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

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

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

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

Learn the signs of heat-related illnesses

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

Symptoms include:

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

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

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

Hydration Tips

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

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

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

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

Alternative hydration sources:

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

How do you know if your child is hydrated?

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

Sun protection

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

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

Sunblock recommendations for 6 months and older:

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

Staying Cool in the Sun

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

Mosquitos

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

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

The most effective line of defense is insect repellent.

Finding the best repellent:

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

RELATED STORIES:

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

• Big Game, Big Responsibility: Water Safety

• Navigating Pediatric Emergency and Urgent Care During the Tournament

“Cook Children's is really invested in prevention in our community, and it's written into our promise,” said Jillian Mitchell, program coordinator for the injury prevention team at the Center for Community Health. 

Drowning is the leading cause of injury for children ages 1 to 4 at the highest risk. According to the 2024 Community Health Needs Assessment, Cook Children’s Medical Centers in Fort Worth and Prosper treated 224 drowning-related injuries from 2021 to 2023. These incidents occurred in bathtubs, open water (lakes, rivers, and ponds), and pools or hot tubs.  

Cook Children's Health Care System shows a slight decrease in drownings in the last five years: 

Mitchell notes that as summer vacation and hot weather arrive, families will be looking to cool off, but months may have passed since the last dip in the pool. 

“As we're heading out to any kind of open water or to a pool, it's important to have preparation top of mind,” said Mitchell. 

Lifesaving Access: Loaner Life Jacket Station 

To help protect swimmers in open water, Cook Children’s supports more than 60 Loaner Life Jacket Stations across North Texas. The stations provide five different sizes of U.S. Coast Guard-approved life jackets, ranging from infant to adult, which families can borrow and return free of charge. Each station features educational graphics detailing how to properly fit and secure the vests. 

Local officials at Lake Worth report that the stations are heavily utilized, with life jackets consistently borrowed and safely returned by the end of each weekend day. 

“We want to make sure that that resource is available for families that maybe don't have the opportunity to get a life jacket for their child,” said Mitchell. In 2025 alone, the program distributed more than 1,800 U.S. Coast Guard-approved life jackets to area lakes across Tarrant, Denton, Rockwall, and Stephens counties.  

Water Safety Tips 

• Transition time
  • Make sure to put a life jacket on children before you get out of the car.
  • If a child goes missing, check the water first.
• Designate a Water Watcher to ensure constant visual supervision.
  • A Water Watcher should be in-reach of the children in the pool.
  • A 10-15 minute shift rotation is recommended. During that time, Water Watchers should not be distracted by conversations, cell phones, reading, etc.
• Keep backyards and bathrooms safe.
  • Dump all water buckets and empty kiddie pools when they are not in use.
  • Install multiple barriers in areas leading to pools and spas: pool fences, self-closing, self-latching gates and door alarms.
  • Keep the pool area picked up and clear of toys and other items which might attract an unsupervised child.
  • Never leave children unattended in the bathtub.
• Wear “U.S. Coast Guard-Approved” or “USCG approved,” life jackets
  • As your child grows, the life jacket needs to meet their new weight.
  • Get a new life jacket if there are rips and tears or if the straps are fraying.
  • Do not rely on floats or other toys to keep children safe.
• Sign up for CPR and swim lessons.
  • The American Academy of Pediatrics recommends starting children in swim lessons as young as 12 months old to reduce the risk of drowning.
  • The National Drowning Prevention Alliance provides parents with a printable questionnaire to help identify the right swim program for their children.
• Have a safety plan in place.
  • If an emergency does happen, remember that seconds count. Call 911 immediately and then begin CPR while EMS is in route.
  • Know water conditions before you get into open water. Water conditions in lakes and oceans can vary on a daily basis.
  • Sit near a lifeguard if there is one present. 

"Combining swim lessons, life jackets, dedicated water watchers, brightly colored swimsuits, and pool fences creates multiple layers of protection," Mitchell said. "The more layers of safety you put in place, the lower the risk of drowning."

Related stories: 

• Big Game, Big Safety: Preventing Hot Car Tragedies 

• Make a Splash: Why Swim Lessons are Essential This Summer 

• The Power of Prevention: Cook Children's Reports a Drop in Drownings 

• Lifeguard Your Child: 6 Tips for Keeping Bathtime Safe in Every Season 

Drowning is the leading cause of injury, with children between the ages 1 to 4 at the highest risk. According to the 2024 Community Health Needs Assessment, Cook Children’s Medical Centers in Fort Worth and Prosper treated 224 drowning-related injuries from 2021 to 2023. These incidents occurred in bathtubs, open water (lakes, rivers, and ponds), and pools or hot tubs.  

“Spring break is really our kind of entry point of getting back into the water,” said Jillian Mitchell, program coordinator for the injury prevention team at the Center for Community Health. 

