Navigating Cook Children’s Health Care System

Quick Facts:

• A Fully Integrated System: Cook Children’s Health Care System is a comprehensive, not-for-profit pediatric organization encompassing two full service hospitals, physician network, home health care, surgery centers, a health plan, and a dedicated health foundation.
• Cook Children's: Within our network, our two full-service pediatric hospitals are officially named and referred to as Medical Centers (located in Fort Worth and Prosper).
• Urgent Care: For non-emergency medical needs that still require prompt attention, the system also operates seven Urgent Care Centers across the region.

An unexpected visit to the doctor can be stressful, especially when traveling. Cook Children’s Health Care System ensures that families can access health care at any time through its seven Urgent Care Centers (UCCs), or its two 24-hour emergency departments. With help from the Cook Children’s Language Services Department, families can receive care in their native language. 

Know before you go 

Whether visiting the emergency room or urgent care clinic, being prepared will help ensure care is timely and the child is back in action as quickly as possible. 

To be able to treat a child, a parent or legal guardian must be present or provide permission for treatment. If a parent or legal guardian is unavailable, a written letter of permission or immediate phone access to obtain verbal consent from the parent or legal guardian is needed. 

The adult accompanying the child should bring:

• A form of identification.
• Traveler’s insurance information (if available).
• A list of the child's medication. 

When to use the Cook Children’s Emergency Department 

With full-service medical centers in both Fort Worth and Prosper, Cook Children’s provides emergency care for children across North Texas.  

“We are always happy and prepared to help,” said Julio Castillo, M.D., medical director of emergency services at Cook Children’s Medical Center – Prosper.  

Cook Children's cares for more than 300,000 children every year through urgent care and emergency room visits, providing care in more than 200 languages.  

“We have local Spanish translators and multilanguage computerized access,” explained Dr. Castillo. 

Caregivers should take their child to the Emergency Department if their child is unconscious, not responding, a bone is sticking out, or the situation seems critical. For immediate assistance, dial 911. When a condition is sudden, life-threatening, or risks causing permanent harm, transport by ambulance is safest for the child. 

Take the child to the emergency department if your child is experiencing:  

• Severe bleeding that does not stop after 15 minutes of direct pressure
• Severe allergic reactions
• Difficulty breathing
• Bluish tint to the lips
• Coughing up or vomiting blood
• Sudden severe joint pain with swelling
• Insect stings accompanied by breathing difficulties
• Accidental swallowing of medications, chemicals or other substances
• Not being able to move or speak
• Severe or persistent vomiting or diarrhea
• Gaping wound (edges won’t come together)
• Head injury with loss of consciousness, vomiting or causing dizziness/confusion
• Visible broken bones or dislocated joints
• Fever higher than 100.4 F in infants under 8 weeks old
• Diabetes/blood sugar issues 

Urgent Care 

“For simple fever, cough, and congestion, your child can be seen in urgent care or by their pediatrician,” said Taylor Louden, M.D., medical director of emergency services at Cook Children’s Medical Center- Fort Worth. 

When a child needs same-day medical attention for non-life-threatening illnesses or injuries such as X-rays or stitches,a Cook Children's urgent care clinic can provide the necessary care.

“Cook Children’s Urgent Care Centers are available to see patients needing routine or urgent care while visiting our city for the event,” said  Kara Starnes, D.O. medical director of Urgent Care at Cook Children’s. 

Not all urgent care centers are the same. Cook Children’s Urgent Care clinics are not just kid-friendly; they are kid-only. Because childhood injuries and illnesses require specialized pediatric expertise, families must make an appointment prior to ensure a smooth, efficient visit.

When to use Cook Children’s Urgent Care 

• Ear infections/pain
• Strep/sore throats
• Cold symptoms
• Flu
• Mild dehydration
• Respiratory illnesses – including respiratory syncytial virus (RSV), bronchitis, bronchiolitis, pneumonia and asthma without severe breathing difficulty
• Sprains and possibly broken bones
• Minor cuts
• Prolonged vomiting
• Persistent diarrhea
• Infected bug bites
• Foreign body removal (marbles, beans and other interesting things)
• Urinary infection symptoms
• Pinworms, ringworm, rashes and pink eye
• Painful muscle strains
• Head injuries without loss of consciousness or vomiting 

Related Stories:  

• Cook Children’s Shares Expert Advice About Norovirus 

• Invisible Barriers in ADHD Detection for Children 

• How to Spot a Counterfeit Car Seat 

With the holidays in full swing, accidents and illness may happen at any time. It is always recommended that you try scheduling an appointment with your primary care doctor first. If that is not an option, Cook Children’s Health Care System ensures that our families can access health care at any time through a telehealth visit, an urgent care center, or an emergency department. To prepare for when you need care, know when to use Cook Children’s telemedicine, urgent care, and when to rush to the emergency department.

