• Teens in the Driver Seat
• Why Parents Should Get Involved Video
• Teen Driver Information

The 24-day long fair brings plenty of fun for the whole family with games, rides, and some of the most gut-busting concoctions of deep fried food in the state. Whether you’re going for the game or not, if you’re going to the fair be sure to check out some of this year’s featured foods and award winning creations. And hopefully as a dietitian at Cook Children's, I can help you enjoy all the fair has to offer and not blow all of your weekly caloric intake in one night.

Best Taste went to America’s Most Famous dessert with a Texas State Fair twist; Fried Jell-O. The classic taste of cherry Jello-O is breaded, fried, and topped with powdered sugar, whipped cream, and a cherry. The award for Most Creative went to State Fair Cookie Fries. These crinkle-cut, deep fried cookies come in sprinkle and chocolate chip flavors and deceivingly come in your standard fry holder. Instead of ketchup, you’ll get the choice of strawberry or milk chocolate sauce for dipping.

If you’re looking for something a little less adventurous but just as decadent, look no further than Dr. Pepper Chocolate Chip Ice Cream. Dr. Pepper is a favorite beverage among Texans, but it just got sweeter and can be found in the Creative Arts Building at Howdy Homemade.

Don’t worry, not all of the food is dessert. Another new food that is sure to please the kids is the Dorito Bacon Mozzarella Cheese Stick. This kid friendly snack is covered with bacon, dipped in a batter of Doritos and then deep fried. Don’t forget the sauce! Choose from “a special marinara” and ranch sauce.

Another noteworthy food to mention didn’t make the Big Tex Choice Awards, but it certainly is making headlines. Mark Cuban brings us the State Fair Edible Cola. This edible cup filled with The Main Root soda in cotton candy or candy apple flavor claims to be a “healthier and delicious soft drink.” Main Root Soda is made from Fair Trade certified organic evaporated cane juice (aka sugar). Not only can you drink the soda, but when you’re done you can even eat the cup! These flavored, edible cups are made by Loliware, a company that Cuban invested in during an episode of Shark Tank.

According to the creator’s website  these biodegr(edible) cups are 100 percent plastic-free, gluten-free, BPA-free, non-GMO, all natural, non-toxic, safe and FDA approved. Loliware is made from seaweed, organic sweeteners and the flavors and colors come from fruits and vegetables. Beware, the cups are said to be sticky and lose their shape quickly. The company recommends taking small bites!

Don’t be fooled by claims that organic soda or an edible cup is healthy. Sugar is sugar and just because it’s organic doesn’t mean it’s healthy. Remember, the fair only comes around once a year, so take the kids and have fun! Consider the following options to help limit your intake of calories and saturated fat while still enjoying all that the fair has to offer.

• Share your food! Split an order of food with the family that way you don’t over indulge.
• Watch a baking competition rather than eating the sweets (no calories for watching!)
• Challenge the kids to a game of basketball free-throws.
• Climb the steps to the top of the colorful slides and then race to the bottom.
• Park farther away or take a stroll around Fair Park to burn some calories.
• Get back on track the next day by eating non-fried food and exercising.

There are numerous new and intriguing food creations. Be sure to walk around and see the seemingly endless options to cure your craving for fair food.

Some of the other new foods for this year include the following:

• Caribbean Pineapple Korn-a-Copia
• Deep Fried Bacon Burger Dog Slider on a Stick
• Deep Fried Pulled Pork “FUNYUN” Dings
• Bacon Cream Corn
• Dallas’ Fried Bacon-Tilla
• Lollipop Fried Bacon Wrapped Smoked Quail Breast on a Stick
• Mama’s Garlic Fries
• Pecan Pie Poppers
• Pina-A-lot-Tas

For a complete list of foods and where to find them, visit an information booth at the Fairgrounds.

And as a friendly reminder, food vendors don’t accept cash, so be sure to stop by a coupon booth on your way to get your fried food or edible cup!

* Photos courtesty of Kevin Brown/State Fair of Texas.

Related story:

Kim Mangham, M.D., a Cook Children's pediatrician, loves the fair. She wrote about her experience last year and offers more ideas for a healthy visit.Click here.

About the author

Virginia Landrum is a dietitian in clinical nutrition 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.

That’s the concern of Justin Smith, M.D., a pediatrician at Cook Children’s. The Houston Chronicle reported “the number of children whose parents decline vaccinations for non-medical reasons rose nearly 9 percent last school year.”

Since 2003, Texas has allowed parents to decline state immunization requirements for “reasons of conscience.” At the time, 3,000 kids were listed as exempt. According to the Chronicle, that number has since multiplied to 45,000 last year.

“If you look at the statistics, you see a lot of geographic clusters of people who choose not to vaccinate at all or to under-vaccinate their children,” Dr. Smith said. “I suspect that is true across our area as well, but I also suspect that there is clustering according to other factors as well: socioeconomic status, church/religious affiliation, etc. Populations where there are multiple families who choose not to vaccinate would be particularly susceptible in an outbreak situation. Let’s pray we don’t get there.”