Cook Children’s Loaner Life Jacket Station provide five different sizes of U.S. Coast Guard approved life jackets, ranging from infant to adult, that can be borrowed and returned. The goal is to make sure no child or adult drowns at a public lake because they didn’t have access to a life jacket. In 2025 more than 1,800 U.S. Coast Guard life jackets to area lakes in Tarrant, Denton, Rockwall, and Stephens counties.  

Mitchell encourages families and caregivers to make a plan before heading to the water. The “Lifeguard Your Child” program teaches parents how to create a safety plan for children anytime they are around water. 

According to data from the Community Health Needs Assessment, 85% of drowning-related injuries were pool-or hot tub-related. Of those 8% were fatal, with most fatalities occurring with children ages 0 to 4. 

While many public and community pools are not yet open, families may travel to lakes, rivers, or oceans.  

“Open water behaves differently than in a pool,” explained Mitchell, “It's dark. It's deep, it's murky. Anyone that is on a lake or a river or in the ocean should wear a life jacket all the time because it is an unpredictable water source.” 

The American Academy of Pediatrics recommends kids begin swim lessons as young as 1 year old. 

Mitchell shares these tips for families heading to the water for their spring break: 

• Learn about the flag system when you go out to the beach. 

• Sit near a lifeguard if there is one present.
• Look for a life jacket that's approved by the U.S. Coast Guard.
• Spring break is a great time to pull out those life jackets from last year. You may find that your child has outgrown the life jacket.
• Make sure that your children know they should always ask permission before going to the water. 

Related Stories:  

• Expert Tips for a Safe Spring Break: Aim for Safety
• Lifeguard Your Child: 6 Tips for Keeping Bathtime Safe in Every Season
• The Power of Prevention: Cook Children's Reports a Drop in Drownings
• Lifeguard Your Child: 5 Water Safety Tips for Parents 

“You’ll shoot your eye out,” she said.

Toy guns have changed since the release of that 1983 classic depicting a 1940s family. If Ralphie were a kid today, he may have his sights set on a water-based gel blaster—one of the popular toy guns of this generation. And Ralphie’s mom would likely say the same, for good reason.

Any toy with a projectile has the potential to cause an injury, especially to the eye. Dan Guzman, M.D., is a pediatric emergency medicine physician on the medical staff at Cook Children’s Medical Center. He also leads Cook Children’s Aim for Safety initiative, which is designed to reduce injuries through gun safety education. Dr. Guzman recently purchased a gel water ball gun to see for himself what hazards they pose to children. Also known as gel soft guns, these toy shooters are similar in design to airsoft guns, but their bullets are made of biodegradable water-filled beads.

“The bullets feel really squishy,” Dr. Guzman said. “But they’re definitely a projectile, and any projectile to the face or in the eye is going to hurt or may cause some injury. I shot them at a tree to see what they would do. Some of the bullets exploded into nothing, but there were some that seemed to be crystallized and actually turned into smaller projectiles once they exploded, which concerned me a little bit.”

A review of the Consumer Product Safety Commission’s electronic injury surveillance system found more than 6,500 cases of eye trauma from toy guns with projectiles between 2010 and 2019, according to a study published in the journal Investigative Ophthalmology and Visual Science. The most common injury was ocular contusion, better known as a black eye. The most serious wound was an open globe injury. Most of those injured were boys, and more injuries occured in December than any other month of the year.

“I haven't seen a lot of injuries from these gel guns just yet, because I think they are relatively new, but I suspect after the holiday, I will,” Dr. Guzman said.

If Santa leaves a projectile-firing toy gun under your tree, Dr. Guzman has a few tips to help keep your child, and those anywhere near the line of fire, safe from injury.

“I'm not going to tell you you shouldn't have one,” Dr. Guzman said. “But I’m definitely going to tell you how to do it safely to make sure your kid doesn't end up in my ER with some horrible injury where they've lost vision in one of their eyes and they'll never be able to see out of that eye again.”

Wear eye protection. Many manufacturers place this warning on their toy gun products, and some even come with eye protection.

Supervise your child and teen when playing with toy guns. They may not be as life threatening but they do shoot powerful projectiles and can cause significant and life-altering injury. Kids—especially teens—are naturally impulsive and don’t always think through the potential consequences of their actions, like what could happen if you aim at someone’s head, or turn the gun towards your face to look down the barrel, or shoot from too close of a distance.

“We just want people to be safe,” Dr. Guzman said. “With these eye injuries, many recover, but some don’t. You truly could put an eye out and nobody wants to be responsible for that.”

Teach kids to respect the danger. To some degree, toy guns that shoot projectiles, be them water-based gel beads or plastic pellets, need to be treated with the same respect and caution as a real gun. Closely monitoring your child while playing with a toy gun gives you the opportunity to see how they interact with the gun, correct concerning behavior and opens the door for conversations about safety that may translate to real guns.

