The Importance of Tourniquet Training

When Emery fractured her leg, the biggest threat to her life was blood loss. That’s the case for the majority of major trauma victims, according to Brad Maddy, a physician assistant who has worked in Cook Children’s Pediatric Surgery and Trauma department since 2023. 

Between 30 and 40% of deaths from traumatic accidents are due to hemorrhage, or blood loss, Maddy explained. Trauma victims can die from blood loss in three to five minutes, before medical professionals have time to treat them. When someone is bleeding out, every minute counts. 

One of the easiest ways to lower the risk of someone bleeding to death is through applying a tourniquet, a device that wraps tightly around a limb to slow or stop bleeding from an injury. This is the device that firefighter Hanetho applied to Emery’s leg. According to Cook Children’s doctors who treated Emery, doing so likely saved the girl’s life. 

Stories like Emery’s are why Maddy’s goal is for everyone to know how to use a tourniquet. 

From 2002 to 2007, Maddy was a field medic in the army. For almost the entire five years, he taught soldiers how to apply their own tourniquets through a program called Combat LifeSaver. That program later morphed into Stop the Bleed, a Department of Defense-backed initiative that aims to teach bystanders how to treat traumatic injuries involving severe bleeding until first responders arrive. 

“You can train the entire medical staff on treatment of post-traumatic hemorrhage, but that doesn’t help 30 to 40% of your patients,” Maddy said. “Stop the Bleed gives us the chance to put the tools and training in the hands of bystanders who are right there; a parent, a sibling, whoever. Somebody who can actually make a difference before the trained professional arrive.” 

The Stop the Bleed initiative at Cook Children’s started in 2019; Manager of Injury Prevention Sharon Evans has been providing the course to Cook Children’s employees on a quarterly basis since 2019 in conjunction with the Active Criminal Event course. However, trainings tapered off during the COVID pandemic. Maddy led the training initiative in March of 2025 with support from Evans and the Injury Prevention Team. 

In February 2025, Maddy began targeting Cook Children’s Medical Center employees to take the Stop the Bleed class. From February 2025 to January 2026 Maddy and team have led 36 training sessions for more than 400 employees. Alongside co-sponsors Fort Worth Fire Fighter Charities and the Fort Worth Fire Department, members of Cook Children's Trauma Department provide Stop the Bleed Classes to Cook Children’s employees and any other community members interested in knowing how to prevent deaths from uncontrolled bleeding. As of January, there have been at least five sessions in the community with plans to expand opportunities in 2026. 

On Sept. 10, Maddy led one such training for 13 people in a conference room at Cook Children’s Medical Center - Fort Worth. He opens with a PowerPoint presentation and clicks through pictures: a car, a bike, a broken window, a saw, a propeller -- everyday objects that can become deadly in the right circumstances. 

Over the hour-long course, Maddy walks us through what to do in an emergency situation if someone - including ourselves - is bleeding profusely. We learn how to apply pressure to wounds and what materials to use to do so -- something absorbent but not bulky, like a bundle of gauze, a handkerchief or strip of clothing, not a towel or blanket. On a flesh-colored cylinder riddled with gashes and fake wounds, Maddy demonstrates how to pack a wound, how much pressure to put on it and, lastly, how to put on a tourniquet. 

The process is straightforward, intuitive and simple. I had never even held a tourniquet before the training, but by the end of the hour, I could confidently do so in about a minute. 

Full Circle: A Heroic Reunion and a New Mission to Help Others

After three weeks, Emery was able to leave the hospital. The threat of losing her leg had not completely passed, but within a few months, her recovery took a turn for the better. By September, she was able to go swimming. And during an interview in August 2025, the soon-to-be freshman said her physical therapist told her she might be able to play soccer again within a few months. 

“Thankfully, all the wonderful people here at this hospital made it happen,” Brown said. “I’m very thankful she was taken here.” 

The firefighters who helped save Emery’s life were relieved to hear she had recovered so well. 

“Makes you feel pretty good, that we were able to make it to where she doesn’t have any debilitating injuries in the future and she’ll be able to get back out there and be a normal kid again,” Hanetho said. “I think everybody has that sense of wanting to do good for the community. I watched my father do it for many years so I just enjoy helping people.” 

On Nov. 20, Emery and her mom formally met the firefighters who saved Emery’s life. Cook Children’s presented the firefighters with Certificates of Recognition for outstanding care of a pediatric trauma patient. 

It wasn’t until Emery was about to leave the hospital that she and her mother learned about the Stop the Bleed program, and how it teaches everyday people to save lives the way Emery’s had been saved. 

The trauma provider who was working when Emery arrived at the hospital told them he had immediately recognized the tourniquet on her leg; it was the same kind of tourniquet the Stop the Bleed program distributes to local fire stations and schools. Emery and her mom immediately decided to take the training. 

“I didn’t know something that simple could save somebody’s life,” Emery said about the tourniquet. 

Brown encouraged everyone to take the training. She said you never know when you might witness a car crash, face a loved one getting injured or be hurt yourself. 

Emery’s experience at Cook Children’s also solidified her dream of becoming a nurse. She hopes to volunteer at Cook Children’s and eventually help other kids the way Cook Children’s staff helped her. 

“It seems cool to help people,” she said. 

Emery’s case is just one of many where a tourniquet meant the difference between life and death. 

For Maddy, Stop the Bleed is a way to not only serve kids at Cook Children’s, but to potentially help children in the entire community. Cook Children's promise, he said, is not limited to the children within the hospital walls, and Stop the Bleed is one way to fulfill that promise for all children in our community. 

If you’re interested in taking the Stop the Bleed training, you can email bradley.maddy@cookchildrens.org or jay.pearson@cookchildrens.org for the next available dates or visit www.stopthebleed.org for area course schedules. 

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.

Cook Children’s is here to help, know you are not alone. We are providing resources below to help support you and your child. Talking to one another and seeking assistance is a vital first step in healing. 

• If your child needs additional support, please reach out to your child’s pediatrician. We have lots of resources here: https://www.cookchildrens.org/health-resources/mental-health/
• You can also access local mental health resources for your family 24/7 through MHMR by calling 1-800-866-2465.
• To learn more about Cook Children's behavioral health services or to schedule an appointment for your child, contact 682-885-3917.
• The Parent Pass app also has many resources for families: https://apps.apple.com/us/app/parent-pass/id1597475361

Social Media posts: Please feel free to share these resources from our Instagram, Facebook and LinkedIn pages.

“I dropped off Avyee and asked my dad if I could go one more ride,” Wyatt recalls.

Jimmy agreed. Wyatt drove to a new subdivision, where many of the homes were still being built or were vacant. The road was unpaved. Wyatt hit loose gravel while making a sharp turn, causing his golf cart to tip over. The cart landed on his foot, causing severe injuries.

“I was yelling for help,” said Wyatt.

The accident happened in front of a home where a family had just moved in that day. The mother there picked up Wyatt and rushed him to his home. As the unfamiliar car pulled up with Wyatt, Avyee rushed inside to tell April.

“I got outside and just saw this stranger holding Wyatt like a baby, and Jimmy wrapping his feet in a swim towel,” April said.

Jimmy sprang into action, grabbing his car keys and rushing him to the local emergency room, where Wyatt was stabilized and transferred to Cook Children’s Medical Center-Fort Worth.

The 11-year-old’s innocent evening stroll ended with scattered road rash along his side, three broken bones, and two ripped tendons.

April shares that it was not until the next day, when they met with the plastic surgeon, that they realized the severity and trauma their family had endured.

“I realized this is our new reality right now,” April said. “We’d have full days of surgeries, with doctors and nurses constantly in and out.”

During the first few days, the Hatchers were overwhelmed with friends and family pouring in to tend to their two youngest children at home. Their youngest was just 8 months old and breastfeeding. It was then that she realized the trauma affected her whole family.

She recalls one moment in the hospital where she was caring for Wyatt and his baby brother, Bodynn. April explained to Wyatt that while the trauma happened to him, it affected everyone.

She told him, "You must be patient versus expectant. We are all learning new things."

“It was a hard lesson for him, and just a beautiful opportunity to remind him that he was the one in the hospital bed, but it was changing all of our lives,” April said.

In the two years since the accident, Wyatt has undergone 11 surgeries and one tendon release. Wyatt's last tendon release surgery with a podiatrist will be when he is 18.

He says it was the words of an anesthesiologist that helped him face those surgeries head-on.

“He said, ‘When you face a challenge, you have to meet it, greet it, and then defeat it,’” Wyatt recalls.

Camp RISE

The family came to know their Cook Children’s child life specialist well. She suggested they attend Cook Children’s Trauma Support Group. Through the group, they learned about Camp RISE, a camp focused on families who have experienced a traumatic event. The camp helps families build coping skills, process trauma, and meet other families, all while taking part in fun activities like zip lining.

“It was an escape from the city life,” April said. “Being out where the stars are so numerous and it's just an oasis, and it’s just such an excitement.”

As the Hatchers arrived for their first day of camp, they were greeted with cheers and welcomed to their private cabin. Avyee, Bodynn, Wyatt, Jimmy, and April were excited for the experience.

Wyatt admits his favorite part of camp was archery, but during his second year, he felt compelled to encourage other children through their trauma. He credits Matthew 17:20-21 for finding that courage.

“If you have faith, faith the size of a mustard seed, you could tell a mountain to move and jump,” Wyatt recites.

To Wyatt, it was about giving hope to someone else.

“This is never going to be normal, but it will become a new normal, and it's going to be okay eventually,” said Wyatt.

After two years at Camp RISE, the Hatcher family graduated in 2024. April said it was a bittersweet moment. The family received a book signed by all the Trauma Support Group staff.

“The ripples were extensive, in what they had us do,” April said. “It’s just a scaffold to bring such healing.”

Just two weeks after the accident, wound vac and all, Wyatt used the anesthesiologist’s wise words to conquer any fears or hesitation he had about getting back in the golf cart. His dad placed him in the seat and gently drove him around the front yard, eventually taking him on the road.

Two years later, at 13, he shows his scar without hesitation. He openly shares and explains the accident with maturity.  

 For Wyatt’s 13^th birthday, he wanted to see starfish and swim with the dolphins. It was being with the dolphins that captivated him. He now has aspirations of becoming a Marineland dolphin trainer.

During that birthday adventure, April says Wyatt found his voice. On his own, while his parents watched, the 13-year-old had to explain to employees and the dolphin trainer why he wears a scuba sock on his injured foot. A scuba sock was something dolphins had never seen before. The trainer told Wyatt he would teach the dolphin what the sock was.

"It was the coolest moment for our kid," April said. "He just walked away with so much more confidence."

Recognizing the need for support during this difficult time, Cook Children's physicians have come together to offer guidance and reassurance. Cook Children's Licensed Psychologist and Prosper Psychology Clinic Manager Christina York, Ph.D., provides valuable advice and guidance for parents navigating this sensitive situation. 

1. How do I help my teen make sense of something so senseless? 
When traumatic situations occur, we naturally want to make sense of them quickly. But when situations don’t seem to make any sense, it can help to think about what we can learn from the experience. 

2. What are the common signs of trauma in teenagers after witnessing or hearing about a violent event?
Teenagers who have experienced trauma may show several common signs, including:

• Trouble sleeping or nightmares 
• Feelings of sadness, helplessness and hopelessness 
• Difficulty concentrating, which can affect their schoolwork 
• Increased fear and anxiety 
• Loss of interest in usual activities 
• Social withdrawal 
• Avoiding things that remind them of the event (like talking about it) 
• Changes in appetite 
• Physical complaints such as stomachaches and headaches 
• Acting out 
• Feelings of anger, resentment or wanting revenge.

These reactions will generally subside over time. If they last for longer than a month or continue to worsen, parents may want to contact a mental health professional. 

3. If my teenager witnessed a traumatic event, is there anything I should look out for? How can I support them?
Pay attention to sudden changes in your child's behavior, speech patterns, and the way they express themselves, as well as strong emotions. Be particularly aware of:

Academic and Social Changes:

• Drastic drop in grades 
• Refusal or reluctance to go to school 
• Loss of interest in usual activities 
• Social withdrawal and increased isolation (which may include feeling numb and disconnected from themselves and others) 

Sleep and Emotional Reactivity Changes: 

• Changes in sleep patterns (difficulty sleeping, sleeping excessively, deliberately staying awake, frequent nighttime awakenings) 
• Increased reactivity (sudden mood swings, being easily startled and on edge, and/or quick to anger or tears). 

Support them by listening attentively and validating their feelings, even if you don’t agree with their emotional response. Instead of reacting negatively, try reflecting back what you hear them saying (for example, "It sounds like you're feeling scared and angry right now"). You might be surprised by how much they open up when you reflect instead of asking questions. Ask them directly how they're feeling and what they think about what happened. Always respect their choice to talk or not talk about the traumatic event. 

4. When should I seek professional help for my teen? 
If any of the signs of trauma listed above continue or worsen after two to three weeks, seeking professional help is advisable. Furthermore, any expression of suicidal thoughts is a critical warning sign requiring immediate professional attention. Additionally, engaging in risky behaviors like substance use, possibly as a way to avoid thinking, talking, or coping with the trauma, is another behavior that should be addressed quickly by a professional. 

5. How do I help my child process all of their emotions? 
First, be patient and never force your child to talk. Think of it as gently opening a door, not pushing it open. Reassure them that whatever they're feeling—sadness, anger, confusion, fear—is normal. If they don't want to discuss the traumatic event directly, encourage other forms of expression like drawing, journaling, music, art, or physical activity. 