Keeping vaccination rates relatively high (somewhere around 90 percent) actually helps protect all children (vaccinated or not) from diseases, Dr. Smith said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

Dr. Smith points to an NBC5 report last year on vaccination rates in local school districts that he found not only enlightening, but a bit frightening to him. The news focused on the growing number of vaccine exemptions in three public school districts (Frisco, Plano and Lewisville).

“At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high,” Dr. Smith said. “My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together.”

In the report, what’s happening in our area includes:

• Thirty schools in the DFW area have vaccination rates below 96 percent.
• Five schools in the DFW area have vaccination rates below 90 percent.
• The highest unvaccinated rate in our area is around 13 percent. The highest in the state is near 50 percent.

Why does it matter?

“If you read the names of the schools, you’ll see a trend,” Dr. Smith said. “They are private schools. They are schools that have a high likelihood of having people go overseas for mission trips or other opportunities. Traveling to countries where diseases are more common increases the likelihood of bringing a disease back to school. Waiting at school are their unvaccinated friends and their vaccinated friends who could even be at risk as the number of cases rise. Outbreaks are possible.”

Do you think this is far-fetched?

Dr. Smith points to the Tarrant County measles outbreak from 2013 that basically had all the characteristics that he’s describing. A large group of unvaccinated people, grouped together based on their faith that contracted measles from a visitor who brought measles into the United States after traveling overseas.

What can you do?

• Get the best start to protection by vaccinating your child.
• Be aware of the vaccination percentages of your child’s school, your church and your social community.
• Be especially cautious when your child’s unvaccinated contacts return from overseas travel. If they are sick, stay away.

About the source

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the fall of 2016.

The latest happened over Memorial Day weekend to an Arlington, Texas teenager. Conner Norman was camping with his family at Lloyd Park on Joe Pool Lake when a copperhead bit the back of his heel. His father, Kip Norman, says his son was walking back to the campsite after taking his sister for a ride on a jet ski when it happened.

"He came into the camper and said 'Dad, I just got bit by a copperhead," Norman said. "I was in disbelief at first, until I turned around and saw his face."

Norman and the family rushed to the emergency room at a local adult hospital. Staff there decided to transfer the teen to Cook Children's Medical Center in Fort Worth. Though his foot and leg swelled nearly twice the normal size, the snake didn't inject enough venom to warrant anti-venom treatment. Conner was closely monitored and released the next day, which also happened to be his birthday.

"He turned 15 at midnight in the ED at Cook Children's. I guess the snake was trying to give him a birthday kiss," Norman joked.

Thankfully, the family can laugh about it now because Conner is going to be just fine.

WFAA-TV reported that a Granbury toddler was bitten by a copperhead snake while on a playground at daycare. The child's father told the TV station that the little girl's finger turned black and became swollen.

At Cook Children's, between 17 and 25 children have been admitted due to snake bites each year since 2013.

"We’ve already seen several snake bites this year," said Sharon Evans Trauma/Injury Prevention outreach coordinator at Cook Children’s. “The numbers we’ve seen are not above normal, but it’s always a good idea to warn children about snakes.”

Evans says it’s not just live snakes that pose a threat either.

“We’ve seen bites that occurred after a snake was killed. Often the parents or kids want to get a closer look of the ‘dead’ snake and the head still had the reflex to bite.”

With the recent rain in North Texas, snakes may be seeking dry areas and may be spotted in places you wouldn't normally see them. Parents shouldn't be alarmed, but this is a good reminder to talk to your kids about snake safety.

Here are nine tips to start the conversation with your child:

1. Don't touch a snake
2. Don't try to kill a snake
3. Ignore the snake if you see it
4. Wear closed-toe shoes in wooded areas
5. Don't put fingers under rocks or crawl under houses or other structures
6. Don't canoe or boat under limbs on rivers, streams or lakes
7. Avoid edges of lakes, streams and rivers where vegetation is high
8. Instruct your children to notify you if they see a snake 
9. If bitten by a snake, seek medical help immediately. DO NOT open the wound or try to suck out the venom. 

Four species of venomous snakes found in Texas: rattlesnakes, cottonmouths, copperheads, and coral snakes.

Rattlesnakes are most populous in dry areas with prevalent rocks and canyons. When threatened, rattlesnakes will curl into a defensive position and rapidly shake their rattles. Rattlesnakes can be recognized by the “rattle” apparatus at the end of the tail. This species of snake has scales in a distinct diamond pattern, as well as a large head and fangs. Depending on the location, rattlesnakes can vary in color from brick red, buff pink, straw-yellow, beige, brownish and light gray:

Cottonmouth snakes (seen on the right), also known as water moccasins, are found where prey is plentiful. These snakes require large basking sites and will travel far from water to hibernate. Cottonmouths spend the majority of their time coiled at the edge of bodies of water or draped over nearby vegetation:

Copperhead snakes are common in wooded areas from the hardwood bottomlands in east Texas, to woody patches in the Trans Pecos of west Texas. Additionally, copperheads can be found in open areas within short proximity of woods. During the summer, copperheads are most active at night:

Coral snakes are extremely common across the state, from the pine forests in the East to the oak juniper canyons on the Pecos River. These snakes thrive in urban, suburban, and other habitats with plentiful rock crevices or plant cover:

Mark Shelton, M.D., an Infectious Disease doctor at Cook Children’s and an Eagle Scout with the Boy Scouts of America, says it’s important to teach respect for snakes.

