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

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

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

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

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

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

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

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

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

As families start their summer traveling, water safety vigilance is key at all ages and no matter where your family might be. Swimming pools, lakes and beaches all pose risks but with the right preparation, you can avoid tragic outcomes.

“Many families stay on rental properties with pools and they may not have a pool at home,” said Sharon Evans, trauma injury prevention coordinator. “Knowing ahead of time what questions to ask and the kind of barriers to put in place lowers the risk of a drowning event.”

Cook Children’s has already treated 10 drownings so far this year, one of which was fatal. Parents need to remember that 70%  of toddler drownings happen during unplanned swim time. This is when parents didn’t expect their child to be in or around the water. 

Ensuring the pool is completely secure after swimming for the day is extremely important. Remove all toys and floats from the pool area so children are not tempted to get close to the water. For above-ground pools, make sure the ladder is removed and not accessible when it’s not swimming time.

Staying Afloat with the Right Life Jacket

Evans says it is not always a matter of strong swimming. Especially with murky water, your child could hit his head on an object underneath and quickly become disoriented. That is why life jackets are a must at lakes and beaches. Texas state law requires all children under 13 years old to wear a U.S. Coast Guard-approved life jacket on boats under 26 feet in length. With so many life jacket options, be sure you choose one that fits properly and is Coast Guard-approved.

A life jacket that is too big will cause the flotation device to push up around your child’s face but too small means it will not be able to keep your child’s body afloat. If there is excess room above the openings and the life jacket rides up over your child’s chin or face, it does NOT fit properly.

A snug fit in these areas signals a properly fitting life jacket. Do not buy a life jacket for your child to grow into – it must fit your child just right. Check the weight limits on the label – and try it on before getting in the water.

A Safe Day at the Beach

At beaches, pay close attention to the warning flags as they can change throughout the day. A red flag is a high hazard meaning high surf and/or strong currents. A yellow flag is a medium hazard meaning moderate surf and/or currents. A green flag is a low hazard meaning calm conditions, exercise caution. A purple flag means dangerous marine life spotted.

“The safest way to play at the beach is with a life jacket,” Sharon said. “Strong waves can come out of nowhere and pull a child down to the bottom causing you to quickly lose sight of them.”

Preparations to make before landing at your vacation spot:

• Check to see if the pool has barriers such as fencing.
• Ask if there are locks high up on doors leading to the outdoors and door alarms.
• Ask if there are dog/pet doors that have direct access to the pool area. Young children can fit through these doors without triggering the door alarm.
• Bring bright swimsuits for your children – choose swimsuit colors that do not blend into the body of water in which your child will be swimming. Light colors, like white or light blue, tend to blend into the swimming pool, making the child harder to see. Neon colors are more noticeable and contrast against the water at pools, lakes and beaches.
• When there are children around water, always designate a Water Watcher, an adult who is in charge of watching all children without any distractions.
• Pack water watcher tags for adults to wear at the pool.
• Refresh CPR and first aid skills.
• Bring portable door alarms and body alarms for additional layers of protection.
• Bring doorknob covers.

RELATED STORIES:

• What Color Is Your Child's Swimsuit? Experts Say Choose Safety Over Fashion (checkupnewsroom.com)
• Tips for Best Fit, Safe Practices for Wearing Life Jackets (checkupnewsroom.com)
• Pediatrician Shares Top Beach Vacation Tips (checkupnewsroom.com)
• Water Watcher Tag: 1 Item Can Help Prevent Drownings (checkupnewsroom.com)

In 2018, Cook Children’s Health Care System formed a partnership with Covenant Children’s Hospital in Lubbock, Texas, to bring cardiothoracic surgical care to families living in West Texas and eastern New Mexico. The partnership is part of an initiative to make treatment more convenient for patients and families in Lubbock and the surrounding areas. Since its launch, eight children have undergone surgery at Covenant Children’s.

Gunner’s parents, Donavin and Cassie Sanchez, said staying close to home for surgery at Covenant Children’s earlier this month where they had the support of family and friends in the area was a gift to all five of their children. Gunner is a quadruplet, along with siblings Arrow, Cheyenne and Scarlett. Hazen is their 8-year-old big brother.

“Our other kids are being spoiled right now by the whole family,” Cassie said when talking about how Gunner’s siblings fared while mom and dad stayed at their son’s bedside.

Gunner, who turned four on May 3 just days after his surgery, showed no outward signs or symptoms of a heart condition. His parents describe him as a typical rambunctious and outgoing boy who loves dirt, cars and any sport with a ball.

Even so, surgery could not wait.