“For simple fever, cough, and congestion, your child can be seen in urgent care or by their pediatrician,” said Taylor Louden, M.D., medical director of emergency services at Cook Children’s Medical Center- Fort Worth. “Your wait times for simple illnesses will be much longer and visits much more expensive in the emergency department than if your child is seen in urgent care or by their pediatrician.”

He explains that doctors expect a fever to return after the Tylenol/Motrin wears off; however, for fevers lasting more than five days, or if a child appears ill, the emergency department is the appropriate place to be evaluated.  

Urgent Care

When your child needs urgent care for things like X-rays, stitches, and illnesses that are not life-threatening but need medical attention the same day, you'll find the medical care you need at a Cook Children's urgent care clinic.

Cook Children’s Urgent Care clinics are not just kid-friendly; they are kid-only.

When to use Cook Children’s Urgent Care

• Ear infections/pain
• Strep/sore throats
• Cold symptoms
• Flu
• Mild dehydration
• Respiratory illnesses – including respiratory syncytial virus (RSV), bronchitis, bronchiolitis, pneumonia and asthma without severe breathing difficulty
• Sprains and possibly broken bones
• Minor cuts
• Prolonged vomiting
• Persistent diarrhea
• Infected bug bites
• Foreign body removal (marbles, beans and other interesting things)
• Urinary infection symptoms
• Pinworms, ringworm, rashes and pink eye
• Painful muscle strains
• Head injuries without loss of consciousness or vomiting

Virtual Urgent Care

Cook Children's patients with a MyCookChildren's account can video chat with one of our medical experts for non-urgent medical conditions without visiting the doctor's office.

This service is for patients who have minor medical conditions, and not for emergencies.

• Animal and insect bites
• Burns or cuts
• Circumcision check
• Conjunctivitis (pink eye) without other symptoms
• Constipation advice
• Covid-19*
• Diaper rash
• Fever advice
• Flu-like symptoms*
• Ingrown toenail
• Lice
• Mouth ulcers, thrush
• Rashes or skin infections
• Sore throat/strep throat*
• Urinary tract infections*
• Vomiting/diarrhea
• Wound care advice

*Drive-through testing available at Cook Children's Urgent Care locations if medically necessary.

When to use the Cook Children’s Emergency Department

Cook Children’s Health Care System has two medical centers with an Emergency Department for our Fort Worth and Prosper little ones. Parents should take their child to the Emergency Department if their child is unconscious, not responding, a bone is sticking out, or the situation seems critical. Dial 911 immediately for an ambulance. When your child's condition is life-threatening or might cause permanent harm, it is safer for your child to be transported via ambulance.

• Severe bleeding that does not stop after 15 minutes of direct pressure
• Severe allergic reactions
• Difficulty breathing
• Coughing up or vomiting blood
• Sudden severe joint pain with swelling
• Insect stings accompanied by breathing difficulties
• Swallowing poison or choking
• Not being able to move or speak
• Severe or persistent vomiting or diarrhea
• Gaping wound (edges won’t come together)
• Head injury with loss of consciousness, vomiting or causing dizziness/confusion
• Visible broken bones or dislocated joints
• Fever in infants under 8 weeks old
• Diabetes/blood sugar issues

El martes, Cook Children's Medical Center en Fort Worth atendió 572 pacientes en el departamento de emergencia. En los siete Centros de Cuidado de Urgencia hubo 842 pacientes. Entre el 10 de noviembre y 16 de noviembre Cook Children's Medical Center en Prosper evaluaron a 113 pacientes por Virus Respiratorio Sincitial (RSV, por sus siglas en ingles) y 29 resultaron positivos.

Cook Children's Medical Center en Prosper también ha notado un gran volumen de pacientes en la sala de emergencia. La mayoría de los pacientes admitidos ha sido debido a VRS, influenza o neumonía.

El aumento de las visitas al hospital se debe a una fuerte propagación del VRS y neumonía ambulante (mycoplasma pneumoniae) en Dallas-Fort Worth.

Cada año por estas fechas, los casos de VRS aumentan más rápidamente de lo habitual este año, dijo El Director Médico de Servicios de Emergencia, Dr. Taylor Louden.

"Hemos visto a más de 1,100 pacientes en los últimos dos días a través de la sala de emergencias, y ha sido es muy difícil para nosotros manejar este volumen de una sola vez", dijo Louden.

De los 972 pacientes examinados en Cook Children's Medical Center entre el 10 y el 16 de noviembre, el 39% de los niños tenían VRS o neumonía ambulante. De ellos, 224 dieron positivo para el VRS y 99 resultaron positivos para neumonía.