Understand they might find it easier to talk to another trusted adult, such as a pastor, youth leader, teacher, counselor, coach, relative, or neighbor, and don't take it personally if they do. 

When your teen does decide to talk to you, ask how you can best support them: by simply listening, offering feedback, or helping to problem-solve. Be ready for any emotion they express and validate it without showing displeasure, anger, or frustration, even if it's unexpected. Instead of asking many questions, let your child guide the conversation and use open-ended questions. Remember that silence is acceptable; when they are ready, they will talk. 

6. What should I do if my teen is experiencing nightmares or flashbacks? 
Nightmares and flashbacks are common after trauma. If these symptoms continue for more than a couple of weeks, it may be helpful to seek help from a therapist experienced in trauma. Again, don't force your child to talk about nightmares. If they are experiencing a flashback, avoid startling them (like shaking or yelling). Instead, speak calmly, sit with them, and allow the flashback to pass.

7. What are some immediate coping strategies I can teach my teen to manage anxiety and fear?
Immediate coping strategies include: 

• Deep breathing: Slow, intentional breaths
• Grounding: Focus on your five senses to bring yourself to the present moment 
• Distraction: Engage in activities like holding ice, listening to calm music or watching something lighthearted 
• Physical activity: Movement can help release tension 
• Get creative: Activities like drawing or writing can provide an outlet for feelings. 

8. How do I help my teen feel safe again? 
Provide them with reassurance. Limit their exposure to repetitive news coverage on television, radio, and the internet, as this can prevent them from emotionally detaching from the traumatic situation. 

Talk with your teen about what they have seen or heard. Help them identify and focus on “cues of safety” in their environment, such as trusted people, rather than solely focusing on potential dangers. 

Because they may feel a loss of control, help them focus on what they can control, such as their choices, their bodies and their daily routines. Sticking to routines can provide a sense of predictability and stability, which is especially helpful when life feels unpredictable and chaotic. 

9. How can I address my own anxiety and fear without transferring it to my teen? 
Parents, please remember you are not alone. Talking with your partner or a trusted friend can alleviate your anxiety. Consider seeking your own individual therapy. Additionally, support groups for parents may be available through mental health clinics, churches, or other community resources, offering a space to connect, discuss fears and learn coping strategies. Taking care of your own well-being shows your children that seeking help is valuable. 

We encourage parents to engage in activities they enjoy, utilize helpful coping skills like deep breathing, mindfulness, meditation, physical activity, and journaling, and prioritize self-care, including sufficient sleep. It's okay for parents to communicate their feelings to their children calmly, as demonstrating their own coping skills in front of children can model healthy ways to manage anxiety and fear. 

Resources

Below is a list of resources for families, compiled by Cook Children’s physicians.

How to cope with traumatic stress
How to help children and teens manage their stress
How to Help Children Cope With Trauma - Child Mind Institute
Acute Stress Disorder in Children: A Quick Guide

Checkup Resources | Healing From the Inside Out | Cook Children's 
Behavior and Emotion Resources | Cook Children's 

The national suicide/crisis hotline (call, text, or chat options): 988 Lifeline 

In November, 10 kids were treated for dog bites, and as of December 5, two more cases were reported, according to Sharon Evans, Cook Children’s trauma injury prevention manager. The victims range in age from one to 15 years old with many of the injuries being to the face, neck, and upper body.

“We really don’t know what the increase is due to,” Evans said. “However, for the 12 bites we’ve had, we know that four were “friends’” dogs, four were family dogs, three were relative dogs and one was unknown.”

Last year, eight bites were reported in November and six in December. Evans speculates that the holiday season might be a contributing factor.

“The kids are home more and there may be more chaos in the house which causes the dogs to be on edge,” Evans said.

According to our trauma injury prevention manager, three of the 12 dog bites were from Pit bulls and three from German Shepherds. The remainder were from various breeds.

Data from the Center for Disease Control and Prevention shows dog bite-related deaths have risen from 2016 to 2021. On average, 43 deaths are reported annually. In 2016, 31 deaths were reported, while 2021 saw a total of 81.

Tips to prevent a dog bite:

·         Never disturb or pet a dog when they are sleeping, eating, or playing with a toy.

·         Try not to make sudden abrupt moves or run around dogs (they like to chase). 

If someone is bitten, Evans recommends calling 911 if the bite is severe. If it is a moderate or mild bite, contact your primary care physician or visit an Urgent Care Center.

Did you know Fort Worth ISD has a Prevention and Crisis Response team dedicated to helping teachers, administrators and students understand how trauma impacts the classroom? Michael Garcia, LPC, and Remington Pohlmeyer, LMSW, join us to talk about their small but mighty team of trauma specialists.

In this discussion, Garcia and Pohlmeyer discuss the pandemic's impact on students and how important it is to understand mental health and trauma in a school setting.

According to FWISD, the goal of the trauma specialist is to work in partnership with administrators and teachers to implement a trauma informed care approach by providing practical tools and interventions; improving academic success, healthy relationships, and emotional regulation.

Their work includes:

• Encourage trauma informed strengths
• Provide training on brain development, trauma, effects of trauma and Trust Based Relational Intervention concepts
• Provide consultations for problematic behaviors
• Provide ongoing support to the campus
• Model a trauma informed care approach to correcting behaviors

Special thanks for Laura Van Hoosier, AVP of Public Relations at Cook Children’s, for joining as a guest co-host.

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

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

Dr. Guzman, pediatric emergency medicine physician and Medical Director of the Aim for Safety Program, says that the school-aged kids who dealt with the tragedy will "definitely have long-lasting effects," some of which will include "stress, anxiety [and] their comfort level with returning to school."

Read the full story here.

Our hearts are broken and hurting for the children, teachers, adults and their loved ones affected by the devastating school shooting in Uvalde. We want to help parents and caregivers as they navigate these tough conversations and emotions.

Kia Carter, M.D., Kristen Pyrc, M.D., and Lisa Elliott, Ph.D., of the Cook Children’s Behavioral Health team discuss what parents and caregivers should know and keep in mind.

What should parents say if their children ask them about what happened in Uvalde?

Dr. Pyrc: I think it is important for parents to be honest with their kids in an age-appropriate way when they ask questions about world events. Kids have a way of asking questions that we as adults don’t have answers to. What helps me is to pause, take a breath, and ask a question like ‘well, what makes you ask that?’  Their answer can tell you what they are curious about or scared of and help guide that conversation.

Dr. Elliott: It is extremely important for parents to be open with their children and be willing to talk. Talking with your child about frightening and scary things helps reduce and manage fear. It helps them to know that their parents empathize and care about their feelings and thoughts.

Children are more anxious when they are dealing with the unknown in general so parents need to be role models to help them feel secure and safe and model sharing of feelings.  It is always better to address subjects directly rather than avoid them and be willing to start the conversation. Your child needs to know that you want to know how they are coping and that you care about them. 

Reassure and reinforce safety and security. If possible, share what you know about what your child’s school does to ensure their safety. And always be truthful – that builds and reinforces a foundation of trust. Answer questions that fit their developmental age and if you do not know an answer, it is OK to be honest, but then do what you can to help find an answer.

An additional side note that is important – kids take their cues from us as parents. They need to see that we care, and it is OK for them to see us express/experience emotion and show them that it is normal after tragic events, but we do not want to overwhelm them with our emotions. We need to model for them how to engage in healthy self-care.  

How do parents avoid feeling numb to this?

Dr. Pyrc: I am heartbroken this morning that I have to send my kid to school.

Dr. Carter: Parents are having to cope with this tragedy just as much as kids are and it's important that parents also process their feelings with other adults, support/communicate with their child's school staff and open up about their feelings and concerns. 

This is a good time to participate in school board meetings, PTA/PTO organizations and maybe forming/joining a parent support group so that parents can feel their voices are being heard and so they can have others to relate to that are dealing with similar feelings. It's also important to be a model for your child but also acknowledge and validate that some of the feelings your child is having are the same that a parent and adult can have. This is a great time to model how to deal with traumatic experiences and model that being open and talking about it can be helpful for everyone.

How does a parent reassure their kids when I can’t reassure myself that everything will be OK?

Dr. Elliott: This one is hard. We can’t guarantee to ourselves, let alone our children, that nothing bad will happen. We can provide reassurance that these tragic events are relatively rare and that we will do everything we can to keep them safe. Our children do take their cues from us and if they see us as highly anxious they will feel more anxiety. Do your best not to project your fears onto your children. It is critical we engage in and model self-care.

Dr. Pyrc: For young elementary-age kids, they are pretty concrete so reminding them of your school's safety features, which may include locked doors and a school safety officer who will protect you, can be helpful. If my daughter is anxious, I will probably walk her to the door of the school where she knows the doors will lock and pick her up after school to help. Older kids will poke holes in the logic that locked doors and a safety officer can keep kids safe, and I think it’s important to acknowledge that. I would walk them through worst-case scenarios and problem-solve the best way to get themselves to safety. Even though most parents will feel overwhelmed by this conversation, honestly as they should, I think it’s important to remain calm ourselves because our kids will look to us to determine how much anxiety they should have.

What are the different responses for elementary-aged children vs teens and high schoolers?

Dr. Elliott: As noted above, parents need to be willing to talk about this, even if that means they bring the conversation up. Bringing up the subject may be different for different ages.

With middle school and high school kids, it is often best to ask them directly. Share that you care and want to know what they know about the event, how they feel and how you can help.

With elementary school kids, you may have to share that something tragic has happened, ask if other students/friends are talking about it and encourage them to talk to you.  For young children, it is best to be brief and give limited or simple information – answer their questions but do not give too many specifics or too much detail.   

Should parents bring this up to children, if they don’t ask?

Dr. Elliott: I believe so. It is a guarantee that kids are talking about this, it will be all over social media and on nonstop news – so yes bring it up. And talking about news – every piece of research and experts will all tell you to limit exposure to media – and this is true for all ages. We know from trauma research that violent images can cause secondary trauma. And parents need to model that as well by limiting their exposure. It is also important to be mindful of adult conversations – kids are listening all the time.

Dr. Pyrc: I think this honestly depends on the age and temperament of the kid. I don’t know that telling a preschooler makes a ton of sense and would instead ask them when they got home from school how their day went and if they heard anything scary at school. I think if they are 10 or older, you have to tell them because they will hear about it from classmates. By communicating the events in a calm way, you get to support your kid and answer any questions they may have.

Can you talk about how parents should take care of themselves in order to help their kids?

Dr. Carter: Parents have to remember that in order to be the best parent to their child, parents have to take care of themselves first. This is just like the airplane scenario with oxygen masks where parents are told to put their masks on first and then help their child. 

It's important to find effective ways to cope during tragedy, which may include speaking with other parents at school, forming/joining a parent support group, and leaning on family members for support. Also exercising, meditation, and continuing your prayer/religious practices help relieve stress. Speak with their child's school counselor for advice on resources or books on supporting yourself and your family through a school-related tragedy.

Dr. Pyrc: I think it’s very important that parents acknowledge their own anxiety about sending their kids to school today and sadness about what happened. Sometimes when we have a national tragedy, there will be 24/7 news coverage of the event. It’s easy to obsess about all of the details and be glued to our TV or phone, but I don’t think this is helpful for our mental health. I would put a time limit on the amount of time I spend reading up on the event. When your mind wanders back to questions about the event, remind yourself that you have 20 min after dinner to read up, and after you catch up on the event, put down your phone and connect with people you love.

There has been a lot going on in the world, such as war, the pandemic, mass shootings and inflation. Can you talk about how important it is to empathize with your children, even if you might not have all the answers to a tragedy like this?

Dr. Elliott:  I have used this story/example so many times when I have worked with children/teens who have witnessed or experienced tragic events from school shootings to tornados. It is the story that Fred Rogers from Mister Rogers shared about his mother. She told him to “always look for the helpers” in times of sorrow, tragedy, fear and anxiety because if you see the helpers you know there is hope.

Dr. Pyrc: The best thing you can do for yourself and your family is to connect with them, tell them you love them, and hold them a little tighter because we are grateful they were able to come home.

Ways to help and ways to find support:

National Parent Helpline run by Parents Anonymous to get emotional support from a trained advocate: 1-855-427-2736

Tragedies such as these highlight the importance of donating blood. Giving blood supports nearby hospitals and rebuilds their supply for patients. Click here to sign up to donate blood at your local Carter BloodCare. 

The next blood drive at Cook Children's is set from 8 a.m. to 6 p.m. on Tuesday, June 14. Register for a time slot here.

Information from the National Association of School Psychologists about tips for administrators and how parents can talk to children about violence.

Ashley Igo was just 8 years old when her world changed forever. She was riding in an Amtrak train car when a semi-truck tried to speed through the crossing. She lost her mother, two friends, a niece and her right foot in the traumatic accident. For years, Ashley suffered from severe anxiety later diagnosed with PTSD. Today, she is a licensed psychologist and registered play therapist, and is passionate about early intervention after trauma.

Learn more about Ashley and the charitable work she does through the Beautifully Flawed Foundation and the Lauren Scruggs Kennedy Foundation here.

Ashley is our guest for episode 7 of the Raising Joy podcast. Here is her conversation with Wini King, Chief of Communications, Inclusion, Equity and Diversity at Cook Children’s. and Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s :

Wini (00:05):

Stress, anxiety and depression are skyrocketing among children and teens and Cook Children's Health Care System is on a mission to bring these topics into the light. I'm Wini King.