If you ignore a snake, more than likely, the snake will avoid you,” Dr. Shelton said. “But kids being kids, that’s sometimes easier said than done. Talk to your children about staying away from the snake. Don’t try to pick it up or kill it. Teach your child not to touch it or walk near it. Children should stand still when they spot a snake, then turn around slowly and walk away. Usually, the snake will crawl away into the bushes.”

Don’t be alarmed by the prevalence of these creepy crawlies within our great state, they love the sun and warmth just like us! Here are 10 tips to stay safe from snakes this summer:

1. Be especially careful of snakes after the rain. They will be seeking dry area and may be on a sidewalk or walking path they normally wouldn’t cross.
2. Don’t canoe or boat under limbs on rivers, streams and lakes.
3. Ignore the snake and they will ignore you.
4. Don’t touch or pick up a snake.
5. Don’t try to kill a snake.
6. Wear closed-toe shoes when in wooded areas.
7. Don’t put fingers under rocks and don’t crawl under houses or other structures.
8. Avoid the edges of lakes, streams, and rivers where vegetation is high.
9. Instruct your children to notify you if they see any species of snakes or other threatening animals.
10. If bitten by a snake, seek medical help immediately. Don’t open the wound or suck out the venom. Seek medical help.

In 2015, 463 people wre killed in distracted driving crashes in Texas and 3,000 more were seriously hurt

A study by AT&T states that nearly 4-in-10 smartphone users look at social media while driving and about 30 percent surf the net while driving.

The Texas Department of Transportation has begun its annual "Talk, Text, Crash" campaign this month, in hopes of stopping texting while driving and to decrease driving distractions. TxDOT reports that 1 in 5 traffic crashes happen because of "texting, talking and other distractions."

According to the National Highway Traffic Safety Administration, texting while driving:

• Impairs driving ability as much as drinking four beers.
• Increases crash risk by 23 times.
• Causes 1.6 million wrecks and 330,000 injuries each year.
• Accounts for 11 teen deaths every day.

Teens may even be aware of the danger, but in the teenage mind, the need to stay in touch often outweighs the need to stay safe.

"Kids who are learning to drive right now have grown up with smartphones and cell phones, so it seems natural to stay connected to their friends all the time," said Sam McCage, Ph.D., LMFT, LPC, manager of Behavioral Health Services at Cook Children's. "When teenagers don't respond immediately to texts, they might feel that they're being rude or will miss out on something important."

McCage said parents should talk to their kids about the dangers of being distracted on the road, but they should also be a good example for their children. Studies show that:

• 48 percent of young drivers have seen their parents drive while talking on the phone.
• 15 percent of young drivers have seen their parents text while driving.
• 48 percent of children ages 12-17 have been in a car while the driver was texting.

And for that extra measure of safety, mobile apps can block messages from being sent while your child is driving and there are devices which can stop all phone use while the vehicle is in motion.

Here are 4 reasons goat's milk is dangerous and could even be deadly:

1. It is usually not pasteurized which can lead to all kinds of bad infections (listeria most commonly).
2. It has more protein so baby's kidneys can't handle it well. This along with high sodium level can lead to strokes.
3. It doesn't have enough folate which can lead to anemia.
4. It doesn't have the same electrolytes which can lead to extra acids building up in the baby's body. This causes multiple downstream problems.

Breast is best. Modern formula is really, really good too.

Goat's milk is nothing to kid around with.

The DSHS has received reports of 205 cases of Cyclosporiasis in Texas. No cases have been reported at Cook Children's. In Cook Children's six-county service region, the following numbers have been reported:

The U.S. Food and Drug Administration's alert says cilantro from the Mexican state of Puebla may be the cause for the recent outbreaks.

Symptoms usually begin 2 to 14 days after ingestion of contaminated food or water.Mary Suzanne Whitworth, M.D.,medical director of Infectious Diseases at Cook Children’s, advises parents to contact their Cook Children’s pediatrician if they have a diarrhea-like illness lasting more than a few days or diarrhea accompanied by severe weight loss or fatigue. Those are symptoms of Cyclospora.

Symptoms include severe diarrhea that can last a week to months, and if not treated, the person may relapse. Additional symptoms may include fatigue, severe weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting and low grade fever. If your child is experiencing these symptoms, do not wait. Contact your Cook Children’s pediatrician. If your child is diagnosed with Cyclospora, an antibiotic can be prescribed.

However, most cases of diarrhea or an upset stomach do not need treatment with an antibiotic. Usually, diarrhea is caused by viruses, so time, rest and diet will take care of the problem.

“Past outbreaks of Cyclospora in the U.S. have been caused from imported, fresh produce,” Dr. Whitworth said. “The best way to prevent Cyclospora in your household is to wash your fruits and vegetables as thoroughly as possible. Let fruits and vegetables soak for a few minutes in clean water in the sink, and then drain and spray them off with clean water before eating them. Thorough washing of fresh produce is highly recommended, but it may not remove the risk of someone in your family getting Cylospora entirely. If your child has these symptoms, it’s best to see a pediatrician and get treated as quickly as possible.”