¿Qué es el VRS y cuando debo de ir a la sala de emergencia?

El VSR generalmente afecta más a niños menores de dos años y puede causar una acumulación de moco y congestión que dificulta la respiración de los niños. Los padres deben tomar precauciones para limitar la propagación del virus. Quédese en casa si están enfermos. La vacuna contra el VRS está disponible para mujeres embarazadas, bebes, y personas mayores.

Si su hijo está enfermo, los padres y cuidadores pueden ayudar a reducir el estrés en el sistema de servicios de emergencia sabiendo cuándo llevar a su hija a la sala de emergencia y cuándo programar una cita. Limitar el tráfico de la sala de emergencias a verdaderas emergencias ayuda a evitar que el sistema se sobrecargué.

Si su hijo está enfermo, pero no tiene problemas agudos, consulte con su pediatra. Si es posible, programe una cita con unos de los Centros de Cuidado de Urgencia en lugar de visitar la sala de emergencias.

El tratamiento para el VSR es monitoreando y tratando los síntomas. No hay cura para el virus. Muchas enfermedades respiratorias virales se pueden tratar en casa con descanso, hidratación y electrolitos. Para la congestión, los padres y cuidadores pueden usar solución salina nasal para diluir la mucosidad y succionarla con una pera.

¿Qué es neumonía ambulante?

Desde el verano casos de neumonía ambulante han estado alto, dijo Louden. Entre el 10 y el 16 de noviembre, 99 niños resultaron positivos para la enfermedad. A comparación del año pasado, durante la misma temporada, Cook Children's reportó menos de 10 de casos de neumonía ambulante entre agosto y diciembre.

La neumonía ambulante suele afectar a los niños en edad escolar. Algunos de los síntomas incluyen: fiebre leve, fatiga y tos. La mayoría de los casos de neumonía atípica se pueden tratar con antibióticos, pero si su hijo tiene neumonía y ha tenido fiebre durante más de cinco días y/o dificultad para respirar, busque atención de emergencia.

La neumonía, el VRS, la gripe y el COVID-19 pueden tener síntomas similares. La gripe y el COVID-19 también pueden incluir dolor de garganta, dolores de cabeza, dolores corporales, escalofríos y cambios/pérdida del gusto y el olfato. Los padres no deben acudir a atención de urgencia ni al departamento de emergencias para hacerse una prueba de RSV, gripe o COVID. Su pediatra puede realizar pruebas para todos estos.

En muchos casos, los médicos pueden evaluar y tratar a un paciente mediante una cita de salud virtual. Descargue la aplicación MyCookChildrens para programar una cita virtual de salud/telemedicina aquí.

¿Cuándo acudir la sala de emergencia?

•  La temperatura mayor de 100.4F o 38°C en bebes menores de dos meses, es una emergencia médica.
•  Si su hijo tiene fiebre por más de tres días, comuníquese con su pediatra o el centro de cuidado de urgencia.
• Preocupación por deshidratación.  En bebes deshidratados habrá menos pañales mojados o falta de lágrimas. La fontanela hundida puede ser un signo de deshidratación.   
• Su hijo está respirando inusualmente rápido y se puede ver la piel entre las costillas.
• Su hijo requiere más su inhalador de rescate o los síntomas de asma empeoran

Síntomas

Síntomas de Virus Respiratorio Sincitial (RSV, por sus siglas en ingles) en bebes menores de 6 meses:

• Irritabilidad
• Letargo
• Apetito reducido
•  Episodios en donde dejan de respirar
•  Fiebre

Síntomas en bebes y niños mayores de 6 meses:

• Mocos
• Congestión
• Apetito reducido
• Tos
• Estornudos
• Fiebre
• A veces sibilancias

¿Cómo prevenir?

•  Nunca es tarde para vacunarse. Llame a su pediatra para obtener la vacuna contra el COVID-19 y la influenza.
• Adopte buenas prácticas de higiene como cubrirse al toser y estornudar.
•  Lavarse o desinfectarse las manos a menudo.
•  Limpiar las superficies que se tocan con frecuencia.
•  Si usted o su hijo se sienten mal, quédense en casa para prevenir la propagación de enfermedad. Tome tiempo para descansar y manténganse hidratado.

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

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

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

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

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

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

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

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

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

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

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

Golf carts can be particularly dangerous.