Dr. Pyrc (00:16):

And I'm Dr. Kristen Pyrc. If you have kiddos in the room, now is the time to put on those headphones. Some of the topics we'll be discussing will not be suited for young years. This is Raising Joy.

Wini (00:32):

Hello, and welcome back. We're so glad to have you back on this episode of Raising Joy. One of our first episodes dealt with trauma and how childhood trauma messes can sometimes mess with mental and physical health. It really kind of throws the equilibrium off of the health.

Dr. Pyrc (00:56):

Absolutely. And we talked about the ACEs study with Dr. Hood Patterson and I just thought she did had a really good job of explaining that to us. And I think that there are all different kinds of trauma. She had lost her dad in her front yard. And that totally changed her life as a teenager. But I think that there are other kinds of trauma that we see and I think that there is some trauma in our society right now just watching the news.

Wini (01:22):

We're seeing it now, as you watch the events of Ukraine open up and just unfold. And now the photos and the video it's becoming so much more graphic. And while of course, my trauma is not their trauma by no stretch of the imagination. It is something that if I look yet long enough, I feel the effect. And so trauma is something that we tend to push down, push down, push down, but that stuff can bubble up and come back. And when we talk about ACEs, I didn't even realize I had about five or six of them.

Dr. Pyrc (02:00):

A lot of people are learning that.

Wini (02:02):

You're like ‘I got to keep my head down, I have to do this. I got to make sure I do that.’ And so you wanna push it down. Today, we are joined by someone I would like to just refer to as a trauma survivor who embodies the word resilient.

Dr. Pyrc (02:21):

Absolutely. So Ashley was just 8 years old when her life changed forever. It set her on a course to help countless others. Ashley, thank you for being here.

Ashley (02:32):

Thank y'all for having me.

Wini (02:32):

Thank you so much. So now that we've set this up, trauma lives around you or has been a part of your life. Tell us about that day.

Ashley (02:43):

The day of the accident, so a little bit of background. A big deal for 8-year-olds and adolescents is the American Girl concept. So my friends and I were obsessed with the American Girl series and so my mom had me and then her best friend had three girls. And so they planned a spring break trip to Chicago to the American Girl store. It was amazing. And instead of taking traditional transportation, we took an Amtrack train and that was cool and exciting. And kind of all the things that go along with new experiences. So it was a really, really cool trip. We spent a week there exploring Chicago and going to the American Girl store.

(03:34):

On the way back, we were headed back from Chicago on our way home to Memphis, which is where I'm from. An 18-wheeler tried to beat the crossing arm of the railroad track. And so, he did not make it. Our train collided with the 18-wheeler. Twelve people died in the accident, hundreds were injured. And I was the only person to survive in our sleeper car. So everyone that I was within my particular car passed away. So my mom, my two best friends and my niece all passed away and my right foot was amputated in the accident.

Dr. Pyrc (04:18):

Oh my goodness. Ashley, I'm so sorry.

Ashley (04:21):

Yeah, it was a lot for sure.

Wini (04:23):

That's a traumatizing situation for an 8-year-old girl. How did, after all that happened, how did that change and how did that affect your life?

Ashley (04:33):

Kind of to put it in a nutshell, I kind of look at healing in three different ways. Personally, first is physical healing. So after the accident kids by nature are physically resilient. I actually went to one physical therapy session. I was like, ‘this is boring.’ And I taught myself how to walk on a prosthesis.

That part kind of was pretty quick. Spiritually, my faith, it was and is still really important to me and I had a great community surrounding me. And so prayer and faith in the Lord really strengthened me during that time.

The mental health piece is something that was not cared for. Not out of, it wasn't my dad's fault, but being a single dad, he didn't really pay attention to that piece. And it was like the late ‘90s, like who cared about mental health, then?  

Wini (05:26):

OK. The physical, the spiritual that's done, onto the next.

Ashley (05:29):

Right. So everyone looked at me and assumed like, 'oh wow. She can walk. She can run. She's doing great. She's totally fine. She's healed. Let's go, let's move on with this, you know, lone survivor, powerful kid.' 

I will say my dad took me to one therapy session with an older gentleman who was not a play therapist. And I sat on his couch and he asked me some questions. I told my dad that I didn't like it. And I never went back. And so I lived with unresolved trauma for decades before it was ever addressed.

Dr. Pyrc (06:04):

I think what's hard too about your situation is its trauma and grief.

Ashley (06:08):

Mm-hmm. Exactly.

Dr. Pyrc (06:09):

I think that just makes it even more hard.

Ashley (06:12):

Exactly.

Wini (06:14):

Trauma and grief together.

Dr. Pyrc (06:16):

How did you figure out, like, ‘Hey, maybe there's something else like maybe I need,’ or how did you see the trauma kind of bubble up for you?

Ashley (06:27):

Like I said, I kind of assumed that I was healed on all fronts until really my early twenties. So, I had looked back, so the anniversaries of the train wrecks over the years were not super significant. But the 10-year anniversary, for some reason, I was like, ‘wow, it's been 10 years since this train wreck, I'm gonna go on YouTube and see if there's any coverage.’ Because I had been contacted by some news agencies out of Chicago, just kind of following up 10 years after the accident.

And since then, it's 20 years after. So I was like, let me look at just some footage and just see from that day. And so that as you're talking about imagery can be extremely triggering. And I found this YouTube montage of the accident that I was in that I had never seen before. So the imagery kind of sparked kind of flipped on this switch that I had not flipped on. And long story short, it kind of launched into this whole kind of spiral of PTSD symptoms and debilitating panic disorder.

Wini (07:37):

You’re seeing this, even from a different perspective, because you experienced the train wreck, but seeing it from a video standpoint, now you're seeing things you didn't see.

Ashley: Right.

Wini:

Things you didn't remember from a perspective that was not what you experienced, you know what I'm saying?

Ashley: Yeah.

Wini: It was different.

Ashley (07:56):

It looked honestly a lot worse on the video footage, like the fire, the flames, screaming, just the horror of it. I had survived it, but I hadn't actually seen it. And so that triggered a years-long battle with anxiety disorder.

Dr. Pyrc (08:14):

Absolutely. I could definitely see how that would trigger that. So just to help me understand a little bit, so do you think you ever had any PTSD symptoms after it happened, like nightmares or flashbacks?

Wini (08:29):

Now that you think back?

Ashley (08:30):

Yes. Now that I think back, and now that I specialize in play therapy and childhood development, I can pinpoint, ‘oh my gosh. That OCD tick that you had was a side effect of unresolved trauma and grief and anxiety.’ I mean, I definitely had OCD and panic growing up intermittently and it looks different in kids than a dozen in adults.

And so my dad, single dad now running this bed and breakfast -- that was my mom's dream. He was running it by himself because she died. He didn't see it. So I just kind of brushed everything, shoved it down, pushed it down. And now looking back, it's like, 'oh my gosh, there were so many warning signs. I didn't deal with them.'

Ashley (09:17):

And so what I've learned through my study in psychology is that, and there's this book it's called ‘The Body Keeps the Score’ is that our body holds on to experiences. Even if we don't process them verbally, trauma lives in the right hemisphere of the brain and actual neuron clusters and it takes in-depth therapy. 

In my case, I did EMDR, which is eye movement desensitization and reprocessing. It's essentially just for PTSD. I did that. I did years of it, in addition to talk therapy, in addition to medication and I would say I still struggle with anxiety and panic. I still have those thoughts, but I don't I don't become immobilized by them. They don't make my life dysfunctional anymore. So yeah, I've learned a great deal. That's why I'm a therapist.

Wini (10:11):

Wow. Did you ever go back to the, EMDR, you went back?

Ashley (10:16):

To EMDR in my twenties, yeah. So I took a decade-plus hiatus from therapy that I needed. I didn't deal with these things until I was in my early twenties.

Wini (10:28):

How did you decide this is what I wanted to do? And this was the best thing for me?

Ashley (10:33):

So I studied psychology ironically enough at SMU, so it had some kind of basic like, ‘oh, the green lights were going off’ in college. It is interesting. Then I kind of through a pathway of individuals became really interested in therapy. I knew I wanted to work with kids. And so, through my master's program at SMU, I really started kind of realizing, I was learning about myself and did research and just kind of was like, ‘OK, I need to do this specific therapy.’ And I found a therapist and kind of went from there. It was a lot of through my own education, I was kind of my best advocate from a mental health standpoint.

Dr. Pyrc (11:21):

That's amazing. Well, it's awesome. I mean, I think that whenever you have trauma and the ‘shove it down’ is survival. Like that is a survival mechanism. ‘Hey, I went through something really bad and I need to get through the day, how do I do that?’ We call it compartmentalization. Kids are experts at this, but it is just to keep going every day. And so I really applaud you for being willing to like open back up the box and be willing to have a look at what is there.

Wini (11:53):

That's painful.

Ashley (11:53):

Painful. It's painful and tough. I mean, I really got to the point where I was in therapy or I was in grad school to be a therapist. And I realized that if I did not deal with my own issues, I could not help other people. So, it was kind of, honestly, by force, I got to where I was having such horrible panic attacks that I couldn't focus. So it was like, 'OK, I've got to do this.' And I did it and it is uncomfortable. It's hard. I mean, it's not fun to feel like that and to kind of face those traumas again, because you're reliving everything. But in the end, your brain is more where we're able to integrate trauma into our lives and make it a part of our story versus just shoving it down.

Dr. Pyrc (12:41):

Absolutely. You've mentioned being a counselor and a play therapist so like how did that come about? Like how'd you figure that out?

Ashley (12:49):

Yeah. So I have always in a sense, wanted to help people and I really became passionate about early intervention when I learned about kind of my own issues and how those could have likely been prevented to some extent, with some play therapy or therapeutic approaches that were appropriate for my developmental stage. 

So I was like, ‘OK, clearly kids need prevention for, or early intervention, with the goal of prevention, essentially.’ So we want to prevent them from experiencing these debilitating issues. Let's get them early. So that's what kind of made me want to work with kids and want to work with play therapy specifically. It's kind of preventing. I would say you don't want to become me. We want you to process this as a 7-year-old versus when you're 25.

Wini (13:50):

But it seems like to me it would be so much harder to deal with a 7-year-old who can't really communicate and who really can't articulate what's going on, as opposed to a 25-year-old who can say, ‘boy, this is painful for me.’ You know, as opposed to that child. It seems to me that one, and I'm looking at Kristen like you do this every day. So it would seem to me harder to deal with as a younger child.

Ashley (14:11):

In a sense, but think about it, like if you go the same way to work every day, it's so much harder to learn a new way. Right? Whereas kids, we can teach them, we can form those neural pathways in a positive. Versus going back and trying to erase the old road and starting a new one. So as adults, we are more stubborn and it actually can take a lot longer and it's harder, to learn new skills.

But if we teach kids like, ‘Hey, it's okay that you feel this way, we accept your feeling and we reflect your emotion.’ And so I always say we accept the feeling. We do not always accept the behavior. For example, when I was growing up, my stress and anxiety came out a lot as defiance and kind of not great behaviors.

Ashley (15:02):

My dad would probably say just smart aleck. But really on the inside I was hurting. Right. I missed my mom. I was lonely. And so I wish that I had had coping skills to implement at a young age, so that those behaviors did not even present themselves. So I'm really passionate about teaching kids, coping skills early. Acknowledging that this is what you're going through and that's OK. And let's help you process through it versus let's just shove it down and make it part of your personality. Right. When you're an adult.

Dr. Pyrc (15:37):

I think that's really key, like exactly you're saying like we can create new, more positive, coping strategies because sometimes trauma and abuse can lead to really negative coping skills. I see it a lot of my practice, like lots of cutting, just horrible self-esteem and that, it just affects everything, like how they interact with the world, what they think they can do whenever they grow up, how they pick a partner, like all these kind of things.

And so I think you're absolutely right. That teaching them, ‘Hey, you have these symptoms here is how to help it.’ I think it also so helps. I think left unchecked and untalked about, the trauma gets bigger and bigger and scarier. Yeah. And harder to deal with but it's like, if, if the message from adults is, ‘Hey, actually you can do this and we're gonna help you.’ It gives the kids a sense of control. And I think that that's ultimately what they need to be successful and to feel good about themselves.

Ashley (16:33): I agree.

Wini (16:34):

Wow. Yeah.

Wini (16:35):

We were talking earlier about how, when you experienced this kind of trauma and I've said it before that I would probably curl up in the middle of the bed and you would never be able to get me out, but the fact that you were out of a space that said, ‘but I want to help, I want to do something different. I want to actually impact in a positive way.’ How does that occur? Because honestly, I know I would have a different approach. I promise you, I would, it would be something totally different, but what happens to your brain that makes you want to do something positive and to really make it better? As opposed to me just lying down and curling up in the middle of the bed?

Ashley (17:20):

Man, that's the million-dollar question. I'm not exactly sure. But  I do, again, like my faith is very important to me, so I see it as thank you Lord for your grace and, and letting me be kind of where I am today, but there's so much good and empowerment that can come in helping other people. And I think even my teenagers who are depressed, like one of them told me that she had this new thing where instead of cutting herself, she was gonna draw a pretty flower on her arm. And so I shared that with another teen who was struggling with depression, and I told the first teen whose idea it was, ‘Look, I shared your idea with somebody else. And it really helped her.’ Wow. And the, her face was it lit up. So just, it's so empowering to use your pain to help others.

Ashley (18:08):

And so I just kind of took that mentality and have been blessed enough to be able to use it in multiple areas, whether it's with amputee or mental health kind of things in my life. And so I think the Lord has given me really great opportunities to do that, but I think it also runs in family. So my mom was a super resilient person. And so I look back and think like, ‘OK, this is kind of a girl power kind of trend in our family.’ But I don't know, it's the grace of God, honestly, because it's nothing that I specifically did.