Cyclospora is generally not transmitted directly from person-to-person, however children with diarrhea should always avoid swimming in pools to avoid the spread of infection.

The Centers for Disease Control and Prevention has more information about Cyclospora.

When should you call your pediatrician about diarrhea? Watch this video from Justin Smith, M.D., for more information.

The Texas Department of Public Safety will be responsible for the licensing of at least three dispensing organizations by Sept. 1, 2017 before CBD will be available for patients.

CBD is the non-euphoric component of marijuana and contains no psychoactive properties, so it doesn’t produce a “high.” CBD is not administered by children smoking. It is typically formulated into an oil-based liquid so it can be given by mouth.

Texas agencies will regulate the distribution of the oils to patients whose symptoms have not responded to available treatments and the risks of treatment are outweighed by the potential benefits, according to their epileptologist. The treatment has to be agreed upon by two epileptologists before CBD can be administered.

M. Scott Perry, M.D., medical director of the Epilepsy Monitoring Unit and Tuberous Sclerosis Complex Clinic at Cook Children’s, estimates he discusses with parents and patients the pros and cons of marijuana use for epilepsy three or four times a day at minimum.

Dr. Perry said families are looking for any therapy that works for their child’s uncontrolled seizures once other options have failed, and some have either left the state or had plans on leaving Texas if the bill didn’t become law.

“I think we have seen enough in the other states that have already made CBD available to understand there is potential benefit to CBD use,” Dr. Perry said. “From what we’ve seen in the medical community so far, it’s very encouraging, but more research still needs to be done before CBD is a treatment of choice for most patients with epilepsy. For now, CBD may provide benefit for a small population with intractable (unmanageable) epilepsy, in which other treatments have been unhelpful. I’m glad that this bill will now afford me the same opportunity as other physicians in my field to prescribe CBD to this population of patients in Texas.”

Thanks to a gracious act of kindness from one teenager in Arizona, a 1 year old from Joshua, Texas is no longer on that list.

Following a head injury while competing in a North Texas motocross event, Kenneth “Buddy” Wentworth III died at the age of 16 on Oct. 3, 2014. Buddy’s parents gave consent for donation. Since his death, Buddy donated his heart, lungs, liver, pancreas, kidneys, corneas and other tissue at JPS Health Network.

Eli received one of Buddy’s kidneys. Eli’s kidneys were destroyed because of massive blood loss by placental abruption, a complication of pregnancy in which the placenta separates from the uterus before birth.

Eli was one of the 134 kidney transplants that have taken place at Cook Children’s since 1993, when the organ donation program began.

The Wentworths and the Marskis met for the first time this week as part of the annual “Life Gift” flag raising ceremony that took place at Cook Children’s on April 16, 2015. The Wentworths flew from their home in Arizona especially to be there.

Darbie, Buddy’s mom, said the organ donation was Buddy’s idea.

Darbie said, “When I took Buddy to get his license, he said, ‘Mom, can I be a donor?’ My response was, ‘Dude, do you know what that means?”

It meant saving a little Eli’s life.

“Because of Buddy’s choice, we have the opportunity to raise our child and for that I will be forever grateful,”said Kammi Marski, Eli’s mom.

How do you know when it is something else or when it could be more dangerous?

A report last week from the CDC described a cluster of infections caused by shigella, a bacteria that can cause severe diarrhea.

Shigella is common, causing an estimated 500,000 cases of diarrhea in the United States annually. But this group of infections is unique because it has been found to be resistant to the most common type of antibiotic used in adults used for shigella. Most cases have been located on the East and West coast and many have been associated with travel outside the United States.

Fortunately, there were no cases of this more severe form of shigella reported in Texas so I feel that we are pretty low risk at this point. I did want to take a second to tell you about warning signs that might alert you that diarrhea might be more than a stomach bug.

Here are some symptoms that might alert you that should trigger a call to your doctor:

1. Severe vomiting with decreased urine frequency or other signs of dehydration.
2. Fever more than 102.
3. Blood or mucous in the stool.
4. Severe belly pain.
5. Diarrhea that last more than one week.
6. Let your doctor know if your child has traveled recently.

What are Salmonella and Shigella?

Two of the most common bacterial causes of infection are salmonella and shigella. They are both fairly frequent causes of severe diarrhea in children.

They can both be transmitted by contaminated food or water but can also be spread from person to person. Salmonella is more frequently caused by transmission from contaminated food, but also can be contracted from infected reptiles. Shigella is more frequently acquired from other children and is much more contagious than salmonella.

(Just to give you an idea, stool of a child infected with shigella contains 100,000,000 bacteria per gram of stool. Ingesting just 200 bacterial cells is enough to cause infection. Because of this, outbreaks of Shigella are common in child-care settings.)

The most common symptoms with both infections are diarrhea, abdominal pain and fever. With shigella, fever is often higher and children are more likely to have blood or mucous in their stools.