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

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

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

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

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

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

Pediatricians and Their Own Kids

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

Here’s what they had to say:

Dr. Guzman:

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

Dr. Starnes:

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

Dr. Arnaout:

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

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

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

RELATED:

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

To get an excused absence due to illness, please:

1. Contact your school’s attendance office to communicate your child’s absence. 
2. Submit a parent note in writing within five school days of your child’s return to campus. The excuse note should include the following:

• Student Name
• Student ID Number
• A written statement giving the dates and reason for absence
• Parent/guardian signature
• Parent phone number

3. If your child is absent for multiple days, contact your school for the attendance petition process.

From Cook Children’s Medical Center: Symptoms to be aware of and action to take

Like many hospitals and children’s hospitals around the country, Cook Children's is experiencing a surge in patients diagnosed with RSV, flu and other respiratory illnesses. The increase impacts our ability to care for patients in a timely manner.

RSV is a common respiratory virus. Some children require hospitalization, but most do not.

It is NOT necessary for your child to take a strep throat, flu or RSV test before returning to school.

RSV and Other Illness Guidelines for Parents

Parents should NOT go to the Urgent Care or Emergency Department for only a flu or COVID test. See your pediatrician, who can test for flu, RSV, strep throat and COVID. Adults can also use at-home tests or tests at a pharmacy.

Call your pediatrician if:

• If your child is experiencing mild respiratory symptoms but is not having difficulty breathing and is well-hydrated.
• If you need to have your child tested for RSV, the flu or COVID-19.

Seek immediate medical care if:

• Persistent fever for more than two or three days. However, any temperature greater than 100.4 in an infant under two months of age is considered a medical emergency.
• You have concerns that your child is dehydrated.
• In dehydrated babies, parents will see fewer wet diapers or a lack of tears. Their flat spot on the head can also appear more sunken.
• Breathing faster than usual or can see the skin between the ribs being sucked in.
• If your child requires frequent use of their albuterol rescue inhaler or is having worsening asthma symptoms.

Prevention:

• Get the flu vaccine and stay up to date on the vaccine schedule from the Centers for Disease Control and Prevention.
• Get the COVID vaccine and approved boosters.
• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If sick, wear a mask in public and stay home.

If your child attends a different district, please call your campus to find out what your absentee policy is.

RELATED

• RSV Decreases While Flu Continues to Increase at Cook Children's (checkupnewsroom.com)
• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

As you can imagine, this has led to frustration for those seeking care. Our exhausted staff has heard an abundance of complaints and mean comments that are discouraging when they are working so hard to serve our patients and families. Unfortunately, they are outmatched by the demand.

Here’s what we know:

1. The vast majority of patients in our UCCs and ED have upper respiratory infections like colds.
2.  Most COVID-19 tests are coming back negative.
3.  All of our pediatrician offices offer COVID testing and it’s safe to wait one to two days for COVID testing if you plan to keep your child at home.
4. If your pediatrician does not have available appointments for your child’s cold symptoms, there are at-home COVID-19 tests available in stores currently.
5. Minor concerns like sore throat, cough, low-grade fever, diarrhea and other stomach problems are issues your pediatrician can help with.
6. The ED should only be used for severe symptoms and injuries.
7. The UCC should be used for moderate symptoms and injuries.

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

For information about some common questions we hear, take a look at these articles:

• My Child's Fever Isn't Going Away. Should I Be Worried? (checkupnewsroom.com)
• Fever, Headaches and Stomach Pain. When Should You Be Concerned? (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)
• 5 Reasons Why Your Child's Coughing Is A Good Thing (checkupnewsroom.com)
• Let's Learn About Fevers (checkupnewsroom.com)
• How Much Sickness Is Too Much? (checkupnewsroom.com)

They shared how Cook Children’s is currently being impacted by a surge in COVID-19 cases and hospitalizations.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases, Corwin Warmink, M.D., medical director of Emergency Services, Kara Starnes, D.O., medical director of Urgent Care Services, and Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Pediatrics Haslet have all worked tirelessly to ensure our patients and families are receiving the best care throughout the pandemic.

During the news conference, the experts addressed what they are seeing in our urgent care locations, emergency department, and Cook Children’s system as a whole.

“We need compassion from the community and this is an illness affecting our children,” Dr. Starnes said. “We are hitting crisis mode and we can’t do it without your help.”

Cook Children's Urgent Care facilities are being stretched thin. Over the weekend, Cook Children’s was forced to close its Hurst location due to a lack of staff members and high demand for services.

"This is the first time we’ve had to take such measures. We closed in an effort to consolidate staff and safely take care of our patients,” Dr. Starnes explained.

On Monday, the six remaining urgent care locations saw 1,400 children. This is twice the number of patients the urgent care centers typically see.

Dr. Starnes stressed that if you believe your child has been exposed to COVID-19, it is best to find a local testing site in the community or use an at-home testing kit. You can find a list of local COVID-19 testing locations here. 