As an emergency department physician, Dr. Guzman has witnessed first hand the devastation that can occur when a gun isn’t handled or stored properly. That’s what drives his passion for gun safety.

“I want to give families the tools to be able to make a great decision,” he said. “If we’re going to play with a toy gun that shoots a projectile, it’s important to know some basic safety steps to keep the entire family safe. Those key safety points then help to shape the conversation about real guns.”

It’s a good idea to practice the same safety measures with projectile firing toy guns as you would with a real gun. When not in use, toy guns should be stored away where kids can’t freely access them. And if they do happen upon one, be sure they know how to respond.

“That's another key point,” Dr. Guzman explained. “What do you do when you find something like this, even a toy, when you go to a friend's house? You don't just pick it up and start pointing at people and playing with it. They need to know to respect that object so they can respond safely.”

Make sure your child knows to keep toy guns at home. Never take them to school or a public place where they can be mistaken for a real gun.

While we love taking care of our patients, the last place you want to spend your holiday if you can avoid it is in the emergency department. Play smart and be safe. We “triple-dog-dare ya.”

It’s summer! That magical time of the year when school is out, and kids can be more active. It also brings sweltering temperatures, which leads to sweaty, thirsty children that can become dehydrated. Dehydration can lead to nausea, dizziness, headache, or even heat stroke.

So, how can you tell if your child is staying hydrated? Ask them what color their pee is! Urine color has been found to be a good marker of how hydrated a person is. Keep reading to find out if your child is staying adequately hydrated. (This, of course, also applies to adults.)

This is an 8-color urine color chart.

Some things to keep in mind:

• When hydrating, water is best, but other fluids count if they don’t include caffeine.
• The amount of fluid that should be consumed differs from person to person depending on weight; ask your child’s pediatrician for an estimate.
• Urine that has no color/transparent means overhydration; cut back on water intake; there is such a thing as water intoxication.
• Some vitamin supplements, like those containing B vitamins, can turn urine bright yellow.

The Center for Children’s Health (C4CH), led by Cook Children’s, installed its first loaner life jacket station in the spring of 2020. The stations provide five different sizes of U.S. Coast Guard approved life jackets, ranging from infant to adult, that can be borrowed and returned. The goal is to make sure no child or adult drowns at a public lake because they didn’t have access to a life jacket.

“Texas has a lot of lakes and having a loaner station at entry points is a great reminder for families,” said Amy Johnson, program coordinator for the Center for Children’s Health. “The signage on the station not only explains how it works but also how to properly fit a life jacket.”

Sadly, the number of drowning patients seen at Cook Children’s this month has already surpassed the number of patients seen in the same time period of 2020. So far, 35 children have been admitted to Cook Children’s for drowning, with two deaths. Three of the drownings occurred at area lakes.

The loaner life jacket program has 12 stations at lakes across DFW, including:

• Cleburne
• Alvarado
• Flower Mound
• Grapevine
• Weatherford
• Lewisville

The stations are constructed by Lifeguard Your Child partner and Texas-based construction firm, Linbeck. C4CH plans to extend the stations to pools in neighborhoods and communities soon.

Cleburne resident Robin Kiel has lived across the street from Lake Pat Cleburne for more than 30 years. As a former pediatric intensive care (PICU) nurse, she has seen her fair share of drownings and fatalities.

Recently, the two new loaner life jacket stations at the lake caught her attention.

“I saw something out of the corner of my eye one day and went to check it out,” Kiel said. “Once I realized it was a loaner life jacket station from Cook Children’s, all I could think about was how many lives could be saved.”

Kiel and her family have seen several tragedies while living directly across from the lake. She recalls instances over the years when helicopters have landed in her yard to transport a child to the emergency room, or emergency personnel rushing past her house to save someone’s life. Kiel says these moments are hard to watch, but what’s even worse is watching the number of children who enter the lake without a life jacket.

“During my time as a nurse, I’ve seen tragedy after tragedy,” Robin explained. “The hardest part was the water fatalities that could have been avoided. There's a lot of children that swim without life jackets and it's dangerous in a lake. You can't see the bottom if they were to fall or get swept away. You can't find them once they're under the water.”

Kiel says with school out and summer in full swing, she expects to see thousands of people at the lake on the weekends and she is hopeful people will take advantage of the loaner life jacket stations.

“I think it's just really important to remind people that if you don't have a Coast Guard approved life jacket, there are some that are loaned here in two different places on our lake and they can just borrow them and put them back when they're finished for someone else.”

Tara Janszen is Kiel’s daughter and the president of the Cleburne Chamber of Commerce. She says she’s also thankful for the additional safety measure at the lake.

“The collaboration between Cook Children’s, Cleburne Fire Department, and the Cleburne Parks and Recreation department is something that will benefit our residents and visitors who come to Lake Pat Cleburne,” Janszen said.

Lake Pat Cleburne is also home to holiday celebrations, and more. Tara says the city is happy to have their Independence Day celebration back at the lake this year, and she is hopeful having the life jackets will be an added safety measure for families.