Dr. Pyrc (18:47):

Right. I have to disagree you know, because like you could have said, ‘I lost my mom’ at a time whenever girls really need it. And I'm mad, I'm frustrated and I'm gonna go the route of like every negative choice that you could make, you know? But I think what it says so much about you that you said ‘hey I’m gonna heal first and then I'm gonna help people.’ I just think that says so much about your heart and your character and resilience and being a strong person. It says to me also that your mom is amazing.

Ashley (19:21):

She was, yeah. I think she'd be pretty proud.

Wini (19:23):

I think so too.

Dr. Pyrc (19:24):

She would be so proud of you.

Wini (19:26):

She is. She is proud. She is. And, probably somewhere hovering. You know, around to kind of give you that, ‘okay, here, tapping on the shoulder, do this, do that.’

Ashley (19:36):

That. Well I have a daughter who's 14 months and she's named June after my mom. So I get to see a little bit of my mom every day.

Dr. Pyrc (19:44):

That's amazing. That is really cool.

Wini (19:47):

Tell us a little bit about the work that you're doing with amputees, because you are not a only helping the people in their mental health but you're helping others through work with other amputees.

Ashley (19:58):

Yeah. So I get to be a part of two really amazing organizations. The first is I am on the board of the Bethany Hamilton's foundation. It's called the Beautifully Flawed Foundation in Bethany Hamilton. For those who maybe not remember she's the soul surfer, shark attack victim. So she's a great friend and have gotten to know her through the years. And every year we hold a retreat in California called the Beautifully Flawed Retreat for amputee girls and women across the world. It is amazing. Wow. It's the best week of the year by far always. And so we just pull these girls together for a whole week in Delmar, California, and love on them. And we focus on kind of those three pieces, so physical, mental health and spiritual health and wellbeing. And we get to, you know, hold each other's legs and talk about prosthetic things.

Ashley (20:57):

I call it group therapy for the week. It's amazing. So there's that. And then I'm also I work with the Lauren Scruggs Kennedy Foundation. So Lauren Scruggs Kennedy is actually from the Dallas area. She was in a plane propeller accident years ago.

Wini (21:15):

I remember that too.

Ashley (21:16):

Okay. Gotcha. So she is another great friend and she, Lisa Curley and I run the LSK (Lauren Scruggs Kennedy) Foundation, which we provide, beautiful silicone coverings for girls and women also so the insurance piece does not cover anything on a prosthetic leg or arm to look real. So you're essentially getting a metal pole and self-esteem does not really allow for that. A lot of place for sure. So we pay for that. We pay for the beautiful piece of that prosthesis. So we actually have a recipient coming next week. I think it's our 13th one. We've been able to do some really amazing things.

Dr. Pyrc (21:57):

It's so cool because I've had patients, maybe not amputee, but who have gone through something that's disfiguring and it really is a huge, huge. Especially if it happens to a teenager. It is such a huge blow to their self-esteem because you're already self-conscious and now you're like, 'oh, look, now they're really gonna look at me.'

And so I feel like a lot of kids they just like turn in on themselves and like wall themselves out, like wall themselves off from the rest of the world because they don't want to be seen. But I think what's amazing about you having a therapy background is that you can say with your personal experiences, you can say, ‘Hey, I've been through this.’ You can actually say, ‘I know how you feel.’ You've been through it all. And I think that just puts you in such a unique spot to help a lot of people. It's amazing.

Ashley (22:47):

It can be really powerful. And I have a couple of girls in my practice who they have Type I diabetes. And so they wear, you know, the Dexcom and you know, I'll see on their intake form that they wear a Dexcom. And so I will intentionally wear like a dress that day or a skirt. And so they can see automatically that like, ‘Hey, there's something different about your body too.’ And so then it's a really cool bond of, ‘my sugars are really low today and it sucked.’ I'm like, ‘yeah, my leg is squeaking for no reason.’ Like, I don't know why it's doing that.

Ashley (23:17):

So it’s not to say that other people can't empathize, but there's something about kind of being in that shared experience of having something different about you. That is comforting.

Wini (23:29):

The last two years have been really hard for everybody. Have you seen anything, any trends, anything in your practice as a result of the last two years?

Ashley (23:38):

Yes. You know, in addition to the anxiety disorders that we have continued to see the depression, the kind of self-harm, just all the things. I would say the most concerning to me, just kind of looking back the last couple of years was the turn inward. Not only to just like, because they couldn't go anywhere where we were doing virtual sessions, was virtual school and everyone on their phones all the time.

And so the turning inward, the turning to their phone, the turning to comparison. Actually, I had a girl who had struggled with disordered eating in the past, but then I had seen her for virtual sessions for a year and then I saw her in person and she had lost a significant amount of weight. She hid it from me. During virtual sessions, she was wearing baggy clothes and, and that kind of thing. So looking back, it's just like wow, these things that were already really difficult for them have now been kind of exacerbated by certain things. And so yeah, I would say that for the most part, most of my cases right now are teenage and preteen girls. I really do see a lot of, kind of the disordered eating, making a, I don't even think it's a comeback, it's rearing its ugly head. I think that it's rough for self-image these days.

Wini (25:05):

And we've talked a lot about how long this is gonna take for us to unravel out of this.

Wini (25:11):

It's not like, okay, now we're through with the pandemic, take off your mask, keep going and, and it's all gonna be over. It's really gonna be an unraveling for years to come.

Ashley (25:23):

There are kids now who don't even want to take their mask off because they got to hide their acne when they wore their mask. So, I mean, it's a whole thing.  I think we're gonna be seeing kind of ripple effects for a while.

Dr. Pyrc (25:36):

I'm curious if – this is kind of a little bit of a left turn -- but what would you say to look an 8-year-old girl who came in your practice who had thing that changed their body? Like what would you tell her?

Ashley (25:51):

Hmm. So my gut would be to sit and sit with them in their discomfort. In whatever is making them have their, whatever, emotional kind of feelings. So parents always say, ‘oh, she has such big feelings.’ And so therapy 101 is ‘reflect the feeling.’ I'm not gonna try to fix it for you. We will sit and we can cry together and we can be sad about that. And we can say that this sucks. But then we, you know, I would hopefully be able to cultivate in her coping skills and positive ways to look at things in a different perspective, but I never want to just brush over things that are the in initial kind of emotional hurt that we need to sit in.

Growing up, I mean, it was uncomfortable for my dad to sit in emotions with me. And so he just tried to fix things.

Wini: And so that's what men do. 

Ashley: That's what men do. So the can got kicked down the road. So I would want to embrace that, whatever she was, you know, struggling with or dealing with reflect those feelings, sit with her and the pain. And then when she's ready to kind of move forward with coping, then that's when we start.

Dr. Pyrc (27:05):

That's amazing. And what would you tell a parent of a kid who had had some sort of like either life-altering trauma or something that changed their appearance or what would you tell the parent? How do they best support their kid?

Ashley (27:19):

Well, first I would recommend finding a therapist to help you.

Ashley (27:25):

But yeah, I mean, again, like we do a lot of parent training through therapeutic parenting skills at our practice and parents want to fix it. They want to say but it's fine. You're OK. Let's move on. And 'oh, but you're so beautiful' and ‘oh, this is great about your life,’ but kids really need to feel heard and understood.

And so we know through research and in neuroscience that if you name an emotion for somebody, it helps them to feel that emotion less intensely because someone else is sharing that kind of burden. Sometimes it is a burden. Sometimes it's not a burden, but someone else is sharing that with you. And so the first thing I teach parents is sit and reflect because sometimes the problem doesn't necessarily need to be fixed. They just need to know that someone's hearing them and sitting with them in that moment. I mean that depends on the case, but I always start there always start with reflecting the feeling.

Dr. Pyrc (28:19):

But I think that's great advice for like kids grieving any grief like if they're grieving their personal appearance, a loss of a relationship. You know, I mean that would apply to a girl who's been broken up with. You know, sit with the feeling.

Ashley (28:32):

A feeling, just sit with them and it stinks and it's uncomfortable and let's move on when you're ready. But I try to be careful not to have kids use their diagnoses as excuses for things. But you know, there's a fine line.

Dr. Pyrc (28:49):

Right, absolutely.

Wini (28:51):

Ashley, thank you so much.

Ashley (28:52):

Thank y'all for having me.

Wini (28:54):

We appreciate it. This has been so enlightening and just like we talked about at the beginning you really are resilient and it's inspiring. And I love sitting in this chair because the inspiration just doesn't stop. It keeps coming through the door.

Ashley (29:06):

You guys have a fun job.

Wini (29:08):

We're so grateful that you spent time with us today. Thank you so much.

Ashley (29:12):

Thanks for having me.

Wini (29:14):

And to our listeners. Thank you for being a part of us and all of your support being with us. Please rate, review and subscribe to help us continue to grow and reach more people with these conversations and inspirations. But until next time…

Wini & Dr. Pyrc (29:31):

Have a joyful day.

Imagine living through a tornado. The wind howling over the sound of sirens. Lightning illuminates your home. Then, you hear it - the roar. You watch the ceiling start to give way. Fear turns to panic. Running on adrenaline, your body prepares for the worst.

This is what trauma can feel like. While a severe weather event can be traumatic, there are many reasons a person may experience trauma. It is defined as anything that overwhelms a person’s ability to cope. But trauma isn’t always easy to spot, even though its effects can last a lifetime.

“There are three different kinds of trauma. The first is acute, or a one-time event like a dog bite or car wreck,” said Denise Coover, LCSW, a trauma informed care specialist at Cook Children’s Medical Center. “Then there’s chronic trauma, where you may have several things happening at once, like domestic violence at home and bullying at school. Complex trauma happens when traumatic experiences occur within the context of a close relationship, such as sexual abuse committed by a family member, or someone who should keep you safe.”

During a traumatic event, the body releases two major stress hormones: norepinephrine and cortisol. Similar to adrenaline, norepinephrine boosts the heart rate and controls the fight-or-flight response. Cortisol is your body’s main stress hormone and slows non-essential functions, like digestion, when a threat is perceived.

“If your body experiences this stress response on a regular basis, it can cause long-term health problems,” said Kia Carter, M.D., co-medical director of Psychiatry at Cook Children’s. “A lot of people don’t realize that chronic exposure to stress hormones can cause high blood pressure, obesity, diabetes, issues with sleep and fatigue, as well as feelings of depression and hopelessness.” 

These hormones can also increase your memory of the event, leading to flashbacks, nightmares and PTSD. But when it comes to memory overall, people who’ve experienced significant trauma may find it hard to remember in general. This is due to the part of the brain that stores memory, the hippocampus, being overexerted.

The amygdala is another part of the brain affected by the stress response. This region controls emotions and can cause someone to react differently to something as simple as a door slamming. You can think of the amygdala as the brain’s ‘watchdog.’

“If someone has experienced something like domestic violence or a shooting, they may be sensitive to loud noises,” said Dr. Carter. “That’s because their amygdala is working overtime to keep them safe. We call this hypervigilance.”

For children, hypervigilance can make it hard for them to concentrate at school and follow directions. Instead of focusing on the classroom, their brain may be trying to anticipate what bad thing is going to happen next.

The prefrontal cortex is connected to the amygdala and is responsible for rational thinking. Chronic stress in childhood can damage the prefrontal cortex, which is still developing, and lead to a survival response being triggered even when there is no danger.

Understanding Trauma

According to the National Council for Behavioral Health, 70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. That's 223.4 million people. 

“Sometimes, when people experience trauma, they will compare themselves to others. For example, they may say, ‘I’m not a Syrian refugee so I haven’t experienced real trauma,’” said Coover. “But it doesn’t matter, if something overwhelmed your ability to cope, that makes it traumatic for you.”

At Cook Children’s, 94% of hospitalized psychiatry patients in 2020 reported experiencing at least one form of trauma. Untreated trauma in children can cause a number of problems including behavioral issues, mood swings, depression, anxiety, self-injury, hopelessness and thoughts of suicide. Kids may feel isolated because of how the traumatic event has affected them. Coover says it’s important for parents and teachers to be aware of the signs of trauma because they’re not always obvious.

“A child who’s falling asleep at school may seem like a problem student, but when you start digging into their history you may realize that they don’t feel safe at home and they’re in survival mode. But when they’re in the classroom, they feel safe so all of the sudden they can sleep,” she explained.

Another sign of trauma in both children and adults is physical pain without a known reason, called somatic symptoms. This is often seen in the form of migraines, stomach aches, and rouge pain the body that is not associated with injury. This phenomenon has been documented by experts such as psychiatrist Bessel van der Kolk in his book ‘The Body Keeps the Score.’ Kolk claims that stress and trauma becomes stored in the body if not addressed, and can eventually lead to illnesses such as autoimmune disorders and cancer.

“Whether you remember the trauma or not, your body always does,” said Coover. “I’ve had parents tell me this or that happened but their child was too young for it to affect them and I have to tell them, “No, that’s not the case.’”

Some examples of childhood trauma include:

• Physical, sexual and emotional abuse
• Neglect
• Domestic violence
• Homelessness
• Parents with untreated mental illness and/or substance abuse
• Divorce
• Bullying
• Losing a parent
• Incarceration of a parent

“Domestic violence is one that seems to surprise people, because they think if the child isn’t being hit it doesn’t affect them,” Coover said. “But it absolutely does, even if they just hear it. Sometimes what they’re imagining is even worse, or maybe it’s spot on. And kids tend to blame themselves for their parents fighting. They take on that guilt even though it’s not theirs to carry.”