“If we waited until we could tell something is wrong, we’ve waited way too long,” said Vincent Tam, M.D., director of cardiac surgery at Cook Children’s Medical Center. Dr. Tam is a part of the Cook Children’s cardiothoracic team that travels quarterly to Covenant Children’s to perform surgery.

“If we were to see symptoms in a kid this age, we’re really in trouble because,” he said. “By then, the valve is really messed up, his lungs would be damaged and his heart would have been overworked.”

The hole in the lower pumping chamber, called a ventricular septal defect (VSD), makes Gunner’s heart work much less efficiently, and extra blood flow to his lungs could eventually result in damage. The defect also led to a narrowing of his aortic valve opening due to a buildup of scar tissue under the valve. As it gradually builds up over time, the scar tissue limits blood flow and can lead to a leaky aortic valve.

“If we don’t intervene, the subaortic membrane narrowing will persist, and it will actually progress over time so that months and years from now the narrowing will be even worse,” Dr. Tam explained. “It will also begin to negatively affect the function of the aortic valve. So, we don’t want things to get to the point where the aortic valve itself is in jeopardy. The extra blood flow from his VSD opening in the lower pumping chamber means more work for his heart.”

It takes a diverse team of clinical professionals from both Cook Children’s and Covenant Children’s for kids like Gunner living in more rural areas of the country to have access to this type of specialized surgical care.

“Heart surgery is teamwork, Dr. Tam said. “It’s not just me. We need a whole team of people from cardiac anesthesia to operating room staff to someone to run the heart/lung machine to ICU doctors.”

Gunner’s surgery was a success, and his parents are hopeful for his future.

“I hope he can be just like his big brother,” Gunner’s mom said. “I hope he can run and play baseball and be the healthy little boy he deserves.”

The sweetest gift of all in this unique collaboration is that Gunner was discharged from the hospital on his birthday, just in time to celebrate with his brothers and sisters.

Learn more about Cook Children's partnership with Covenant Children's 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.

First of all, families need to discuss risks and benefits of traveling by car or plane. I understand the desire to see your grandparents at Thanksgiving and Christmas. My own Grandma is in an assisted living center and I have had very little contact with her over the past six months. We don’t want our relatives to spend the holidays alone, but we also don’t want to put them in any unnecessary risk. So, do we stay or do we go?? There is no “correct” answer to that question. We want to cherish time with our relatives, especially the elderly ones, but need to be cautious if visiting older or immunocompromised family members.

If you choose not to travel, having a small intimate family holiday will be a nice change from the normal, sometimes stressful, celebration. You can FaceTime or Zoom other family members and still be engaged at mealtime, present opening, cooking favorite recipes, and even coordinate games together. Technology affords us the opportunity to stay close, even when we’re far away.

Ideas for a socially-distanced holiday:

• Cook a family recipe and host a contest on who nailed it the best: presentation, taste, closeness to “how Grandma makes it.”
• Gingerbread house decorating contest.
• Play games: My family was laughing so hard we couldn’t speak when we played the Heads Up! game on our phones last year. Grandma nearly peed herself laughing when her clue was “monkey” and all adults ran around the kitchen acting like crazy animals at the zoo!
• Make a shared album for photos/ videos and upload pictures daily for the rest of the family to see and enjoy.
• Purchase themed family pajamas and put on a fashion show.
• Holiday light or tree decorating contest.
• Scavenger hunt/treasure map.

If you choose to travel, I recommend smaller groups visiting older or immune compromised family members. This is not the best year for a 50 person family reunion. Stay in the largest home available and spread out. Wear a mask for close contact inside and when cooking. Wash hands more frequently. Weather permitting, eat and socialize outside. Who wouldn’t love making s’mores in a fire pit?!

Ideas for safe traveling during the holidays:

• When driving: many fast food restaurants do not allow customers inside for potty stops, so be mindful to stop at rest stops or gas stations. Wear your mask inside, wash your hands very well, and have hand sanitizer in the car. Pack snacks and drinks and limit unnecessary pit stops.
• If travelling by plane: pick the first flight of the day when the plane is the “cleanest.” Pack plenty of snacks so you don’t need to purchase in the airport; I advise fruit & veggie squeeze packs, trail mix, crackers, cereal bars, practically enough to be a mini meal if needed. Use antibacterial wipes and hand sanitizer often. Keep your mask on the entire time you are in the airport and on the plane.

In this unprecedented year, holidays may look different. Decide on what will work best for your family this season and be safe no matter what you choose.

With so many people out on the road, it means more opportunity for danger.