“We have thousands of people that come out to enjoy the lake for the day. We shoot fireworks off the dam that evening,” Janszen said. “We want people to have fun, but first and foremost, we want people to be safe. I think this new opportunity for kids to be able to loan or borrow a life jacket, and for families to utilize this program is going to make our event just even better this year.”

Johnson shares the same feelings. She wants people to get out and have a good time, without any tragedies. Thus far, the stations have been well-received at all six lakes.

“Our community partners and families are excited about having the stations and how easy they are to manage,” Johnson explained. “The feedback from lake-goers has been amazing, and they are using the life jackets, which is the goal.”

Kiel says she enjoys walking out of her front door and seeing neighbors and visitors enjoying the lake, and she is hopeful this summer will conclude with every family making it back home safely.

“I think the life jackets can help save lives,” Kiel said. “Drowning happens so quickly, and it’s such a tragedy for families. I think it could save a lot of children's lives and I believe that’s the goal for Cook Children’s and the City of Cleburne.”

Johnson understands families are excited to get together for the summer, but safety has to be the top priority for everyone to have a good time.

“We know everyone is eager to enjoy the summer, but along with that we know there are a lot of potential distractions,” Kiel expressed. “We want families to remember to have an emergency plan in place, always designate a pool and lake ‘water watcher’ for safety, and to remember to keep a child’s life jacket on until they are safely away from the water’s edge.”

Important to note:

If you live in a community with a lake or pool that could benefit from a loner life jacket station, send an email to Safe.kids@cookchildrens.org. To learn more about the loaner life jacket program and other safety measures, visit lifeguardyourchild.com

This is my friend Van.

Van is at my pool. Since all of us parents are now COVID-vaccinated, we are feeling more comfortable with outdoor playdates. And our new pool has been a great escape from the heat!

We parents have loved to see each other. Hanging out and listening to music and eating meals together has been so much fun. We’ve missed it so much.

But our new pool poses a risk that wasn’t there before during backyard playdates.

Over the weekend, five children were victim to drownings in our area, and were rushed to the Cook Children’s ER. Some went home. Others did not.

Look at Van’s wrist. He’s wearing a WATER WATCHER band.

This band says that, no matter how many people are in or around the pool, the wearer is in charge of watching the water. The lifeguard, if you will.

The band is traded out every 15-20 minutes. The person who wears it stands guard by the pool with no distractions.

You don’t have to have this fancy band – though it will be available at my office in Forest Park very soon to pick up, and other Cook Children’s PCP offices as well. You can use anything really – a lanyard, a fancy scrunchie, a jangly bracelet.

As long as the responsibility is assigned, and someone is always watching.

Let’s ENJOY these much-missed moments together! We have earned our time together again after last summer’s solitude.

But let’s be SAFE in and around the water – the statistics are sobering in our area lately and now is the time to lifeguard your child!

Water safety advocates urge parents to stay vigilant to protect their children over Memorial Day Weekend and throughout the summer as backyard pool parties start happening again.

People are excited to socialize in person as coronavirus restrictions ease up -- but they must still keep close watch on the kids in the swimming pool. Drownings can occur even with many adults present.

“Everyone is so eager to get back into a normal routine and have those gatherings as COVID-19 decreases,” said Dana Walraven, manager of community health outreach for the Center for Children’s Health, led by Cook Children’s. “We’re just hoping for a heightened sense of awareness. When people are so happy to get back together, there may be distractions.”

In 2019, prior to the pandemic, the number of drowning admissions at Cook Children’s hit 71. Seven of those patients died. By comparison in 2020, there were 48 drownings seen at the medical center, three fatal. Those statics include drownings in bathtubs and open water, such as lakes; the majority, however, occurred in swimming pools.

2020’s decline in drownings came as a happy surprise to those who work to prevent injuries and deaths due to accidents in the water. One possible explanation? Last summer’s social distancing kept many families and friends from meeting up in big groups. Those big gatherings tend to be occasions when everyone assumes someone else is supervising the swimmers.

Sharon Evans, trauma injury prevention coordinator at Cook Children’s, encourages adults to take turns as designated watchers, fully attentive and within arm’s reach of kids in the pool. Designated watchers can spot trouble before it turns into tragedy.

“They don’t talk, they don’t drink, they don’t look at their phones,” Evans said. “You have to have that person in charge of watching. That is your job for 10-15 minutes, then you pass it off.”

Evans said drowning cases typically ramp up starting on Memorial Day. The age group most susceptible to drowning in pools is 1- to 4-year-olds. Precautions should be taken as well for older kids, even if they’re strong swimmers.

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

“It’s not like it is in the movies where they’re thrashing around and yelling for help,” Evans said. “In real life it almost looks like they’re climbing a ladder underwater, and if they can get their head above water, they just get a breath.”