Experts like Coover and Dr. Carter also warn that isolation triggered by the COVID-19 pandemic has led to even more traumatic experiences for many kids, especially those growing up in unhealthy environments. With so many students being forced into virtual school last year, their ability to escape and connect with people outside of their home was taken away.

“We are starting to see more kids talk about the effect the pandemic has had on them,” said Dr. Carter. “I had a patient tell me recently they’d been home alone for many months and hadn’t been able to see their friends or other people. They said they were tired of living that way, this patient became hopeless about life changing, which resulted in this patient attempting suicide.” 

The Power of Sharing

Dawn Hood-Patterson, Ph.D., thinks about trauma in the context of her own life. At 17, she was living in Colombia with her family when her trauma story began.

“I lived in Colombia during the time when Pablo Escobar had a grip on many regions in the country—there were car bombs, protests and the sound of gunshots. During that period of unrest, my dad was murdered outside our home,” she said. “So when I think about my trauma story, I think about what fostered my capacity for dealing with that.”

Dr. Hood-Patterson attributes her resilience in part to her parents who gave her a loving and supportive home. She also credits the school counselors who recognized that her frequent stomach aches were not just random pain, but the result of the stress that comes with living in a country experiencing civil unrest.

“It was all the adults who recognized the trauma was bearing impact on my life, and who said, ‘This trauma is real and we see Dawn in the midst of it,’” she said. “These same people gave me tools that helped me make meaning out of the chaos. And they said, ‘Here are some friends around you that have experienced similar things so you don’t feel so alone.’”

As program manager of Community Health and Adverse Childhood Experiences at the Center for Children’s Health, led by Cook Children’s, Dr. Hood-Patterson is using her experience to help people in North Texas. She’s part of the team behind The ACEs Task Force.

Adverse Childhood Experiences (ACEs) is a term based on a study conducted between 1995 and 1997 by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC). The study, which involves 10 questions about what a person experienced before the age of 18, shows ACEs are associated with high-risk behaviors, chronic disease and reduced quality of life in adulthood. In 2019, The ACEs Task Force unveiled their “Blueprint for Safe, Healthy and School-Ready Children”. The plan includes 25 ways pregnant women, families, children and caregivers need to be supported in order to counteract adversity. Access to health care, healthy food, quality, affordable and safe housing are among the top concerns. Transportation, mental health services, substance use disorder treatment and high quality, affordable child care are also priorities for the task force.

Currently, Dr. Hood-Patterson and team are working on a project that would create support groups for parents and caregivers living with adversity. The so-called ‘Caregivers Alliance’ is part of the Build-a-Bridge program, led by Cook Children’s, and is in the early planning phases. It would focus on giving people a chance to share their stories of trauma and connect.

“This was born out of conversations that we had with community partners where we learned that a lot of people who are struggling with adversity often feel like they have a laundry list of things to do,” she said. “For families who receive things like housing assistance or SNAP benefits, every conversation they have is about updating paperwork and not missing deadlines. We envision this alliance to be a space where people can be seen and heard, and support one another.”

The Caregivers Alliance would also include access to education from the Center for Children’s Health for topics like car seat safety, water safety, safe sleep practices and more.

“I’m a believer that something powerful happens when we share out stories with each other,” said Dr. Hood-Patterson. “When we have the opportunity to share our stories, whether they’re of triumph or trauma, it hones our ability to make meaning out of the seemingly meaningless chaos of suffering.”

One year into COVID-19, it’s clear the pandemic is taking a toll on the mental wellbeing of children and teens.

In March, a record 43 patients were admitted to Cook Children’s Medical Center after attempting suicide. This staggering figure is nearly double the number of suicidal patients seen during the same time period of 2020. Even worse, kids are dying. Last year, Cook Children’s recorded seven suicide deaths, marking the first time suicide was the leading cause of trauma deaths at the hospital, surpassing child abuse and car wrecks.

“The mental health crisis was already happening, then it met a global pandemic and these are the consequences,” said Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s.

“They’re less engaged and have less interaction with others, and instead are spending more time online and in virtual settings. And it’s hard for them to be hopeful about anything because so many things, like prom and graduation parties, are canceled.”

The issue is not unique to North Texas. Doctors and nurses from across the nation are reporting similar statistics. In February, NPR released an article titled “Child Psychiatrists Warn That The Pandemic May Be Driving Up Kids' Suicide Risk.” It found that children’s hospitals across the U.S. are seeing up a 250% increase in suicidal patients in emergency rooms since the pandemic began. While there are no nationwide numbers on child suicides in 2020 available yet, experts agree there is reason to be concerned.

The Impact

More children are suffering from stress, anxiety, depression, and suicidal thoughts than at any time in recent memory. Pediatricians like Kathleen Powderly, M.D. from Cook Children’s Pediatrics Magnolia say children as young as 7 are needing help.

“I’ve had a couple of elementary school students, which you don’t see very often, who are actively suicidal or have already had a suicide attempt. I’ve also managed more kids on antidepressants since the pandemic because it’s hard to get into doctors right now,” Dr. Powderly said. “COVID-19 is not as impactful in terms of volume of cases in pediatrics, but our volume of psychiatric patients has increased quite a bit.”

Previously, Dr. Powderly was the medical director of Cook Children’s Hospitalist Group, the attending physicians who care for children in the hospital. She says her team was seeing an increase in suicidal patients before she transitioned into the office setting five years ago and that the pandemic created a perfect storm. On top of the stressors kids were already dealing with, they’re now struggling with isolation, virtual school, and a loss of activities.

“We’re not going to be able to flip the switch and just go back to normal when this is over,” said Dr. Powderly. “This is going to take some time to come out of. I’ve even had patients tell me they’re struggling with being around people.”

Members of Cook Children’s Youth Advisory Council shared similar experiences in a recent meeting. The teens said they feel more anxious being around their friends in person because they’re so used to only seeing people online now. In addition to new stressors, there is a severe lack of mental health resources across the board.

A Growing Need

“There weren’t enough psychiatric beds to begin with, and then COVID happened and the capacity was reduced because you can’t have patients sharing rooms,” said Dr. Pyrc.

The need for more inpatient psychiatric beds for children and teens has been known for years. In 2017, Cook Children’s opened the Rees-Jones Behavioral Health Center to help address the issue. The unit has 15 inpatient beds available for children between the ages of 2 and 12. As we reported when the center opened, the kids who end up here are patients with complex trauma, medical and social needs. They are often suicidal or have tried to hurt someone else. Eight out of 10 have had something traumatic happen to them. They have either been abused physically or sexually, or they have experienced some sort of neglect.

Teenagers who need inpatient psychiatric care have to be treated elsewhere but often end up waiting on the medical floor of Cook Children’s until a bed opens up in the community, which can take days. With more kids needing these services, it’s not uncommon for Cook Children’s to have a dozen or more patients waiting in a regular hospital room for a transfer to a psychiatric facility that can care for them.

“There are just not enough resources in general,” said Dr. Pyrc. “It’s an awful place to be in. This is a national problem, but it affects us here locally. We need more funding and we need more mental health professionals to care for these patients.”

On the outpatient side, finding a licensed therapist to see a child can take months. The waitlist just to see a counselor at Cook Children’s can be as high as 250 days at any given time. Even with easier access to appointments with virtual visits, there are not enough mental health professionals to meet the need.

Kia Carter, M.D., co-medical director of Psychiatry at Cook Children’s, has been a vocal advocate for increased mental health funding. Testifying in front of the Texas Senate’s Committee on Health and Human Services recently, she said early identification, intervention and treatment is essential to preventing further complications from mental illness. But there are roadblocks.

“We get insurances denying a specific level of care saying that a child doesn’t need an inpatient level of care. We also get a lot of pushback about medication,” Dr. Carter said.

She also asked lawmakers for increased support and to consider giving mental health care providers more leverage with insurance companies.

Hoping for JOY

In the meantime, Cook Children’s aims to bring awareness to the mental health crisis affecting children and teens with the launch of a new suicide prevention campaign.

The Joy Campaign is an acronym that stands for:

Just breathe.

Open up.

You matter.

“If we can just get kids to slow down, realize that what they are experiencing is temporary and that they have a long life ahead of them, I think we can make an impact,” said Dr. Powderly.

For the next month, Cook Children’s will be releasing a series of articles on Checkup Newsroom weekly that address many of the issues at play, such as the pandemic, the role of over-the-counter medications, social media, as well as how minorities and LGBTQ+ young people are impacted. We’ll also be speaking with families who have lost a child to suicide to examine the effects on parents and siblings.

If you feel your child might be struggling, here are some of the warning signs to watch for:

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

If you’re concerned about your child’s mental health, seek help early. Schedule an appointment with a licensed counselor. If your child is actively suicidal, call 911 or take them to the nearest emergency room.

Read this story in Spanish here.

The National Weather Service previously warned of widespread freezing rain and sleet across North and Central Texas, which left roadways wet and slick.

Going into the weekend and early next week, temperature highs will range in the teens up into the 30s, and some areas are expected to see 2-7 inches of snow. If you don’t have a reason to leave home, please stay inside, stay safe and stay warm. If you have to go out, have a plan in place and rid yourself of any distractions so you can focus on the road.

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

“The injuries we see from car wrecks are because parents are making the same mistakes over and over with car seats,” explains Sharon Evans, trauma injury prevention coordinator at Cook Children’s.

The American Academy of Pediatrics recommends parents keep their children rear-facing as long as they fit within the height and weight requirements printed on their car seats. Evans says another prevalent issue is the lack of transitioning children into booster seats.

“Children should be in a booster seat until they’re 4-foot-9. We often see parents letting them go into a seat belt too early,” Evans explained.

She reminds parents to keep children calm and quiet when traveling, whether that means playing their favorite music, letting them bring a safe toy, or talking with them before leaving home. “Children can read your emotions,” she said. “If you’re uptight, they will be able to sense it.”

Here are more tips for parents to consider before getting behind the wheel:

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

At some point, we all fell down and probably scraped a knee or an elbow. But what happened next determined how well we handled our next fall and eventually how successful we were at riding a bike.

"Likewise, life can be tough sometimes. We don't always realize our day-to-day struggles as parents can have lifelong effects on our children?," said Anu Partap, M.D., director for the Center for Prevention of Child Abuse and Neglect at Cook Children's. "It can be a hard fall if we don't actively protect and nurture our children through those tough times."

What kind of tough times can have such a long-standing impact?

The Centers for Disease Control and Prevention (CDC) released a new report Tuesday that found that people who experienced abuse or neglect as a child were at higher risk of dying from five of the top 10 leading causes of death.

Such traumas are called Adverse Childhood Experiences, or ACEs. They can include:

• Sexual abuse
• Physical abuse
• Emotional abuse
• Physical neglect
• Emotional neglect
• Domestic violence
• Divorce
• Community violence
• Having a parent with substance abuse or mental health issues.
• Having a parent incarcerated.

Trauma, and more specifically, the toxic stress connected to trauma, is the link between not only chronic health issues (asthma, cancer, kidney disease, diabetes, obesity, and heart disease), but also mental health issues and risky health behaviors. These issues can include depression, anxiety, alcoholism, smoking, substance abuse and suicidal attempts or ideation.

How people are affected by ACEs?

The CDC's recent report gives the first estimate of how many American citizens are impacted by adverse childhood experiences and stresses the importance of preventing these traumas. The report, based on a survey of more than 144,000 adults from 25 states, found that almost 60% of Americans faced at least one adverse experience during childhood, with 15.6% experiencing four or more different types.

"A stressful home can leave children feeling scared or alone, and that stress can trigger pathways to disease," Dr. Partap said. "What stresses one child dramatically may be less stressful for another. Part of that is our personality, but a large part may also be how nurtured and protected a child feels. So when life is tough, the child who feels alone will respond much worse than a child who knows loving people protect them."

Jamye Coffman, M.D., medical director of the Cook Children's Center for Prevention of Child Abuse and Neglect and the CARE Team, knows a report on trauma can be overwhelming, even depressing. But she offers hope for anyone who has gone through trauma as a child.

"Childhood trauma impacts how you parent and your mental health," Dr. Coffman said. "It impacts how you respond to stress and even how you bond with your child. Trauma impacts all of those things. But it doesn't mean you can't become a loving, caring adult. It is about your own introspective as an adult and receiving the counseling or parenting coaching you need to become a productive grownup. It's never too late for any of us. But you have to identify the issue; then you can fix it and have a better, more productive life."

Another positive takeaway from this information is that the effects of trauma are reversible. Communities that promote resiliency within the family, schools and the community can alleviate the debilitating effects of toxic stress and help children and families bounce back from adversity.

"It is critical to continue to study the link between adverse childhood experiences and serious chronic health issues," said Denise Coover, LCSW, trauma-informed care specialist at Cook Children's. "The more we understand this link, the better that public and mental health programs can plan and provide interventions and resiliency strategies to curb the onset of later costly health issues."

The experts interviewed for this article agree that parents and adults are the mitigating factor between toxic stress and resiliency. What makes the trauma experience so toxic, is many times children are left to manage high levels of stress on their own. If parents or other adults in a child’s life can provide a low-stress, loving environment, then the child is more likely to build the resiliency they will need to thrive.

"My recommendation is always that it is not about what you can buy for your child, but the quality of the love, listening and attention that is important," Coover said.