Cook Children’s Emergency Department (ED) is experiencing patient volumes not seen since the H1N1 pandemic in 2009. On Monday, the ED saw 601 patients with patients arriving every 2.5 minutes.

“We are breaking records we don’t like to break,” Dr. Warmink said. “I have been at Cook Children’s for 18 years and this is the worst it’s ever been.”

We encourage all families to come to the emergency room for emergencies but ask that they do not come for a simple COVID-19 test. This pulls resources away from critically ill and injured patients and takes up already limited bed space. Along with COVID-19, we are still seeing RSV cases but thankfully, they appear to be on a downswing.

“The adults in the room need to step up and do the right thing,” Dr. Warmink said. “If you send your kid to school without a mask, it’s not if they are going to get sick, it’s when.”

Dr. Warmink advises all parents, “Ask yourself if this can wait” before bringing their child into the emergency department.

Most children have mild illness with COVID-19, but that is not the case for everyone. Throughout the course of the pandemic, Cook Children's has hospitalized 1,129 children with COVID-19, with 241 of those admitted to the Intensive Care Unit (ICU). Throughout the pandemic, seven children with COVID-19 have died. Two died this past week. They were a 4 year old and a 15 year old. 

"We are seeing more severe illness than we have seen at any point during the pandemic. The January surge was nothing compared to what we’re seeing now,” Dr. Whitworth said.

As a result, on Monday, Cook Children’s opened up a third COVID-19 unit for the first time since the start of the pandemic. This unit has nine beds – and within the first 24 hours of being open, was completely full.

With Labor Day weekend ahead of us, Dr. Whitworth encourages everyone to be safe, mask up, and socially distance, as we cannot handle another influx at this time.

“Every child that has the virus inside of them has the potential to spread it to someone else, and they don’t mean to,” Dr. Whitworth said. “Much of what we are seeing is 100% preventable, children have to wear a mask.”

Cook Children's also set a record for COVID-19 hospitalizations on Wednesday with 35 patients. This is the highest number of COVID-19 patients hospitalized at the medical center at any point in the pandemic. The COVID-19 ICU was also filled. 

What can the community do to help?

All four experts we heard from on Wednesday have a few simple pleas:

1. Get vaccinated and get your child vaccinated as soon as possible.
2. Please have your children wear a mask to school.
3. Wash your hands frequently.
4. Re-think gatherings – if you gather, wear masks, stay socially distant and gather outdoors if possible.

Across the board, Cook Children's is seeing record numbers of families each day who are wanting rapid COVID-19 tests for their children.

"We understand this is a scary time, but want to remind families not to panic if your child was exposed to COVID-19," Dr. Starnes said. "We understand schools have requirements, but we need you to understand we do not want you to panic or rush in to be seen immediately after an exposure. Rushing to our urgent care locations puts a strain on our resources.”

The best thing you can do if your child was exposed is find a local testing-only site in the community or use an at an at-home testing kit.

Cough, fever, runny nose, sore throat, body aches, headache, vomiting and diarrhea are all common symptoms of COVID.

For children over the age of 3 months, these symptoms can typically be managed at home with symptomatic care. Medications such as acetaminophen or ibuprofen can help with fever and pain. You should encourage your child to drink plenty of fluids and it is ok if they do not have much of an appetite.

Parents should seek care for their child over 3 months of age if they have had 5 days or more of fever, difficulty breathing, inability to keep fluids down or stay hydrated (no tears or no urination for 8 hours or longer) or if their child is having pain or fever that is not helped by an appropriate dose of fever reducer/pain reliever.

Patients under 3 months of age who are sick should be seen in person and evaluated.

Also, if there is at least one known positive case at home and others are sick, it can be assumed that all have COVID and everyone needs to isolate at home for 10 days from the start of symptoms.

“We cannot magically create hospital beds at the drop of a hat,” Dr. Whitworth said. “Wear a mask no matter if you’re vaccinated or not, wearing a mask is not an option.”

“If your child needs emergency care treatment, our Emergency Department is here for you. That’s why we’re here,” said Natalie Carpenter, director of Emergency Services at Cook Children's. “But please don’t come to the emergency department for a simple COVID test.”

Carpenter said many parents have come to Cook Children’s ED in a panic because their child was exposed to a classmate at school who tested positive for COVID-19. The parents often bring younger siblings too, so that the whole family can be tested in the ED. High volumes of non-emergency patients puts unnecessary strain on the department.

“It pulls away staffing from the critically-injured and ill and it takes away bed space,” she said. 

As an example, Carpenter said, of the 361 patients seen in the ED on Tuesday, almost half were considered less urgent or non-emergent. Many of the patients could have been seen at a pediatrician’s office or clinic.