“Lifeguard Your Child,” a drowning prevention campaign created by Cook Children’s, aims to get the message out through a regional collaboration of partners from eight counties across North Texas. The coalition includes school districts, police and fire departments, pool builders and swim lesson providers such as the YMCA. “Lifeguard Your Child’ promotes safety strategies through its website, videos, online classes and social media.

“The biggest piece we’re trying to do is have parents think about water safety and drowning prevention all year long,’’ Walraven said.

Campaign partners came up with new methods to reach their audiences during the COVID lockdown. Those efforts included a shift to greater virtual education. And in spite of the pandemic, “Lifeguard Your Child” reached 6,950 adults and children with educational toolkits between October 2019 and September 2020.

Highlights for drowning prevention include:

• Young children should know to never get in the water unless an adult is within reach and watching. Learn to swim and swim with a buddy.
• Teens should be alert for hazards lurking in murky lake water. No horseplay or risky stunts. Wear U.S.C.G. approved life jackets.
• Caregivers should create barriers to the pool, such as four-sided fencing. Don’t lose track of the kids during the transition from swimming to the next activity (a trip inside to the bathroom, loading the car etc.). Hospital admissions data increasingly show that drownings tend to occur during these unplanned situations “when one child goes back for a toy, or a child wants to jump in one more time,” Walraven said.

In addition to the education component, “Lifeguard Your Child” has distributed 1,296 life jackets this year in drive-through events and through six loaner stations at area lakes. The program recommends only those life jackets approved by the U.S. Coast Guard. Proper fit is essential too.

For more information about steps to prevent drowning, go to www.lifeguardyourchild.org.

In the wake a baby is dead and her mom has been charged with her murder. In addition, the baby’s dad has been charged with aggravated battery and cruelty to a child for diluting their baby’s breast milk with water, then refusing to take the child for medical care.

By the time they did take her to the hospital, she was already dead.

Unfortunately, this is not uncommon. I remember a similar case from years ago in which a child’s family was desperate for money and thought they could use extra water to make their formula last longer. In a study from Clinical Pediatrics, up to 25 percent of families considered “food-insecure” admitted to using various methods to make their formula last longer.

The problem is that extra water is not safe for babies. It causes the sodium level in their blood to drop. Low sodium will lead to brain swelling which can cause poor feeding, lethargy, seizure and eventually death.

Giving free water to babies is not just an issue of formula stretching. Families commonly ask during the summer months if their babies need extra water due to the heat. The answer is NO!

Some reasons babies don’t need water:

• Breast milk and formula is mostly water (80-90 percent). Babies don’t get thirsty. Their diet is primarily liquid.
• Water does not have nutrition or electrolytes babies need. If a baby is going to be drinking something, why not make it be something that can help them grow?

Babies can safely start to drink some water after six months but they still don’t need a lot. They can get one to three ounces during their meals if parents want to introduce and practice with a sippy cup.

But I hear from my patient families all the time that it's anything but relaxing.

The American Academy of Pediatrics recommends doctors ask parents three questions about mealtime:

1. How anxious are you about your child’s eating?

2. How would you describe what happens during mealtime?

3. What do you do when your child won’t eat?

When offered a healthy, well balanced meal with fresh fruits, vegetables, and lean proteins, kids will stop eating when they are full. Children will naturally refuse to eat when they are not hungry. We often describe these as normal appetite slumps. We can disturb children’s natural satiety cues by either forcing them to eat or by offering foods high in added sugar or salt when they won’t eat. This results in a child who will “only eat chicken nuggets.”

Parents are most successful in feeding their children more fruits and vegetables when they model healthy eating, set appropriate limits, and have a positive attitude at mealtime. “The parent determines where, when, and what the child is fed; the child determines what to eat.” ⁽¹⁾ In other words, “parents provide and kids decide”. ⁽²⁾ 

Here are some tips on eating mindfully and encouraging your kids to eat in a manner that gives them more energy and helps them avoid chronic disease. These are easy ways to change your lifestyle that don’t involve a ton of work and expensive supplements.

1.Drink more water. Kids should not drink juice or soda except on special occasions.

2.Drink milk with meals. Children from age 1-2 should be on whole milk. After the age of 2, low fat or skim milk is recommended.

3.Vitamin supplements are not needed unless your child does not drink milk. Vitamin D is essential for bone health and immune function and may play a role in prevention of chronic disease.

4.Serve 5-9 servings of fruits and vegetables daily. Encourage your children to at least take a bite of everything you serve. Remember that children will need to taste a food 10-15 times before they decide they like it. Lean protein like fish and baked chicken might be better accepted if you add ketchup as a condiment.

5.Add healthy protein likes nuts (for older children) and legumes. Peanut butter is fine for younger children and new allergy immunology guidelines suggest that early introduction of peanut may actually decrease the risk of peanut allergy.