Dr. Partap wants this study to draw attention to ACEs. She hopes people in the health care community who can make a difference will be able to connect the dots from adult concerns back to the trauma many youth experience.

"Childhood is such a precious time," Dr. Partap said. "This connection that what happens in childhood matters forever is powerful for everyone to embrace. It affects me as a mom every day. Sometimes life gives us challenges we didn't ask for, and it may be depression or a loved one who struggles with addiction. Some folks lose their homes, but we have to know the strongest prevention act is asking for help.”

Dr. Partap continues, “That's how we prevent or help reduce the impact of these tough times on our child's life-long health. Sometimes help is a neighbor, a relative and sometimes it's a service like therapy, addiction treatment, or a shelter. Anything that helps parents be more present for their child prevents the impact of toxic stress on a child's health."

Resources Available

We all need help and there are many resources available. You shouldn't feel alone when you're raising children. Tarrant Cares and Aunt Bertha are web-based resources anyone can check out. Visit the website 211texas.org, which even has a staffed phone line. Try not to feel alone through difficult experiences, especially when you're raising children.

In 2018, she and her family joined the often overlooked but growing homeless population in Fort Worth. When Dana and her husband became unemployed and could no longer afford to put a roof over their heads, they turned to the Union Gospel Mission shelter for help. It was there that they were introduced to a program called the Homeless Initiative, which aims to provide a medical home for children experiencing homelessness in Tarrant County, a population of roughly 15,000.

“The Homeless Initiative program provides medical care, actually any service that Cook Children’s can offer, to the children who reside in the three shelters in Tarrant County: Presbyterian Night Shelter, Union Gospel Mission and Arlington Life Shelter,” said Pat Ballard, an RN at Cook Children’s and one of the two case managers for the Homeless Initiative. “We do well checks, sick visits, TB testing, we have a flu clinic, we get them up-to-date on vaccines, any specialty doctors that they need, dentists, dental care, dental surgery, we schedule it all.”

The Homeless Initiative began in 2008 as a collaboration between Cook Children’s and former Fort Worth Mayor Mike Moncrief. The goal was to provide a path to medical care for this vulnerable population of children who, too often, were only seen by emergency room physicians.

“Back in 2008, about 98% of homeless children in Tarrant County were using ERs for primary care issues,” said Ballard. “That’s a huge burden for any ER and it puts stress on the whole system.”

The initial goal of the program was to make sure children had a primary care physician through Cook Children’s Neighborhood Clinics. These doctors would provide appointments for things like well checks, ear infections and upper respiratory conditions. It didn’t take long, however, for organizers to realize the need for mental health services and trauma-informed care, which takes a person’s traumatic experiences into account and promotes environments of healing.

“I don’t think we fully understood the problem in the beginning,” explained Denise Coover, LCSW, trauma informed care specialist at Cook Children’s. “Many of these kids have been through a lot of trauma. The more questions we asked, the more we learned.”

Coover joined the program in 2013 and provides on-site behavioral health assessments of children in the three shelters where the Homeless Initiative operates. Many of the questions in her assessment gauge what children have witnessed or endured such as physical and emotional abuse. She adds that being able to talk to the children themselves is key because often, parents don’t know the extent of what their children have been through, especially if they’ve been separated due to time in jail or foster care.

“A lot of our children have witnessed domestic violence. We have a lot of children who make disclosures of sexual assault, physical abuse, neglect and sex trafficking,” Coover said. “When we think about trauma, we have to remember the true definition is an event, or the threat of an event, that overwhelms someone’s ability to cope. If you can think of something that would overwhelm your ability to cope, our children are dealing with that.”

According to the National Center on Family Homelessness, children experiencing homelessness get sick twice as often as other children. They also suffer from more mental health issues such as anxiety, depression and withdrawal.

“We know while these children are in the shelter, this is our opportunity to intervene with them and provide them help,” Coover said. “They can’t wait six weeks, 12 weeks on a waiting list. They need intervention and they need it now.”

To make sure children experiencing homelessness in Tarrant County get the care they need quickly, Cook Children’s provides free transportation to the program’s families.

“We have a 16 passenger shuttle with a full-time, dedicated driver that delivers our kids to every appointment that we make,” Ballard explained. “That means picking up the parent at the shelter, going to school and getting the child, bringing them back to the clinic, whatever we have to do to get that child to an appointment we do.”

And if an appointment interferes with a family’s ability to eat lunch, the driver will make a special stop to make sure parents and children don’t miss a meal.

Another major goal for the Homeless Initiative is to make sure families transitioning out of homelessness have everything they need to succeed. Cynthia Thomas, LMSW, another case manager for the program, spearheads this mission. She says her job is to support and empower families experiencing homelessness.

“I provide strollers, car seats, anything a parent would need. They may need assistance in the education system, or school supplies. My role is to find out what non-health resources are necessary for them to be successful,” expressed Thomas, who works for The Women’s Center of Tarrant County.

While such supplies are necessary for success, Thomas’ main goal is to cultivate life skills families can take with them when they leave the shelters. To foster these skills, she organizes parenting classes several times a week at all three shelters. Thomas works with community volunteers and organizations across Tarrant County to create educational presentations meant to equip parents for raising children and teens.

“When they leave the shelter, we want them to feel empowered and we also want them to be able to speak for themselves,” said Thomas.

Some families need a little extra help with this, especially those who have children with special needs. Thomas often acts as a mentor and spokesperson for these parents who may have trouble navigating the special education system.

“A lot of times, the parent doesn’t understand the verbiage of the special education program, so I will go through it with them so they understand it better,” said Thomas. “One of the most rewarding parts of my job is seeing parents gain confidence and feel empowered. One mother was too afraid to say anything during meetings we had with the school. I was able to watch her learn how the system works, become comfortable and lose that fear.”

It’s been 11 years since the Homeless Initiative began and the impact is visible. As of December 2018, nearly 16,000 children and their families had been transported to medical appointments through the effort. Forty-five percent of those children returned to a neighborhood clinic after leaving the shelters, meaning they were no longer using emergency rooms as their medical home.

“I can go in the clinic two, three years later and I’ll see a mom sitting in the clinic with her kids,” said Ballard. “That’s really nice to see that you’ve made a difference in their medical care.”

The program isn’t intended to be just an appointment at a doctor’s office. Cook Children’s hopes it will be a support system when families need it most.

“It’s a chaotic world right now, but this is one of the things we don’t have to stress about,” said Brown-Bonner. “When I forget something, I get a reminder. They go above and beyond to make sure you’re comfortable and that things are taken care of. I’m very grateful and I know that there are other parents that are as well.”

For the Homeless Initiative team, the work seems never ending, but they know their efforts have a higher purpose.

“We know the outcomes for these children are not good if there’s no intervention medically and emotionally,” said Coover. “But the thing about resilience, that is the ability to bounce back from difficult life experiences, is it just takes one person believing in a child to build the resiliency they will need to succeed.”

Over the past five years, the Cook Children’s Emergency Department has seen over 50 fall-related injuries and more than 20 drownings during the July Fourth weekend. Parties, lake trips and higher amounts of people on the road are often the sources of injuries in children around the Fourth of July. With more distraction comes more risk of accidents such as motor vehicle, ATV/golf carts and snake bites. Many of these injuries are preventable and can be avoided with proper safety equipment and watchful eyes of parents.

In 2018, there were five drownings associated with the July Fourth weekend alone. Children in or around water should be watched by a responsible adult using the mindset of a lifeguard.

Corwin Warmink, M.D., medical director of Emergency Services, says adults should be within arm’s reach of young swimmers, especially in open water.

“The lakes are jam-packed and people are celebrating and not always using their best judgment. Overloading of boats is a recurring theme, everyone in a boat should have a life jacket within hands reach if not on,” Dr. Warmink said. “Letting children swim or out on open water during the Fourth of July is inviting trouble. We’ve had multiple injuries and deaths from people struck by boats while in the water and on kayaks or jet skis.”

In comparison, over the past five years, Cook Children’s has only seen three burns related to fireworks during the holiday weekend. Still, these injuries can be harmful and painful to a child. Dr. Warmink warns parents to be attentive especially during down times when activities are finished. Many injuries and deaths are preventable but can happen to anyone in 30 seconds or less of distraction.

“Fireworks rarely cause death but we often do see serious burns and occasionally injuries that could cause loss of an eye, finger or hand,” Dr. Warmink said. “Every year we have at least one tragic story that ruins not just a family's holiday, but their entire life.”

Top Injuries Seen at Cook Children’s During July Fourth Weekend

For More On This Topic:

• Lifeguard Your Child (Drowning Prevention)
• Aim For Safety (Protecting Our Children From Firearm Accidents)
• Vehicle/Car Safety
• Firework Safety Tips from SafeKids
• Is This an Emergency?

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

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

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

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

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

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

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

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

The first death occurred in Providence Village on Thursday, June 24, 2019. CBS11 reports the 4-year-old boy was found outside a home just before 5 p.m. when temperatures were in the mid-90s.

The second tragedy occurred on Sunday, June 23, when an 18-month-old was left inside a car for five hours outside of a restaurant in Galveston. 

The deaths were the first two of the year in Texas and the thirteenth pediatric vehicular heatstroke deaths nationwide.

The peaking 100 degree temperatures are dangerous, especially for children, whose body temperatures rise three to five times faster than adults. There have already been 11 pediatric hyperthermia (heat stroke) deaths this year in the United States from children being left alone in cars.

Although there have not yet been any recorded in Texas, this state typically leads in hot car related deaths. Since 2010 there have been 60 juvenile deaths in Texas from children being left alone in a hot car.

Most cases of child heat stroke deaths in cars are accidental. There was a change in mom or dad’s routine, and the child was unintentionally left in the back seat. Like drowning, it is quick and it can happen to anyone.

“We do get a very small amount of people who leave the child in the car intentionally, but the majority is when you just totally forget,” Cook Children’s Injury Prevention Coordinator Sharon Evans said. “There is no socio-economic, no educational or cultural factors. It can be anyone.”

Evans and her team have partnered with Safe Kids Worldwide to develop a Texas Hyperthermia Board to educate Texans about how and why this can be preventable. The task force has changed legislation in 2016 to require birthing hospitals to educate new parents about hyperthermia and car seat checks.

“The biggest problem with injury prevention is everyone thinks it won’t happen to them,” Evans said. “We hear lots of people saying, ‘Oh, that’s just a horrible parent. How could they forget?’ Today’s world is so technologically driven, and people give more time than ever to their cellphones. If you can forget your phone somewhere, you can forget your child in the backseat.”

Outdoor temperatures don’t have to be sweltering for heat stroke to occur. The first vehicle-related heat stroke death this year occurred in April with 79 degree weather. The temperature in a car can rise nearly 19 degrees in ten minutes. Heat stroke can occur when a body temperature rises above 104 degrees and body organs begin to shut down near 107 degrees.

There have been many instances where people walk through the grocery store parking lot, see a child alone in the car and do not act for fear of prosecution if they damage the car. Texas released Texas House Bill 478 (HB 478) in 2017 to protect Good Samaritans and potentially save children from heat stroke.

HB 478 allows citizens to rescue a vulnerable child under the age of seven if there is no reasonable method for the child to exit the vehicle without assistance and if the Good Samaritan has reasonable belief that entry into the car is necessary to avoid imminent harm to the child. HB 478 also requires law enforcement must be notified and the citizen must not use more force than necessary to enter the vehicle.

Child car-related heat strokes are preventable, but can happen to anyone. It’s important to take measures in educating adults and children about the dangers of a closed car door. The effects could ultimately last a lifetime.

“It doesn’t matter how good of a parent you are. It’s just a tragic accident,” Evans said. “Being vigilant could save a life.”

Click here to see full story on cbsdfw.com.

That’s the simple message that the folks at Cook Children’s who watch out for your kids’ safety wants you to know.

From March 14 to April 10, 2018, five children were rushed to the Emergency Department for drowning, with one resulting in death.

“There is no amount of time that it’s safe to leave your child alone in the tub,” said Magdalena Santillan, Trauma Injury Prevention specialist at Cook Children’s.

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.

“Safety begins in the home,” said Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coalition. “Bath time is not only a good time to bond with your baby, but a dangerous time in and around water. Support safe habits with adult, not sibling, supervision.”

SafeKids Tarrant County, led by Cook Children’s, gives these facts:

• Drowning is quick and silent.
• Children can drown in as little as one inch of water.
• Irreversible brain damage occurs in as little as 4 minutes.

To protect your child from drowning in the tub:

1. Never leave your child unattended in the water.
2. Put the cell phone away. Give your child 100 percent of your attention.
3. The job of supervising a child in the pool is for adults only and not siblings. A child or even a teen should not be held responsible for supervising a child in the bathtub.
4. If you have to answer the door or the phone, take your baby out of the water and hold him or her while you do so.
5. Fill the tub only with enough water to cover the infant's legs.
6. Once the bath is over, immediately drain the tub.
7. Don't rely on bath rings or seats to keep a baby safe.
8. Store empty tubs, buckets, containers and wading pools away after use. Store them upside down and out of a child’s reach.
9. Keep doors to bathrooms and laundry rooms closed.
10. Learn CPR for infants.

Learn more at safekids.org.

“We usually expect an increase in motor vehicle crashes during the summer, but we are seeing them earlier this year for some reason,” said Sharon Evans, Trauma Injury Prevention Outreach coordinator at Cook Children’s. “The crashes are devastating and leave a lasting impact on the kids and their families forever.”

Following the accidents, the Trauma department at Cook Children’s wants to get out the message to parents: Properly secure your children in the car.