 The U.S. Centers for Disease Control and Prevention (CDC) lists these COVID-19 symptoms requiring emergency care:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

With schools reopening and COVID-19 cases on the rise, parents should encourage their children and teens to wear masks, social distance, wash their hands frequently, and follow guidance for quarantining. Carpenter encouraged parents who suspect their child might have COVID-19, and are not exhibiting symptoms, to get tested at drive-thru centers or other designated testing facilities. 

It’s important to know that Cook Children’s urgent care clinics are unable to perform rapid COVID-19 testing on a child who doesn’t show symptoms. Cook Children’s does have drive-thru testing sites, but those appointments are scheduled only through a Cook Children’s pediatrician and for specific times and locations.

Kara Starnes, D.O., medical director of Cook Children’s Urgent Care, said patient numbers and wait times have dramatically increased recently. Dr. Starnes said 737 patients came to urgent care on Tuesday – compared to a previous maximum of about 650 patients.

“The usual surge that comes when school starts is usually about two to four weeks post back-to-school,” she said. “We’re seeing strep infections, common colds and pink eye as well as the expected substantial increase in COVID cases as kids are now congregating together at school, often without masks.”

Where do you go when your child needs to be seen by a doctor? Here’s a guide:

• Go to the emergency room if your child has trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition.

• Call your health care provider if your child has ear pain, sore throat, diarrhea or vomiting, rash, cough or other non-urgent health concerns. The pediatrician ’s office can help you decide what steps to take.

• If you can’t get to your provider’s office or it’s after hours, go to an urgent care center. Urgent care centers manage the same problems as your regular health care provider plus services such as X-rays, stitches and splints.

For more information, visit www.cookchildrens.org/coronavirus.

But choosing the best place to go for your child's care  can be a difficult one for some parents. After all, Cook Children's offers several options within its system, ranging from primary care, urgent care, the neighborhood clinics and the emergency department.

So how do you know where to go? To begin with, visit the handy infographic to the right or click here.

"Every patient who comes into our Emergency Department is important to us. However, some patients may be able to receive the care they need from their primary care physician, a neighborhood clinic or an urgent care center," said Corwin Warmink, M.D., medical director of Cook Children's Emergency Department. "The best thing a parent can do is know what constitutes an emergency, so they know where to go when that time comes."

When it comes to choosing where to go, Kara Starnes, D.O. medical director of Urgent Care at Cook Children's, advises parents to think about the severity of the issue.

For instance, your child's Cook Children's pediatrician can see a number of ailments, including allergies, the flu, migraines, pink eye, sprains and vomiting.

During times when your pediatrician's office is not available, the Urgent Care Centers at Cook Children's can handle the same ailments, along with most fractures (broken bones) and cuts. Fractures with severe deformities or open fractures should not come to the Urgent Care but instead should go to the Emergency Department (ED). The ED has more equipment to handle the most severe cases, and the child can be admitted quickly to the medical center for continuing care.

If your child has multiple injuries, neck injuries or head injuries with loss of consciousness and/or vomiting, they should go to the ER. These kids typically need the ER because the UCC is not as equipped in imaging and other sophisticated tests available at the medical center.

"Possible surgery, such as appendicitis, is tough for parents to determine because most of the time, abdominal pain is caused by something simple like constipation," Dr. Starnes said. "But severe abdominal pain, testicular pain or swelling, bleeding when vomiting or severe bleeding with bowel movements are reasons to go to the ER."

You should visit the ED with your child in case of a medical problem that could cause death or permanent injury if not treated right away.

Daniel Guzman, M.D., a Cook Children's Emergency Department physician, adds “when in doubt of the severity, always visit the higher level of care such as the Emergency Department” and if immediate attention is required call 911.

And of course, we are right in the middle of flu season. Last week (Jan. 5 to Jan. 11, 2020), 837 kids were tested for the flu. Of those kids, 141 tested positive for Influenza A, 187 for Influenza B and another 102 for RSV. 

For those kids, Cook Children’s has a variety of options for care including the primary care offices, neighborhood clinics and urgent care locations.

“If your child is over 3 months old and has a fever, even a high one, it’s OK to see your pediatrician as long as they are breathing comfortably and drinking well,” said Diane Arnaout, M.D., a pediatrician at Cook Children’s Forest Park. “If your child has mild wheezing, we can give breathing treatments in the primary care offices. If you’re not sure whether your child’s issue is an emergency, our nurses can talk to you over the phone about symptoms and help you decide between the ER, urgent care and a primary care visit.”

While these popular summer spots are a great way to beat the summer heat, they can pose a danger to anyone not wearing shoes.

“Children often forget that the pavement is hot because they are wet and they aren’t feeling the heat as much, but any dry pavement that is out in the sun is a potential place for children’s feet to get burned quickly,” said Kara Starnes, D.O., medical director of Urgent Care at Cook Children’s.