6.Eat more meals at home. Keep staples such as eggs, whole grain pasta, pasta sauce, yogurt, carrots, frozen vegetables, chicken breasts, and fruit stocked at all times so that in a pinch you could throw together a simple meal.

7.Double your recipes and freeze 1 meal at the same time that you cook the other meal. This will save you from making a trip to a fast food restaurant when you have that go to meal in your freezer.

8.Serve only whole grain breads and pastas.

9.Avoid buying, eating, or serving processed foods (chips, cookies, cakes).

10.Avoid fried foods and fast foods.

To read more about nutrition needs of children at different ages, I highly recommend the book “Nutrition: What Every Parent Needs to Know" available on the American Academy of Pediatrics (AAP) online bookstore.

See choosemyplate.gov for more information about how your child’s plate should look at meal time.

Realize that children’s tastes will change over time. They will sometimes refuse foods they readily accepted in the past, and they will readily accept foods that they refused in the past. Involve your children in shopping and meal planning. Let them help in the kitchen! Take them to a local farmer’s market and let them choose something new for everyone to try.

Take a matter of fact and pleasant approach to meal times and ENJOY YOUR FAMILY! Create wonderful childhood memories.

References:

1. “A Practical Approach to Classifying and Managing Feeding Difficulties” Pediatrics Volume 135, number 2, February 2015

2.Nutrition: What Every Parent Needs to Know. AAP

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

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

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

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

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

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

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

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

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

Texas health officials say:

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

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

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

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

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

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

Related to this topic:

www.KyleCares.com

New hope in fight against deadly brain-eating amoeba

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

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

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

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

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

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

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

Play it cool

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

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

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

Staying safe

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

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

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

About the source

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

The safety experts at Cook Children’s say kids can’t afford anything less than 100 percent adult supervision at the pool at all times. That means not taking your eyes off of a child while he or she is in the water.

Forgive the safety experts at Cook Children’s if they are coming across as bossy or even condemning, but they are at their wits’ end trying to find a message that will stop the tragic amounts of drownings over the past few summers. 

But they have come with a response: Lifeguard Your Child. And that starts with putting away perhaps the greatest competion for a grownup's attention - their smartphone.

“We understand the need for a phone at the pool, in case of emergencies, but those phones need to be put away until you leave the swimming area,” said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County Coordinator. “Parents should only be spending time watching their kids and not on the phone.”

Smartphones have changed the way we look at the world, but it’s also made it much easier to be distracted and not pay attention to what is happening right in front of us.

Nonfatal injuries to children under age 5 rose 12 percent between 2007 and 2010, after injury rates were steadily falling the previous decade. During that same time period, smartphone users increased from 9 million in mid-2007 to 63 million at the end of 2010.

The Centers for Disease Control and Prevention estimates more than 1,100 people a day are injured in car crashes that involved a distracted driver.

Sharon Evans, Trauma Injury Prevention/Outreach coordinator for Cook Children’s Medical Center says she would like to see similar research into distracted adults and drownings.

But she doesn’t need stats to know that it’s the adult’s responsibility to stay focused on the children, and nothing else, while they are swimming.

“Parents are distracted enough with people around them talking, eating and everything going on in their lives. After a hard day they may even zone out for a little while. But parents can’t afford to be distracted and that includes using their smart phones while their child is in the water,” Evans said. “I don’t think parents understand how quickly and quietly drowning occurs. There is no thrashing, no yelling for help. The drowning child is just trying to push down on the water to get their head above the surface to gasp a breath of air.”

Walraven reminds parents it takes only two seconds for a drowning to occur.

She encourages any adult watching children at the pool, including parents grandparents, family friends or babysitters, to use Water Watcher system if possible where the grownups at the pool take shifts with the sole responsibility of keeping an eye on the children swimming at all times.

They are expected to stay sober and focused during their 15 minute shift or if they are the only one out there, to stay alert the whole time. This isn't a job for kids, even older children. Walraven said this is a job solely for the adults. It shouldn’t be the responsibility of a teen. The younger person may be easily distracted, have trouble pulling the child out of the water and in case of a fatal drowning, the child could be scarred for life.

“This is definitely a job for a grownup, but that means acting like an adult,” Walraven said. “Many drownings occur when a caregiver is present. But being ‘present’ or being ‘there’ is not enough, you have to watch and be involved. Drowning is silent so keep your eyes on the water, not the phone. A text is not worth the risk and it’s certainly not worth your child losing his or her life.”

Other resources:

• Drowning prevention page at Cook Children's
• 9 ways to protect your child from drowning
• Is your baby ready for swim lessons?
• This life-saving tip could prevent your child from drowning
• Life after drowning
• Be a water watcher. Adult supervisions saves lives.
• Drowning tragedy - 'I can't believe this happened to me.'
• The life-saving reason for Water Watchers

February isn’t over and already four children have been treated for near-drowning accidents at Cook Children’s Emergency Department. All of these incidents occured in swimming pools.