From Dec. 20 to Dec. 31, 2018, the Trauma Department at Cook Children's reports 17 children were admitted at the Medical Center for injuries related to motor vehicle crashes and an additional 29 children were treated and released after a visit to the Cook Children's Emergency Department. One wreck during that time frame included a fatality and a total of three children died during the entire month of December.

“Unfortunately, we've seen children die around the holidays," said Debbie Wheeler, a Child Life specialist for the Emergency Department at Cook Children's. "With other traumas, we’ve seen young kids live by the grace of being properly restrained in the correct car seat. I really want to encourage parents to travel safely this holiday season, especially for everyone in the vehicle to be buckled up appropriately. It is really sad to see a patient hurt and have injuries that could possibly have been prevented if they were in a car seat, a proper car seat, or a seat belt.”

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

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

“Honestly, it’s just so infuriating,” Evans said. “These crashes are 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 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."

Holiday Injuries Treated at Cook Children's (Dec. 20-31, 2018)

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. 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 and 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.

However, 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 the 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 a halo brace for severe neck injuries 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.

If you are having even the slightest trouble, questions or concerns regarding your child’s safety in the car, certified child passenger safety technicians are able to help or even double check your work.

For those of you in the Tarrant County area, you can call Safe Kids Tarrant County, led by Cook Children’s, at 682-885-2634.  Also visit this site for a quick car seat checklist with the top 5 things to do to check your seat. 

1. When can my child change from rear-facing to forward-facing?

The American Academy of Pediatrics (AAP) recommends children ride rear-facing until at least 2 years old or until they reach the maximum height and weight for their seat. Keeping children in a rear-facing position better protects their heads, necks, and backs. Seats will indicate on the side labels what the rear-facing weight/height limit is and you can also check the manual of the seat. Parents often worry about the safety of a child’s legs when the child is growing taller and is still rear-facing.  Studies show that a child’s legs are actually injured less often when a child is rear-facing.  Both of my children were in the 90+ percentiles for height at age 2 and both remained rear-facing past 2 years old.

2. When can my child use a booster seat instead of a harness forward-facing seat?

The AAP recommends children ride in car seats with a harness until at least 4 years old, however they should continue to use a 5-point harness up to the highest weight or height allowed by the manufacturer of the seat.  Moving from a 5-point harness to a booster seat is a step down in safety, so a child should remain in the harness seat as long as possible.

3. When does my child no longer need to use a booster seat?

Texas law requires children to remain in booster seats until at least age 8, unless the child reaches a height of 4 feet, 9 inches before age 8 (which is extremely uncommon). 

Recommendations state a child should remain in a booster seat until at least age 8 or until the seat belt fits correctly. Most children are 9 years or older before they reach 4 feet, 9 inches, which is when the seat belt will usually fit them correctly without the booster seat. You can use the “Safety Belt Fit Test” to help you determine if your child is ready to use the seat belt alone without a booster seat:

1. Have your child sit all the way back on the vehicle seat.  Do the knees bend at the front edge of the seat?  If no, then your child should stay in a booster seat.  If yes, then go to No. 2.
2. Buckle the seat belt.  Does the lap belt lie on the upper legs or hips (not the stomach)?  If no, then your child should stay in a booster seat. If yes, then go to No. 3.
3. Does the shoulder belt rest on the shoulder or outer collar bone (not the neck)?  [Note- Never put the shoulder belt under a child’s arm or behind a child’s back.]  If no, then your child should stay in a booster seat.  If yes, then go to No. 4.
4. Can your child maintain the correct seating position for as long as you are in the car without slouching or moving positions causing the belt to move improperly to the neck or stomach?  If no, then your child should stay in a booster seat.  If yes, and you answered yes to all 4 questions, then your child is ready to use a seat belt without a booster seat.

4. When can my child sit in the front seat?

Children should not ride in the front seat until age 13. The safest place for a child in the car (or any person for that matter) is the back seat, particularly since the most common crash is a frontal crash.  Air bags deploy with such force that they can cause severe head and neck injuries to a child.

5. Do car seats and booster seats expire?

Yes, all car seats and booster seats expire. Usually they last about six years, but be sure to check for an expiration date on the seat label.

For more information:

• Car safety
• Is your child's car seat safe?
• FREE car seat checks
• Never leave your child alone in a car
• Look and lock
• Spot the tot
• From the car seat to the driver's seat
• Resources

About the author

Nicole Wineriter, M.D., is a Cook Children's pediatrician at the Heritage Trace Clinic. She is a Fellow with the American Academy of Pediatrics and a member of Safe Kids Tarrant County, led by Cook Children's, and a certified child passenger safety technician. 

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.