For either infection, your doctor can run stool studies to confirm the diagnosis. This may not be necessary if there are known cases that the child has been exposed to.

Both infections will typically go away on their own in seven days or less. Most healthy children do not require antibiotics. I do not routinely recommend anti-diarrheal medications in children because they can prolong symptoms with some infections.

If you suspect your child has one of these infections, consult with your doctor and keep them out of day care until we are sure they will not put other children are risk.

In the state of Texas, it's illegal for anyone under 18 years of age to use an indoor UV tanning facility, even with a parent's permission. But recent studies show that the use of tanning beds can become an obsession and parents need to make sure their child is not finding a way to work around the law.

Why?

The dangers of cancer:

• Ultra-violet (UV) light in tanning bed is known to cause cancer.
• Every year, more than 170,000 cases of skin cancer related to indoor tanning are diagnosed.
• One indoor tanning session increases your risk of getting melanoma skin cancer by 20 percent.
• Melanoma is the second most common type of invasive cancer in teens and young adults and is the leading cause of cancer death in women ages 25 to 30.
• One indoor session increase your riks of getting squamous cell carinoma by 67 percent.

"While all tanning is bad, tanning bed usage exposes people to ultraviolet A rays," said Sandra Peak, M.D., a Cook Children's pediatrician in Lewisville. "UVB rays cause sunburn, but UVA rays penetrate much deeper into the skin."

Other icky health risks may also be found at your local tanning salon, including bacteria that can lead to staph infection. Regular trips to the tanning bed can also change skin texture and cause sunspots, which probably aren't what your teen is after.

So what if your child begs you to go? It's time to talk.

"Parents should sit down and discuss the risks of indoor tanning with their children," Dr. Peak said. "Melanoma has become the cancer of young people."

Instead encourage your children to use a self tanner to get that summer glow, and urge them to always apply a broad-spectrum sunscreen with a minimum sun protection factor of 15 before heading outdoors, even during winter months. Dr. Peak recommends staying away from spray tans, since the chemicals can damage delicate mucus membranes.

About the author

Sandra Peak, M.D., joined Cook Childrens Physician Network in Lewisville in 2004. Dr. Peak enjoys gardening, yoga, and boating and in her spare time can be found at the lake with her husband Jay, stepson Sage and the world’s most amazing Lab, Sugar Mae.

Now she prays for Tre’s caregivers to make her son all better.

Tre, who is 9 years old, has been seen by the Rehabilitation Services team at Cook Children’s since his parents adopted him as an infant. Most of those issues centered on his articulation skills. Tre’s history with Rehabilitation Services started with audiology and other physician specialists; speech therapy services began at 7 years old working on articulation skills. 

Then about 15 months ago, Sara Adams, Tre’s speech pathologist, received a call from Jennifer to say her work with him would have to go on hold indefinitely.

Tre was involved in a horrible boating accident. He sustained a head injury and was in a coma at another hospital. But the miracle for the Faulkner family occurred and within two weeks, Tre was up and walking.

After his accident, Tre returned to therapy at Cook Children's Urgent Care and Pediatric Specialties – Mansfield and worked with Occupational Therapy, Physical Therapy and Speech Therapy to regain skills that were lost after his brain injury.

A year later, much of Tre’s care takes place at the Cook Children’s Rehabilitation Services at Mansfield. The focus is on Tre’s short-term memory loss and his severe ADHD, as a result of the injury.

“God has blessed us so much,” Jennifer said. “The Mansfield community has been with us since the beginning, I’m so thankful. I’m also thankful for the amazing care Tre has received since his injury. At Mansfield, Tre has really been helped in many ways, through his physical, occupational and speech therapy. They have helped him so much with his memory and his balance. It’s truly been miraculous.”

The rehab at Mansfield is working for Tre. Academically, Tre’s test scores are in the average range for a child his age. His mom says he’s learning and making strides every day.

And Tre’s doing very well physically. He recently received his gold belt in karate. Makes sense for a kid who has proven time and time again how tough he is.

“The progress Tre has made since his accident is truly remarkable,” Adams said. “Tre still has some struggles with his attention and memory that impact him every day. However, he continues to improve and learn how to work through these struggles. Tre’s sense of humor, determination, and supportive family are his greatest strengths. Tre is such a funny kid! He loves to tell jokes and riddles. One of his favorite jokes is: ‘Why don’t ducks tell jokes when they are flying? … They might quack up!’”

To see how far Tre’s come since his injury it’s hard not to smile at the miracle that’s occurred and the occasional duck joke.

For more information

At Cook Children's, we provide more than 60 pediatric medical and specialty clinic offices throughout Texas. Thanks to our skilled group of clinicians who support the leading-edge technology found among our specialty services, Cook Children's is the destination when it comes to taking care of your children.

Cook Children's Urgent Care and Pediatric Specialties - Mansfield is located at:

801 Matlock Road

Mansfield, TX - 76063

To make an appointment, call 817-347-8400.