“So often we think of the summer months as the time when we see drownings,” said Sharon Evans, Trauma Injury Prevention coordinator at Cook Children’s. “But as long as a child is around water, the threat is real for a child to drown. In Texas, we have 70 or 80 degree days during the winter and kids are outside playing around pools. If you have a pool, parents should be outside with their child. If not, the results can be tragic.”

The threat of drowning is a continuing concern well before summer begins. By the end of April 2016, 12 children were admitted for drowning injuries (9 in a pool) at Cook Children's, including two that were fatal (one pool death, one pond).

Even non-fatal, or near, drownings can be devastating for a child. Corwin Warmink, M.D., medical director of the Cook Children’s Emergency Department, says there’s a large amount of children who survive a drowning, but end up with catastrophic outcomes. The most effected parts of a near-drowning victim are the brain, lungs and kidneys. “The one that is most catastrophic and the one that will kill you is the brain,” Dr. Warmink said.

As a parent, Dr. Warmink stresses supervision of his own children in the pool. He calls it a hallmark of making sure children are safe. Half of all drownings occur within 25 feet of an adult.

“Children should never be in water without adults watching them,” he said. “If you have a toddler, that child shouldn't be in water without what we call touch supervision. You need to be in hand's length and it's not just pools. That includes bathtubs or any other container with water. I've seen kids drown in buckets. A child can drown in any water, even a few inches deep.”

The most important step a parent can make in making sure their child is safe around water is simply being present without distractions. Drowning is silent and quick, so a grownup should be watching children near water at all times and never leave, even for a brief moment.

“Active adult supervision and layers of protection such as door alarms and a fence can lower the risk for your child,” Dana Walraven, Community Outreach manager said. “The majority of these water-related incidents happen in the child’s own backyard pools and to children 4 years old and younger. Preventing pool drownings begins with adult supervision.”

Children are protected by layers of protection by using these safety techniques whenever children are around the pool:

• Always have adult supervision present when children are swimming or around pools.
• A fence with a locking gate should surround the pool.
• Install door alarms to alert adults when a child is entering the pool area.
• Require life jacket use for non-swimmers.
• Enroll children in swimming lessons.
• Parents and caregivers should undergo CPR training.

Other Resources:

• NRH Water Safety 365 Drowning Prevention Coalition
• Grownups be smart: Put down the phone at the pool
• 9 Ways to Protect Children From Drowning
• What Your Children Should Do If They See Someone Drowning
• Is Your Baby Ready For Swim Lessons?

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

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

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

And what would happen if you did drink the water?

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

About the source

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

Fort Worth ISD tested nearly 1,500 samples of water across 116 campuses. Thus far, results have shown elevated levels of lead from 28 schools, most of which were tied to problematic water fountains (generally 1-2 per school).

The ISD has taken those water fountains out and flushing the water lines have already resulted in decreased lead levels to below the recommended EPA action levels in those affected schools.

Recent news about lead exposure in Flint, Mich. has appropriately heightened awareness about lead. However, it’s important to note that this situation is very different. In Flint, the central water was the source of lead, which caused prolonged exposure and significantly increased the risk of toxicity. Because the number of elevated sites of lead at each Fort Worth ISD campus was low, the likelihood of a buildup of lead over time is highly unlikely.

While the attention right now is on schools, the primary source of lead exposure in the United States is not from water, but more often is from lead dust and soil from deteriorated lead-based paint homes built before 1978.

Children at the highest risk for increased blood levels from water are infants and children under 6 years of age. The risk to an individual school aged child is considered low because they would have to drink water repeatedly from a contaminated drinking fountain over an extended period of time to achieve a clinically significant blood level.

Lead toxicity in children results from exposure to lead over a long period of time. Symptoms of lead intoxication (high blood lead levels) might include:

• Vomiting
• Anorexia
• Abdominal pain
• Irritability
• Lethargy
• Headaches
• Convulsions

While it’s easy for me to tell parents the risk of toxicity in the students of Fort Worth ISD is low, I understand you might be concerned about your young student. If you have concerns about your child, it’s important to talk to your pediatrician.

About the author

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

And yet, one in three parents surveyed has left their child at pool for two to three minutes without supervision.

You may have seen movies of someone drowning and splashing in the water and making a big, dramatic scene. But that’s only in the movies.

Drowning is a silent killer. In reality there’s very little splashing, waving or screaming. You likely won’t hear your child drowning until it’s too late.

“Parents should stay in the water and within arms-reach of their child,” said Sharon Evans, Trauma Injury Prevention/Outreach coordinator for Cook Children’s Medical Center. “Don’t rely on a lifeguard, or an older child, to save your child. Be in the water. A drowning can happen too quickly not to be in with a child.”

Watching your children in the pool isn’t a job for kids, even older children.