Dr. Starnes says she’s seen patients who’ve suffered burns on their feet and suggests children wear water shoes while swimming so that if they step on hot pavement, their feet will be protected.

She’s also seen children injured from playing outside at home.

“If your children are like most, they like to run outside to play without a thought about shoes,” Dr. Starnes said. “An option to protect your children’s feet, especially at home, is to place interlocking foam pads down over pavement on patios or other areas where your children commonly play. While these pads do still get hot, it is not typically enough to cause a burn.”

So how do you know when burns are bad enough to seek medical attention? Dr. Starnes advises parents to seek treatment for burns on your child’s feet:

• If there are blisters forming on the bottom of the feet.
• If simple measures such as Tylenol or ibuprofen, aloe to the area or sunburn pain relieving sprays do not relieve symptoms.

But when it comes to newborns, forget everything I’ve always taught you about fever. If an infant has a fever, it is a sign something is wrong and a serious cause for concern

In older children, fever is almost never an emergency, the exact degree of the temperature doesn't really concern me and unless there are other reasons to do so, a workup isn't indicated.

In babies up to 3 months of age, the opposites are true.

Fever in a newborn is an emergency. When a newborn has a fever, parents should have a sense of urgency.

An accurate temperature really matters for newborns. You don't need to go around checking your baby for fever randomly. But if they feel warm, are not eating well or you're otherwise worried, we recommend taking a rectal temperature. Rectal temperature is important because it's the most accurate way to determine the temperature and the studies that tell us what to do with your baby are based on rectal temperatures.

Once you have an accurate temperature, I recommend that you call your doctor with any temperature over 100 degrees. Technically fever is anything over 100.4, but it's good to let us know so we can coach you on what you should be looking for. It also helps us decide what should prompt a visit to the emergency room if it rises overnight.

Fever is such an emergency in babies because they can be an early sign of serious, even life threatening infections and babies can't tell us if something hurts. Babies can have blood stream infections, meningitis or urinary tract infections with little other symptoms. They also can get all the other things that older kids get too like stomach bugs, flu and other viruses but we would rather be safe than sorry.

Because of these risks, babies with fever will typically receive some type of lab work to determine if infection is present. This can include blood work, urine test and possibly a spinal tap to rule out meningitis.

While it's scary and no one wants to think of your baby needing this work-up, the fear of missing one of these serious infections or leaving them untreated, even for a short period, is even scarier.

Most babies with fever will be started on antibiotics while we wait in results from the test. This prevents babies from getting worse while we wait for results to come back.

So, as you can see, fever in newborns is a LOT different.

But, the important thing to remember is to call your doctor if the fever is over 100 and we'll help you keep your baby safe from there.

Related Topics:

• My Child's Fever Isn't Going Away. Should I Be Worried?
• 7 Types of Thermometers and to what Degree You Should Trust Them
• My Child has a Fever. Should We Go to The ER?
• 5 Days of Fever. Now What Should I Do?
• When It Comes to Your Kids It's Never Just a Virus
• Let's Learn About Fevers
• 4 Reasons Why This Pediatrician Doesn't Alternate Tylenol and Motrin for His Kids

With that many kids sick in our area, expect longer wait times if you take your child to the Emergency Department.

Cook Children’s has brought in extra staff to help accommodate the high number of flu cases seen in the Emergency Department. We are early in the flu season and that means waits times will only increase over the course of time.

“The winter is always the busiest time of the year for the Emergency Department. With the high volume of patients, our team needs to prioritize patients according to the apparent severity of medical illness or injury,” said Corwin Warmink, M.D., medical director of Emergency Services at Cook Children’s. “Our team works very hard to care for children as safely and quickly as possible, but we have to make decisions to see the sickest kids first and that sometimes causes frustration for parents.”

Normal signs of the flu include:

• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches
• Headache
• Chills
• Fatigue
• Sometimes diarrhea and vomiting

"The best way to prevent the flu is vaccination. It's very important for the entire family to be vaccinated against the flu, including parents and their children," said Parul Martin, M.D., medical director for Cook Children's Urgent Care Services. "Additionally, enforcing frequent hand washing and use of hand sanitizers can help prevent the spread of the flu virus and many other respiratory viruses."

She adds that the treatment for kids who have the flu, who are normally healthy and don't have chronic medical conditions is pretty straightforward: TLC, fluids, rest and symptomatic treatment.

The CDC recommends that the treatment for the flu is only for those patients at high risk, such as patients that are 2 years or younger and those patients that have chronic medical conditions for example: Autoimmune diseases, Cardiac concerns, and Pulmonary diseases such as Asthma. The treatment recommended for both Flu A and Flu B is oseltamivir which is most effective when taken within the first 48 hours of flu symptoms.