Specialty services at Mansfield inlcude:

• Endocrinology and diabetes
• Gastroenterology and nutrition
• Nephrology and dialysis
• Neurosciences
• Orthopedics
• Pediatric surgery (inpatient/outpatient)
• Psychiatry and psychology
• Rehabilitation
• Urgent care

The growing trend of water birth needs to be addressed on many levels. First off, we need to come up with a definition of what a water birth actually is. Does it mean sitting in a tub during the first stage of labor or going all the way to delivering the baby into the water?

Secondly, we need to be clear about the benefits of water birth. There have been a few reviews that show that water birth can decrease the amount of medicine used during labor.

Finally, can we all agree that if we are going to be using water birth, there should be guidelines and a trained professional (with specific training in water birth) available?

The baby who died in Texas was delivered in a circulating tub, with difficult to clean tubes. The water was drawn from a well, purified with commercially available drops and left to circulate for 2 days prior to delivery. We can pretty safely say that none of these strategies would be in the guidelines.

If you are considering water birth, ask questions. Make sure that you understand the benefits and any potential risks.

If you need or want details, check out this article by a great friend of mine, Dr. Clay Jones: An Update on Water Immersion During Labor and Delivery.

Thalasso Bath Method

A “cute” and “relaxing” video is circulating around social media of twin babies in a bath who, “don’t even seem to know they are born yet.”

The video highlights a bathing method known as the Thalasso method which was developed by a French nurse, named Sonia Rochel. She gives babies a bath in relatively deep water, with water running over their face and eyes and then submersing the babies to where just their face and mouth are above water. The proposed benefit is that the bath is an environment that mimics the womb and thus is calming and peaceful for the baby.

I say that the videos are “cute” and “relaxing” because that’s what all the commenters say, but, frankly, I find it more “anxiety-provoking” than anything else. I have seen the nurse say in several interviews that this should only be done with a health care provider who is familiar with the technique, but I doubt that this prevents many people from trying it out at home.

Consider that the babies in the videos are relaxed and happy, but remember that they are putting their best foot forward. I wouldn’t be surprised to learn that they cut a few videos of screaming, wiggly babies. Seeing that would make this technique look a lot less safe. Just a few things to think about.

Water Neck Floatie Things for Babies

This is, by far, the easiest one to pick on. It’s basically an inflatable flotation device that you stick around your little baby’s neck and leave perilously floating in the water. Apparently, there are even spas cropping up where you can pay to have your baby do this and then be taught how to give them a full body massage.

I am all for physical touch with your baby, but I think we can skip the floating around. Lest you say, surely parents aren’t completely trusting these things to actually help keep their child floating on their own … check out the pictures. I’m hoping there are parents right outside the frames of these things, but often there are 4 or 5 infants floating in a single pool with no parent hands in sight. If you want your baby to like water and physical touch, let’s go ahead and combine the two and hold them in the water.

We should evaluate anything we see as a new trend with skeptical eyes and with a grounding in common sense. If you have questions, ask your pediatrician.

About the author

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

What is the point of a checkup?

If you ask a dozen doctors, you might get two dozen answers.

Even then, there might not be a single one of them that lines up with what you want from a checkup.

Here are some goals that we can all agree are important:

Answer questions about your child. The most fulfilling checkups for me are those where a parent brings a list of questions (on paper, napkin or iPhone).

Monitor your child’s growth. Following along those graphs and height and weight percentiles are not only used as a way to compare your child to your friends on Facebook; they provide great insight into your child’s overall health.

Discuss your child’s development. Discussing your child’s new skills helps me intervene when things are not progressing as we would like.

Here are three reasons that are important to me (that might not be as important to you):

1. Talking through 2 or 3 issues per check-up that I think are too important to not miss. Some examples are back-to-sleep for newborns and diet and nutrition for older children.
2. Completing a full physical exam. This helps me determine if there are any subtle health problems that might not have been noticeable to the family. Some common problems identified at check-ups are eye problems, hernias and heart murmurs.
3. Vaccinations. Vaccinations. Vaccinations. There are very few things that I do as a general pediatrician that protect lives. Vaccinations do.

Even when you think everything is going well, it is important to show up yearly for your checkups. You never know when that routine visit could turn into something very important.

That news made us wonder about bees and just how dangerous they are. We asked Michael D. Warriner, the nongame and rare species program supervisor for the Texas Parks and Wildlife Department, for more information on bees. 

Warriner said there are well over 700 different bee species known from Texas. But how many of them are dangerous?

Any insect that lives in a social life in a colony (the queen and its contingent of workers) will likely exhibit defensive behaviors if disturbed, Warriner said. Social bees and wasps can defend with their venomous stings when needed.

The majority of native bees and wasps in Texas (well over 90 percent) are not social. They are known as solitary bees, which means they are not defensive at the nest and do not mount sting attacks against perceived attackers.

“Any stinging insect might be dangerous if the individual stung has a heightened sensitivity to that species venom,” he said. “Any stinging insect that lives in a social colony (honeybees, paper wasps, bald-faced hornets, red-imported fire ants) should be treated with respect. Because European honeybees live in such large colonies (up to 50,000 workers in a colony) they can mount a pretty large attack against what they perceive as disturbing them. No other bee or wasp in Texas lives in such large colonies. The potential for the delivery of hundreds if not thousands of venomous stings makes European honeybees a public health concern.”