Motor vehicle injuries are the leading cause of death among children in the United States. Many of those deaths could be prevented if parents took the extra time to make sure their children were properly restrained.

Evans says it’s extremely frustrating because she has seen wrecks where one child who was properly restrained lives and the other child not buckled in dies.

“These accidents are totally preventable. I don’t think people think it can happen to them,” Evans said. “But it can happen to anyone. It just breaks my heart because these are deaths that shouldn’t occur if people would just place their kid in the proper car seat and buckle them up with a seat belt."

The Centers for Disease Control and Prevention (CDC) found that, in one year, more than 618,000 children ages 0-12 rode in vehicles without the use of a child safety seat or booster seat or a seat belt at least some of the time.

“If your child is injured in a car accident, there are no do-overs,” Evans said. “It’s important to keep your children rear-facing as long as possible to keep them protected and to reduce the risk of injury.”

Statistics show this is especially a problem for Hispanics in the community. In the past three years, ninety percent of Cook Children’s patients who were ejected from a vehicle were Hispanic.

“I think a lot of it has to do with our culture,” said Magdalena Santillan, Trauma Injury Prevention specialist at Cook Children’s. “These are people who love their kids and they want to hold their baby. Many people don’t want to hear their baby cry and so it’s easier to hold their baby in the car. They are showing love, but the consequences are too high. This can be a deadly mistake.”

Texas law states that “all children younger than 8 years old, unless taller than 4’9”, are required to be in the appropriate child safety seat system wherever they ride in a passenger vehicle. The safety seat MUST be installed according to the manufacturer’s instructions.”

That means that when a child reaches his or her eighth birthday – no matter their height, it is legal for the child to use only the adult safety belt in the passenger vehicle.

But the Texas Department of Public Safety states on its website that best safety practice is: “if the child is not yet 4’9”, they are better protected if they continue to use the appropriate child safety seat system until they can fit properly in the adult safety belt.”

“From a safety standpoint, I encourage parents to follow the best safety practice guidelines,” Evans said. “Graduating to a seat belt too early does keep children in car if they crash, but when the seat belt doesn’t fit properly it can cause serious injuries. That is something else we are seeing right now at Cook Children’s – children in neck braces because they were in seat belts too young and too early.”

Call 682-885-2634 to set up a FREE car seat checkup to ensure your seat is properly installed.

Learn more about Vehicle/Car Safety by clicking here.

Watch the live interview with Dr. Coffman here.

Unfortunately, it can also be a time of tragedy when kids are rushed to Cook Children’s for help.

From May 1 to 15, six children were admitted to Cook Children’s and two were treated and released from the Emergency Department. Last month, nine kids were admitted to Cook Children’s. Seven were admitted and two were treated and released.

Maybe it’s distracted drivers or maybe it’s the nicer weather. Regardless, it’s up to adults to keep an eye out for children walking or riding their bikes outside and not the other way around.

In the fiscal year of 2015, 34 kids were injured in auto-pedestrian collisions. The number increased to 49 in 2016 and more than 30 kids have already been injured this year.

“We’ve never seen numbers like we have so far and it’s not even the summer time, when more kids will be outside playing. Children do not have the cognitive skills to be crossing streets safely alone until at least age 10,” said Sharon Evans, Trauma Injury Prevention outreach coordinator at Cook Children’s. “They haven’t yet developed the depth perception or the ability to maturely judge the speed of an object.”

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

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

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

Teaching Your Child Pedestrian Safety

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

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

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

Safe Kids recommend teaching your kids these safe behaviors:

• Look left, right and left again before crossing the street. Cross when the street is clear, and keep looking both ways while crossing. Walk, don’t run.
• Understand and obey traffic signals and signs.
• Walk facing traffic, on sidewalks or paths, so that you can see oncoming cars. If there are no sidewalks, walk as far to the left as possible.
• Require children to carry a flashlight at night, dawn and dusk. Add retro-reflective materials to children’s clothing so that a child can be seen by motorists, even in the dark.
• Don’t let kids play in driveways, unfenced yards, streets or parking lots. Drivers may not see or anticipate children playing.

For more information:

Bicycle Safety

Vehicle/Car Safety

Does your child wear a helmet while on a bike?

If not, statistics say you may make a visit to an Emergency Department near you very soon.

A report from Safe Kids Worldwide and Nationwide’s Make Safe Happen program found that nearly 40 percent of the 1,600 parents surveyed admitted their child doesn’t always wear a helmet while on wheels.

That’s despite the facts that more than 426,000 children – nearly 50 every hour – visited an emergency department in 2015 due to a wheeled sports-related injury.

• Serious head injuries, including concussions, internal injuries and fractures, made up 11 percent of those ED visits across the four-wheeled sports.

• Fractures to shoulder, arm, elbow, wrist or hand were the most frequent diagnosis for hospital admissions.

• 19 percent of hospital admissions for scooter injuries to children in 2015 were because of a head injury.

While head injuries are a concern, the majority of ED visits for wheeled sports in 2015 were for fractures, contusions and abrasions.

Less than 1 in 5 parents of children who scooter and less than 2 in 5 parents who kids skate said their kids always wear knee or elbow pads. Parents of children who skateboard reported less than 1 in 3 of their children always wear knee or elbow pads and less than 1 in 5 reported always wearing wrist guards.

Safe Kids says, “Between 2005 and 2015, the number of ED visits for bike- and skateboard-related injuries decreased, but visits for skate- and scooter-related injuries increased significantly. In fact, scooter-related injuries shot up by 40 percent over the 10-year period. Worryingly, the survey found that parents were least likely to make children wear a helmet while scootering at only 57 percent.”

From 2010 to 2013, less than 10 percent of patients seen at Cook Children’s for bike injuries had a helmet on and 0 percent of the patients on skates, skateboards and scooters wore a helmet.

Numbers have improved from 2015 to 2017 thanks to community education from groups like Peaks and Ladders, a collaboration between Cook Children’s, the Fort Worth Fire Department and Fort Worth Firefighter Charities.

During the past two years, 25 percent of children admitted for bike injuries wore helmets and it’s up to 10 percent now for kids on skates, skateboards and scooters.

“Those numbers are still too low, but we’ve made some progress,” said Sharon Evans, Trauma Injury Prevention coordinator at Cook Children’s. “It’s so important for kids to wear their helmets at all times. Even if they are taking a spin around their block, they need to wear a helmet. Injuries can occur anywhere, even when cars aren’t around. We’ve admitted children who have been injured in their driveways. Even little spills can result in concussions and broken bones.”

Evans said a great way to encourage helmet use is to let your child pick out the helmet and decorate it with stickers and markers to his or her liking. Then, make sure you set the example by wearing your helmet too.

Among parents who say they always wear a helmet, 86 percent say their child also does. However, among parents who say they never wear a helmet, only 38 percent say their child always does.

“With warmer weather ahead, your child will be spending more time on wheels – which means more opportunities for kids to get hurt,” Evans said. “The most important way you can teach your child to be safe is to always wear a helmet."

Safe Kids offers the following tips to help protect your child:

· Wear properly-fitted helmets, which are the best way to prevent head injuries and death, for every ride.

· Ride in safe locations like sidewalks, bike paths or bike lanes whenever possible.

· Follow the rules of the road.

· Check all equipment at the start or end of every season.

· Ride together until kids are comfortable enough to ride on their own.

For more information:

• Child Safety Center
• Bicycle Safety
• Safe Kids Worldwide

In 2015, five children were seen at Cook Children’s for lawn mower related injuries. Ages ranged from toddlers to teens and all five were run over by the lawn mower. Already in 2016, two kids have been involved in lawn mower accidents.

Each year approximately 10,000 children are seen with injuries caused by power mowers are treated in emergency departments across the nation.

Lawn mowing injuries can be severe, including amputations, broken and dislocated bones, burns and eye injuries.

“Lawn mower injuries are easy to stop, just don’t let children be outside if the mower is on, said Sharon Evans, Cook Children’s Trauma Injury Prevention/Outreach coordinator. “If the child is young there needs to be an adult inside the house supervising them. If the child and/or adult has to go outside there should be the rule that they signal, call or whatever to get the rider’s attention and then the rider turns off the mower as soon as possible before anyone approaches it. The rule should be the same for older children too.”

To prevent lawn mower injuries to children, the American Academy of Pediatrics recommends the following:

1. Use a mower with a control that stops the mower from moving forward if the handle is let go.
2. Children younger than 16 years should not be allowed to use ride-on mowers. Children younger than 12 years should not use walk-behind mowers.
3. Make sure that sturdy shoes (not sandals or sneakers) are worn while mowing.
4. Prevent injuries from flying objects, such as stones or toys, by picking up objects from the lawn before mowing begins. Use a collection bag for grass clippings or a plate that covers the opening where cut grass is released. Have anyone who uses a mower wear hearing and eye protection.
5. If the lawn mower is on, make sure all children are not outside and are safely inside.
6. Start and refuel mowers outdoors, not in a garage or shed. Mowers should be refueled with the motor turned off and cool.
7. Make sure that blade settings (to set the wheel height or dislodge debris) are done by an adult, with the mower off and the spark plug removed or disconnected.
8. Do not pull the mower backward or mow in reverse unless absolutely necessary, and carefully look for children behind you when you mow in reverse.
9. Always turn off the mower and wait for the blades to stop completely before removing the grass catcher, unclogging the discharge chute, or crossing gravel paths, roads, or other areas.
10. Do not allow children to ride as passengers on ride-on mowers.

James saw Nickolas with a football. He’d waited a long time to throw and catch a football once again with his dad.

It wasn’t that long ago that Nickolas was in tears from the sharp, stabbing feeling in his abdomen. The nerve block procedure he’d just awoken from did little to ease his pain. Groggy from anesthesia, he didn't know what he was saying to Cook Children's pain management physician, Artee Gandhi, M.D. He only knew that the years he'd spent laying on the couch because it hurt too much to move had to end.

"He kept saying 'please help me, you're all I have Dr. Gandhi, you have to help me,'" said Julie McCanless, Nickolas' mother.

The pain in the upper right quadrant of Nickolas' abdomen began suddenly in 2011, when he was just 10 years old. Though he was an active child who enjoyed playing football, there was no injury or incident the family could point to as the trigger for his pain. His parents began searching for someone who could provide a diagnosis and also relief. Despite seeing physicians in Texas, Oklahoma and even Minnesota, no one could tell the North Richland Hills family what was plaguing their son.

"It was out of control. He couldn't play sports anymore. It affected his appetite, his mood, nothing seemed to help," said Julie.

The family tried everything they could think of to ease the pain. Essential oils, massage therapy, acupuncture, they even visited a chiropractor, but none could offer Nickolas reprieve. Out of ideas, they turned to a Dallas pain clinic.

"They put him on every kind of pain medication you could think of from hydrocodone to ibuprofen, Tylenol, all the way to oxycodone and oxycontin," said Julie.

She says the drugs gave him some comfort, but left Nickolas with zero quality of life. He was often too drowsy from the medication to interact with family or friends. Attending school was also made difficult. The McCanless family spent nine months trying to find a prescription that would help without the negative side effects, all while hoping someone would one day give them a diagnosis. Then they turned to the Pain Management program at Cook Children's, one of only 35 pediatric pain clinics in the United States.

Dr. Gandhi helped launch the Pain Management program seven years ago. At the time, she was the only pain management physician at Cook Children’s and would visit patients in their rooms while carrying charts in a roller bag. The program has since grown into a multidisciplinary department complete with two board-certified physicians, clinical, physical and massage therapists, nurses and a biofeedback therapist. Instead of treating pain solely with medication, Dr. Gandhi and her team aim to help patients manage it with relaxation techniques, diet, exercise, lifestyle modifications and sleep.

In Nickolas’ case, Dr. Gandhi used many of these treatments as well as nerve block injections, which interrupt how pain signals are sent to the brain. He’d undergone these injections at other hospitals, and they usually offered temporary relief.

“We decided to try the nerve block injections, but every time it would wear off the pain would return, ” said Dr. Gandhi.

She started to think that Nickolas might have a rare condition known as abdominal cutaneous nerve entrapment syndrome (ACNES). It occurs when a nerve becomes ‘entrapped’ in the abdominal wall. Because it’s not common, ACNES is often overlooked and misdiagnosed for a gastrointestinal issue. Dr. Gandhi knew she would have to think outside of the box in treating Nickolas if she was going to keep her promise to him.

“She said she wasn’t going to give up and she didn’t. No matter how many times the pain blocks failed, she would try to find something else,” said Nickolas.

Dr. Gandhi’s search for a cure led her to believe that surgery might be the answer they were all looking for. She tuned to Chad Hamner, M.D., Trauma Medical Director at Cook Children’s for help.

“I told Dr. Hamner what I thought Nickolas had and that a neurectomy may be helpful,” said Dr. Gandhi.

A neurectomy is performed by removing all or part of a nerve. Dr. Gandhi thought that by removing the nerve she believed was ‘entrapped’ that his pain could be stopped. Dr. Hamner agreed to meet Nickolas to see if surgery was a feasible avenue to explore.

“He did some more investigation as well as an exam and decided to do the surgery, and low and behold, it worked,” said Dr. Gandhi.

Nickolas underwent surgery in April. By mid-May, he was doing things he didn’t think he’d ever do again.

“I asked Nickolas what he’d want to do if the surgery worked. He said ‘throw a football,” said Julie.

Three weeks after surgery, Nickolas bought a football. When his dad arrived home from work that evening, his sister told their father that Nickolas had a surprise for him.