“Every patient who comes into our Emergency Department is important to us. However, some patients may be able to receive the care they need from their primary care physician, a neighborhood clinic or an urgent care center,” said Dr. Warmink. “The best thing a parent can do is know what constitutes an emergency so they know where to go when that time comes.”

If it is not an emergency, Cook Children’s offers other options for your child.

Call your child’s primary care physician first to schedule an appointment. To find a Cook Children’s pediatrician in your area, click here.

Cook Children’s is also home to seven Neighborhood Clinics in Arlington, five in Fort Worth and Richland Hills. Click here to find a Neighborhood Clinic. All neighborhood clinics accept Medicaid, Chips and most commercial insurance plans. Click here to find a Neighborhood Clinc near you.

After hours, consider one of Cook Children’s Urgent Care Centers. The Urgent Care Centers are filling up quickly as well, but your wait time will be a bit shorter and you will be able to treat your child with non-emergent needs such as the flu, strep/sore throat and cold symptoms. Click here to find an Urgent Care Center in your area.

The Urgent Care Centers have continued to see increased volumes because of the many respiratory viruses that are currently in circulation, flu being one of them, according to Dr. Martin.

UCC hours are the following:

• Alliance, Southlake and Mansfield are open from 11 a.m. to 10 p.m.
• Fort Worth UCC is open from 7 a.m. to midnight.

"The Urgent Care Centers gratefully welcome you and your family," Dr. Martin said. "We are prepared to see you and your family as promptly as our volumes will allow. My Urgent Care Center staff and providers are working very hard and doing everything we can do reduce our wait times at the clinics with your child's safety and care a priority."

Urgent care or emergency room?

Every parent knows there are a plethora of reasons their child might need doctor this time of the year. They could catch a cold, come down with the flu or injure themselves on the playground.

When it comes time to make that call, be prepared by knowing when to use Cook Children’s Urgent Care and when to rush to the Emergency Department.

Urgent care situations are illnesses or injuries that need medical attention.

When to use Cook Children’s Urgent Care

• Ear infections/pain
• Strep/sore throats
• Cold symptoms
• Flu
• Mild dehydration
• Respiratory illnesses – including respiratory syncytial virus (RSV), bronchitis, bronchiolitis, pneumonia and asthma without severe breathing difficulty
• Sprains and possibly broken bones
• Minor cuts
• Vomiting
• Diarrhea
• Infected bug bites
• Foreign body removal (marbles, beans and other interesting things)
• Urinary infection symptoms
• Pinworms, ringworm, rashes and pink eye
• Painful muscle strains
• Head injuries without loss of consciousness or vomiting

Cook Children’s is home to a brand new and expanded Emergency Department (ED). However, you only want to visit the ED in case of a medical problem that could cause death or permanent injury if not treated right away.

When to use the Cook Children’s Emergency Department

• Severe bleeding that does not stop after 15 minutes of direct pressure
• Severe allergic reactions and/or breathing problems
• Coughing up or vomiting blood
• Sudden severe joint pain with swelling
• Insect stings accompanied by breathing difficulties
• Swallowing poison or choking
• Not being able to move or speak
• Severe or persistent vomiting or diarrhea
• Gaping wound (edges won’t come together)
• Head injury with loss of consciousness, vomiting or causing dizziness/confusion
• Obviously broken bones or dislocated joints
• Fever in infants under 8 weeks old and under
• Diabetes/blood sugar issues

“Every patient who comes into our Emergency Department is important to us. However, some patients may be able to receive the care they need from their primary care physician, a neighborhood clinic or an urgent care center,” said Corwin Warmink, M.D., medical director of Cook Children’s Emergency Department. “The best thing a parent can do is know what constitutes an emergency so they know where to go when that time comes.”

If your child is sick, know this:

• If during the day, call your Cook Children’s primary care physician first to schedule an appointment. Cook Children's is also home to six Neighborhood Clinics in Arlington, Fort Worth, Berry Street, Fort Worth, 8th Street, Fort Worth, McCart Avenue, Fort Worth Miller Avenue and Fort Worth, Northside.
• After hours, consider one of Cook Children’s Urgent Care Centers. Cook Children's has four Urgent Care Centers to treat your children in Fort Worth, Mansfield,Southlake and Northeast Hospital.

If your child doesn’t have life-threatening symptoms, an urgent care center can be more convenient and the right choice for your family.

Cook Children's has several urgent care clinics across Tarrant County. The newest clinic opened in Sept. 2016 in the Alliance area of North Fort Worth. It also includes a specialty clinic.