European honeybees and Africanized European honeybees are the same species (Apis mellifera). They are nearly identical morphologically and have the same venom chemically. The Africanized European honeybee is a mix of different European honeybee subspecies (European and African). African European honeybee subspecies differ from those in Europe in being more defensive at the nest, ability to nest in smaller cavities, store less honey and swarming more often.

So what should parents tell their children about bees?

“If they see large groups of bees flying in the air, clusters of bees attached to a branch, or a string of flying bees entering and exiting one location to not approach,” Warriner said.

Warriner thinks of honeybees not so much as enemies, but our grouchy neighbor. They need to be respected and they serve an important service.

“Honeybees are also essential to the production of many of the fruits and vegetables we eat,” he said. “The annual value of insect pollinated crops (honeybees do most of the pollinating) to the U.S. economy is around $18 billion annually.”

Bees around flowers represent less of a sting risk as they are away from the nest (no nest to defend) and really only interested in foraging for food. Foraging bees can be watched, but should not be swatted or captured. However, that’s not the case with all honeybees.

Feral (or wild) European honeybee colonies near human occupied areas should be removed (live or dead), preferably by an expert.

“Remember, European honeybees are not native to North America,” Warriner said. “They are essentially ‘farm animals’ – used for production of honey and wax as well as pollination services - and not integral components of our native ecosystems. Honeybees belong in boxes managed by beekeepers, not living wild and free in Texas. Think of pigs on farms versus feral hogs in natural systems. The latter case is not good.”

“Feral European honeybees have spread across most of Texas and a good percentage of those are likely Africanized,” Warriner said. “Because they live in large colonies, their presence is often not hard to miss. That gives humans a chance to spot a potential danger before the bees perceive us as (a threat). Feral European honeybee colonies can represent a public health threat in occupied areas (that’s why feral colonies should be dealt with in human-occupied areas). Our biggest concern with European honeybees is the potentially negative impacts they may have on native bee communities (competition for food) and plant communities (honeybees have been shown to increase seed set of certain non-native, invasive plants).”

Warriner said the biggest misconception about bees is that all bees live in big colonies and will mount mass sting attacks against disturbances. The vast majority of bees in Texas are completely benign.

“Ninety percent of our native bees are solitary and do not live in colonies or mount sting attacks to defend their nest sites,” Warriner said. “These bees are of little if any health concern. The only real way to get stung by those bees is if it were to become trapped in your clothes or you were to press it against your skin.”

I know you are at your wits end. You are tired of getting the phone calls from teachers. You are scared that every time the day care calls, it could be the call saying that your child needs to be picked up and never come back. Believe me, I want to help … but medication does not fix everything.

The primary and best, first treatments for Attention Deficit Hyperactivity Disorder (ADHD) are not medications.

If your child is hyperactive, he or she needs structure and a consistent behavior plan that is applied across all caregivers. This means that mom and dad, grandma and grandpa and the school need to all be on the same page about what is acceptable behavior and what is not. Reward good behavior, be consistent in responding to bad behavior.

For children who have problems with attention, medication might help them remember to get their homework home or turn it in on time or help them get their chores done at home. It might help, but many times their bad habits are so entrenched that medication won’t touch it until you put a system in place that will help them organize their day. A system of folders for homework, listing chores with checkboxes and other simple fixes can go a long way and will likely be necessary whether your child is on medication or not.

Anytime I make the diagnosis of ADHD and we move toward using medication, there is one message I want my parents to hear loud and clear: “The goal of using ADHD medication is not perfection.”

We are not looking to get your child to be the citizen of the year … at least not with medication. The goal of medication is to help your parenting strategies to be more effective.

Here are some symptoms that are not necessarily a result of your child having ADHD: being disrespectful (especially talking back), physically violent or being mean to other children. Medication is not likely to improve any of these behaviors. Yet, many of these are the behaviors you specifically want me to help with.

However, when these symptoms are present or when things are not improving the way we would like, it is important to include counseling in the treatment regimen for ADHD. Counselors can help children understand what is going on and give them strategies to cope. Perhaps more importantly, they can help you, as the parent, better understand and manage your child’s ADHD and other behavioral problems.

I can’t “fix” your child with medication but together we can help them.

Sincerely,

Justin Smith, M.D.

Dear person who think that ADHD does not exist,

I get it. Most likely you’re reacting to one of the following:

1.It seems like everyone you know is putting their kids on medications.

2.A teacher recommended that your child be put on medication even when you think they are normal (and they are).

3.You think that ADHD is a result of bad parenting.

You have a good reason to be concerned. But do not overreact and make the statement that ADHD is not real or smugly share the article, “Inventor of ADHD on his deathbed says that ADHD is a fictitious disease.” What he actually said was ADHD is over-diagnosed and doctors should investigate all the psychological and social reasons why the child is struggling before prescribing medication.

What I see in practice is this:

1.Parents who want a quick fix for everything (see above).

2.Parents who are desperate to help but just don’t know how.

3.Parents who are desperate to help, have tried everything and are coming to me as a last resort.

Some of my most difficult patients are #1. They get very angry when I will not prescribe medication and recommend counseling instead.