“He put his stuff down and I came running out. I threw him the football and he gave me a big hug. We both started crying,” said Nickolas.

He’s now well on his way to being a normal kid again, running, throwing and hanging out with his friends. His mother says she couldn’t be more thankful.

“I know there are hundreds of children out there going through what my son went through,” Julie said. “The only thing I can tell them is don’t give up.”

To make an appointment with Pain Management, call 682-885-PAIN (7246) phone. Click here to learn more about the program. 

Pain Management at Cook Children's

Cook Children's Pain Management program cares for infants, children and adolescents with chronic and acute pain. C​ook Children's is one of a few children's hospitals in the U.S. providing a comprehensive pediatric pain management program.

The program's goal is to improve the quality of life for our patients by giving them the tools to cope with and overcome pain. Some of the therapy options are medications, interventional pain procedures, medical acupuncture, relaxation therapy, guided imagery, biofeedback, hypnosis and cognitive behavioral therapy. The team also teaches patients and families how to manage pain through exercise, diet, lifestyle modifications, and sleep hygiene.

The team includes two board certified anesthesiologists trained in pain management, a licensed clinical social worker specializing in psychophysiology, a physical therapist, a clinic nurse coordinator, and referral to a dedicated clinical therapist. Click here to learn more.

Distracted driving is becoming increasingly common and dangerous, causing traffic crashes and fatalities. In 2015, 463 people were killed in distracted driving crashes in Texas and 3,000 more were seriously hurt.

This month, the Texas Department of Transportation begins it's annual "Talk. Text. Crash." distracted driving campaign. According to TxDot:

"In 2015, 38 percent of Texas drivers admitted to talking on their mobile phone while driving at least some of the time, according to a survey conducted by the Texas A&M Transportation Institute, and more than one-fifth (21.2 percent) of drivers said they read or send text messages or emails when behind the wheel."

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 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 do not respond immediately to texts, they might feel that they’re being very rude or will miss out on something important.”

The most dangerous time of the year for teens to drive, is the first year after they receive their driver license. Drivers between the ages of 16 and 17 have a higher crash rate than those drivers between the ages of 18 and 19. Sixteen –year-old drivers are less experienced and haven’t developed the skills necessary to handle distractions, road hazards and poor traffic situations.

Parents can help their teen drivers by riding in the car with them, even after they obtain their license. The only way teens learn to drive is by driving, and they will get better at driving when coached by an experienced older driver. Please don’t assume that just because your teen has passed their driving test, that they know everything about driving.

Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children’s, knows that guns will be a popular gift this holiday season for not only children, but for adults too.

According to the journal Injury Prevention more than one-third of American adults own a gun. Last year, Cook Children’s saw 10 total injuries related to shootings of a gun (ranging from a BB to rifle). Since 2009, Cook Children’s has seen 104 shootings and three deaths.

Dr. Warmink asks parents to explain to children that BB guns can be dangerous, with harm ranging from severe eye damage to liver and kidney injuries.

Dr. Warmink says it’s important that parents educate their children about gun safety and make sure kids know to leave the area if another child, or someone other than their parent, has a gun.

“We live in Texas and I know many kids are raised hunting and have guns in the home,” Dr. Warmink said. “But if you give your child a gun for the holidays or if the adult in the house is given a gun, it’s important to take the proper precautions. The thing we want parents to remember is to keep guns locked, unloaded and separate from ammunition”

1. Lock the gun and keep it out of reach of kids. Hiding the gun is not enough.

2. Unload your gun. Take all ammunition out of the firearm.

3. Store the keys for the gun in a cabinet or safe different from your household keys. Keep the keys out of the reach of children.

Along with guns and replica firearms, such as airsoft guns that use hydraulics to shoot pellets, Dr. Warmink lists these gifts as dangerous and even life threatening:

• Ripstik Casterboard, Skateboards, roller skates …
• Pull toys with strings over 12 inches
• Trampolines
• Backyard playground equipment
• Hard plastic swords

Sharon Evans, Trauma/Injury Prevention coordinator at Cook Children’s, knows that owning a bike or scooter is part of growing up. But she encourages parents to take the proper precautions before placing wheeled gifts under the tree.

“Parents, please don’t forget a helmet for all riding toys,” Evans said. “Make sure the helmet is on properly and read the instructions.”

For younger children, Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coalition, warns parents to be aware of any small parts or potential choking hazards from their own toys or perhaps older siblings.

“The holidays can be an especially dangerous time for the little ones,” Walraven said. “Pick out toys and activities that will be appropriate for their age. On Christmas, designate an adult to supervise the children. It’s surprisingly easy to lose track of small children and with just a little planning we can keep choking hazards away from them. When it comes to young children, preparation is key.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Teaching Your Child Pedestrian Safety

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

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

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

Safe Kids recommend teaching your kids these safe behaviors:

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

Practice safe behaviors:

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

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

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

Try the interactive infographic from Safe Kids

For more information

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

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

Three kids have been ejected total, with one child surviving. It probably doesn’t come as a surprise the cause of the tragedies – the children weren’t restrained properly or not at all in their car seat.

Since April 2015, Cook Children’s Trauma team has treated 13 children who were ejected from a car.

Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s, says it’s so frustrating because she has seen wrecks where one child who was properly restrained live and the other child not buckled in dies.

“Honestly, it’s just so infuriating,” Evans said. “These accidents are totally preventable. It’s because the adults in the car aren’t doing something that could save their child’s life. I don’t think people think it can happen to them. But it can happen to anyone. It just breaks my heart because these are deaths that shouldn’t occur if people would just place their kid in the proper car seat and buckle them up with a seat belt.”

Statistics show this is especially a problem for Hispanics in the community. Ninety percent of the ejections that have occurred since April 2015 were Hispanic.

“I think a lot of it has to do with our culture,” said Magdalena Santillan, Trauma Injury Prevention specialist at Cook Children’s. “These are people who love their kids and they want to hold their baby. A lot don’t want to hear their baby cry and so it’s easier to hold their baby in the car. They are showing love, but the consequences are too high. This can be a deadly mistake.”

According to the Centers for Disease Control and Prevention, car crashes are a leading cause of death among children ages 3 to 14. From 2002 to 2011, about 9,000 children under the age of 12 died in car accidents, the agency’s statistics show. Correctly using a child safety seat can reduce the risk of death by as much as 71 percent.

“We know that car seats are working,” Evans said. “Research shows that a properly installed rear-facing car seat is five times safer and can dramatically reduce the risk of head, neck and spinal cord injury if your child is involved in a crash.”

Call 682-885-2634 to set up a FREE car seat checkup to ensure your seat is properly installed.

• 2 deaths to begin the month of July
• 26 non-fatal drownings from June 1 to July 1, 2015
• 43 non-fatal drownings from Oct. 1, 2014 to July 1, 2015
• 4 fatal drownings during that same time frame

And now we head into the July 4^th weekend where people will be throwing pool parties at their house or apartment or going out to area lakes … and at many of those parties there will be drinking.

So what’s left to say? Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s, admits to being tired, frustrated, sad and even a little angry that no matter how much the message is delivered, kids drown.

“I feel like a broken recording at this point,” Evans said. “But I don’t know what else to do. We have to keep telling people. We have to keep getting the word out. Tell your friends. Tell your neighbors. Tell your other family members. Kids are dying.”

And then Evans collects herself to deliver the message again.

“I don’t think people know how quickly it happens,” Evans said. “It’s just seconds and it’s a silent killer. Kids died silently. You can’t just let your kids go. Water is dangerous. It scares me because now we are headed toward the July Fourth weekend.”

If nothing else, Evans wants to make sure everyone reading this gets this point.

“It can happen to you,” Evans said. “I can say it, but I don’t think people really realize it. It can happen to you. Don’t take your eyes off of your child. You have to hold on to his or her hand sometimes. The most important thing is to be there for your child. And my God, whatever you do, you can’t let your kid go swimming or to the water alone. You have to have adult supervision.”

Evans speaks strong, but you can hear the pain and heartbreak in her voice. She’s seen a lot of this in her career and twice the amount of drownings over the last month as she saw last year. And what troubles her the most is that she knows no matter how much she speaks about drowning prevention, she will see more again.

“I wish I had a better line, a better solution,” Evans said. “I don’t know what else to say. I just know it’s preventable, if we take the right precautions.”

Click to read the following information for those precautions:

• Drownings double from a year ago 
• Be a water watcher. Adult supervisions saves lives.
• Is your baby ready for swim lessons?
• Drowning tragedy - 'I can't believe this happened to me.'
• Cook Children's drowning prevention page

Six days after her high school graduation, Harkey found out she was pregnant. During her pregnancy she faced several complications due to the fact that her son’s intestines were located outside his belly, a condition known as gastroschisis.

Once Aiden Wayne Harkey-Ellis entered the world, Harkey got to hold her son. But only briefly before he was rushed to Cook Children’s Medical Center where Chip Uffman, M.D., performed surgery on Aiden.

Healthy babies are born with about 200 centimeters of the small intestine. Aiden now has 20 centimeters and only one-third of his colon. He has severe short bowel syndrome (SBS) and will always have trouble gaining weight and absorbing nutrients.

He has had 26 surgeries since birth, including  two transverse enteroplasty procedures to lenghten his bowels and exploratory bowel surgery, a G-button where he receives feeding through a tube and several line placements.

“He is now home safe and sound, however we have been in and out of the very place that saved his life, Cook Children’s, and will be here for years to come,” Harkey said. “I was recently reminded, even if it seems like we’re not progressing, every breath is a miracle and progress.”

Short bowel syndrome occurs any time enough intestine is lost to cause poor absorption of nutrients. There are many causes of SBS. The most common cause in children is necrotizing enterocolitis, a rare complication of prematurity or other serious illness in the newborn period. Other causes include congenital intestinal anomalies (such as gastroschisis, malrotation or intestinal atresias), surgical resection for Crohn disease, trauma, malignancy, radiation, or vascular insufficiency, to name a few.

“SBS is a problem because affected individuals may not be able to absorb enough nutrition and water to grow and thrive,” said Danny Rafati, M.D., Ph.D., a gastroenterologist at Cook Children’s. “Also, because certain parts of the gastrointestinal tract perform unique roles, even losing relatively short segments can lead to a problem absorbing important nutrients.”

Individuals with SBS may need special formulas or even intravenous supplementation (often called TPN) to ensure they have enough nutrition and fluid to stay healthy and thrive. Due to these special needs some children require feeding tubes or long-term central venous lines.

And this is where Harkey becomes upset. She’s seen in the news lately where celebrities have been using the same IV nutrition that children with conditions like SBS need to survive for preventing hangovers or jet lag.

Beth Deen, a pharmacist at Cook Children’s, says that most of the components of the parenteral nutrition solutions have been on back order at some time in the past few years. One of most problematic has included intravenous calcium that premature neonates and cardiac infants cannot live without.

The reasons for shortages include a shutdown of a manufacturing plant due to contamination, which has stopped the production of important products.

When this happens, it creates shortages of needed medication.

Deen said the government and agencies such as the Food and Drug Administration have been involved in the past five years to help solve this problem, but it remains a day-to-day struggle.

“Judicious use of medications includes reserving it for those who truly need it,” Deen said. “We give these medications and vitamins we place in IVs to provide these kids with the nutrition that sustain them. To use them for any reason other than to help the patients in need  are a waste of the materials needed to save lives.”

He’s not hurt and had a presumably bright future in the NFL.

Why did he retire?

In light of the recent focus on repetitive trauma, concussion and brain injury, he decided that it was in his best interest to stop playing football.

Consider it this way: After years of playing football, starting a very young age, succeeding in high school and later at the University of Wisconsin, he reached the pinnacle of his sport and decided it was better to walk away than to keep playing. Granted, he’s only one player and many, many more will continue to make the decision to go back to training camp in July.

Most football players will never reach that point where they’ll have to decide if the NFL is right for them. I played junior high football, but didn’t move on to high school. I like to tell myself that I was making sure I was protected from injury for tennis season (truth was, I was probably a little scared of being small and getting hit by bigger high school kids. Sorry for lying, Coach West).

If you look at the research,  it seems like cumulative trauma is the issue. The older and bigger you get and the longer you play, the number and the force of the traumas increase. The rules are changing in an attempt to make the sport safer. But, I’m sure many of you read this and worry about your young football players.

My sons haven’t asked to play football yet. At 5 and 3, I think the level of risk for concussion is higher when I pick them up and throw them as high as I can in the air barely grabbing them before they crash into the ground. But living in the middle of Texas, football countr,y and having an older son built like a perfect tight end and having little brother with a canon for an arm, I am sure that is a conversation we will have some day.

I wonder if someday we’ll look back on the days when football was played and think, “I can’t believe that they used to do that to themselves.” Or, will the sport look so different that we will barely recognize it?

What about you? Do you have concerns about your sons playing football?

Evans is concerned because at Cook Children’s:

• In 2013, there were three motor vehicle crash deaths (compared to 0 in 2012).
• There has been a 10 percent increase in injuries due to unrestrained kids and a 4 percent increase in ejections.

“This is the time of the summer when a lot of families will be traveling on the road,” Evans said. “I’m very concerned about the amount of unrestrained children we are seeing. I would ask all parents to make sure their children are buckled up correctly to prevent a tragedy to their family.”

Graco car seat recall, what you need to know

To see if your model may be covered, or for additional information, call Graco at 1-877-766-7470, or visit www.gracobucklerecall.com, or email consumerservices@gracobaby.com. Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s, stresses to parents to register car seats when purchasing them so they will be notified of recalls.