Some of my favorite patients are #2 and #3.

Most of these kids are not “bad kids.” They are struggling. They can be challenging to manage in the classroom and in the home. I am often exhausted after just a 30-minute consultation with them and their families; I can’t imagine what the parents are feeling.

My first discussion is generally walking through the non-medical tools we can use for ADHD. I can plug the families in with a good counselor. I can talk about what medication can do for their child, as well as the possible side effects, but I never prescribe medication as a first treatment.

The satisfaction that comes from seeing a child, who is struggling in school and at home, respond to either non-medical or medical treatment is amazing. I do not care what brings about the results, the goal is results.

So, please stop saying ADHD doesn’t exist. Stop sharing articles without knowing the true story. It’s insulting to me but, most importantly, it’s insulting to parents who are simply working hard to do the best for their children.

Sincerely,

Justin Smith, M.D.

“Mom, my legs hurt.”

It wouldn’t be so concerning except that it’s happening four nights a week, for months. Right?

So, what do you do?

• Scream (or sweetly say), “Your fine, now get back in bed!” Confidently roll over and go back to sleep.
• Pull the child up into bed with you and worry till they go to sleep, then scour Google trying to figure out what the heck is going on.
• Take them back to their room and massage their legs until they are able to go to sleep.

Growing pains…

• Are not really because of growth but we’re not really sure why they happen.
• Are located in the legs, sometimes in the arms.
• Occur at night (bedtime or 1-2 hours into sleep) or with activity.
• Occur at ages 3-6 years of age and again at 8-12.
• Are concentrated in the muscle and not the joints.

You should be more worried when there is..

• Swelling or redness
• Associated fever
• A limp
• Pain is consistent throughout the day

What do you do to treat your child?

• Reassure them that everything is OK
• Massage
• Warmth (heating pad)
• Ibuprofen if severe pain

“When a child plays an electronic game and receives frequent intermittent rewards, their brains release dopamine – a neurotransmitter that is closely related to reward motivated behavior,” said Lisa Elliott, Ph.D., a licensed psychologist and manager of the Cook Children’s Behavioral Health Clinic in Denton. “In school or in other social situations, a child does not normally receive these rewards, making it more difficult for them to stay focused in a non-technology based situation.”

Elliott believes this is a factor contributing to the recent rise in ADHD. She said she is concerned about gadgets, especially video games, and what they could be doing to harm our children.  By allowing so much focus on technology and mobile devices, children aren’t learning to hold their attention without some type of reward.

Whatever the cause is, Elliott offers four simple ways to prevent the damage that gadgets could be causing your child:

1.Remove any screens from the bedroom.

2.Pay attention to the content your child is viewing, especially violence.

3.Set limits on screen time each day. The American Academy of Pediatrics recommends screens be kept out of kids' bedrooms and children should be limited to less than two hours per day of screen time. For children under 2 years of age, all screen media exposure is discouraged.

4.Create healthy playtime such as outdoors or being active.

These simple changes may make the difference in how your children perform this school year.And while your kids may be upset now, they'll thank you later.

About the source

Lisa Elliott is a licensed psychologist and clinic manager of Cook Children's Behavioral Health, located at 3201 Teasley Lane, Ste. 202, Denton, TX 76210. To make an appoinment with her, call 682-885-3917.

About the author

Caroline Gayler volunteers in the public relations department at Cook Children’s Health Care System. She is a senior at TCU majoring in Strategic Communications. 

For many families, the summer means boating and swimming season. But it can also mean danger, as one of the worst drowning weekends of the year. Please take these extra precautions for a safe, fun holiday.

1. Don’t drink and drive. This takes on dual meaning, both on the road and in the water. According to the Texas Parks & Wildlife website, open containers on boats are legal, but operators of boats are subject to boating while intoxicated laws, the same as driving a vehicle. “Operators or passengers may also be subject to public intoxication laws. Drinking and boating is DANGEROUS and the cause of most boating fatalities,” the site said.

2. You also need a license. You need to know how to operate your boat, just like a car. The course is $20. In Texas a person cannot operate a windblown vessel over 14 feet in length, a motorboat with more than 15 horsepower, or personal watercraft unless he/she:

• Was born on or after September 1, 1993 and has passed a boater education class or equivalency examination prescribed by the department.
• Is 18 years of age and can lawfully operate the motorboat and is on board the motor boat when underway.
• Is at least 13 years of age and have successfully completed a boater education course approved by the Department.

3. Kids don’t get on a personal watercraft without an adult. Children under 13 are specifically prohibited from operating a PWC unless accompanied on board by a person at least 18 years of age.

4. Life jackets are an absolute must!! Everyone on any watercraft at the lake should be outfitted with a jacket. When selecting a life jacket, size matters. Learn more from the Texas Parks & Wildlife site.

5. Teach your kids to swim. Drowning is the leading cause of unintentional injury-related death in children ages 1 to 4 years old and the second leading cause of unintentional injury-related death for ages 1 to 14. Whether if it’s in a lake or a pool, your child needs to know how to swim. Learn more today or start them on swim lessons this weekend.