"Teens can be easily distracted and they may not have the judgement skills to handle the job," said Dana Walraven, Community Health Outreach manager at Cook Children’s. "If there's a problem in the pool, a child may have trouble getting another child out of the pool. And this is not a responsibility for a young person. A drowning, even if not fatal, can scar a child for life if something happened if he or she were in charge. This is definitely a job for a grownup."

Evans said she was alarmed at a recent event she was at when she asked children what they should do if they saw a friend drowning or struggling in the pool. Too many said they would jump in and save the child.

“That’s the last thing we want to happen,” Evans said. “The child may not be strong enough to support the other child or a strong enough swimmer to support both kids. If a kid jumps in to rescue a friend, you can easily have two victims.”

Evans said to make sure your children know the best way they can help if they see someone in trouble in the water is to run and get help. Notify a lifeguard at a pool if one is on duty or find the nearest adult. Have someone get help and call 911 immediately.

So what should you tell your child to do if they see someone drowning?

First, know the signs. The American Red Cross says to watch for these signs a person may be drowning:

• The person is upright (vertical) in the water.
• The person is unable to move forward or tread water.
• The drowning person is pressing his or her arms down at the sides, trying to keep the head above water to breathe.
• The person spends energy just trying to keep his or her head above water.

If a child sees someone showing signs of trouble, he or she should stay out of the water and look for something to grab a hold of to help the person in trouble:

• A pool noodle
• Any flotation device by the pool
• Fishing pole
• Rake
• Canoe paddle
• Boat oar
• Stick
• Tree branch
• Baseball bat

Children who are too small to pull someone in or the person in the water is out of reach, should find objects to throw in to the water including:

• Kickboard
• Empty picnic cooler
• Life jacket
• Ring buoy
• Water jug
• Basketball
• Inner tube

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.

SafeKids Tarrant County, led by Cook Children’s, offers other sobering facts for parents leading into this swimming season:

• Drowning can still occur even if you know how to swim.
• No one is “drown proof” – no matter their level of swimming ability.
• Falls, entrapments and injuries lead to drowning regardless of swimming level.
• A majority of people overestimate their own and their child’s ability to swim, especially in a panic.
• Drowning is quick and silent.
• Drowning occurs in as little as 2 minutes.
• Irreversible brain damage occurs in as little as 4 minutes.
• Most children who drown are out of sight or missing for less than 5 minutes and usually in the presence of 1 or both parents.
• Most children die who are submerged for as little as 6-10 minutes.
• Children who drown do not scream splash or struggle. They silently slip beneath the water, even with adults and lifeguards present.

That’s scary information, but there are steps you can take to help protect your child and have a safe summer while in the water:

1. Constant visual supervision

• Assign an adult water guardian whose only responsibility is to watch children who are in the water.
• Teach children who can’t swim to stay away from water unless they are with an adult who is within arm’s reach and has eye-to-eye contact on them.

2. Learn to swim

• Studies show that formal swim lessons for children under age 4 reduce drowning by 88 percent.
• Take swim lessons with your child if you don’t know how to swim yourself. Even adults who are strong swimmers should never swim alone.

3. Keep backyards and bathrooms safe

• Dump all water buckets and empty kiddie pools when they are not in use.
• Install safety latches on toilets
• Never leave children unattended in the bathtub

4. Multiple barriers on all pools and spas

• Install pool fences, self-closing, self-latching gates and door alarms in areas leading to pools and spas.
• Keep a phone by the pool and call 911 in an emergency
• Keep pool area picked up and clear of toys and other items which might attract an unsupervised child.

5. Always check pool/spa first for missing child

• Make sure to look at the bottom of the pool or spa.
• Do not quickly scan the top and move on – children who drown often sink to the bottom and appear as shadows that easily be overlooked.
• Every second counts.

6. Wear life jackets

• Children who cannot swim should always wear a properly sized Coast Guard approved life jacket.
• Do not rely on water wings, floats or other toys to keep children safe.

7. Learn CPR

• Studies show CPR doubles the victim’s chance of survival.
• Use hard/fast compressions in the center of the chest until help arrives.
• Refresh CPR skills yearly, certifications every two years.
• Post CPR guidelines near the pool.

Related Links

• Cookchildrens.org/safety
• Safe Kids’ Water Safety Tips
• Play it Safe on the Water - Texas Parks and Wildlife
• Backyard and Pool: Household Safety Checklist
• Household Safety: Preventing Drowning

• Standing water can contain the risk of diarrheal disease.
• As little as 6 inches of swiftly moving water can sweep you off your feet. If you have to walk in water, walk where the water is not moving. Use a stick to check the firmness of the ground in front of you.
• If floodwaters rise around your car, when water is not moving or not more than a few inches deep, abandon the car and move to higher ground. You and the vehicle can be swept away quickly. Call 911 in case of an emergency.
• If your vehicle is trapped in rapidly moving water, stay in the vehicle. If the water is rising inside the vehicle, seek refuge on the roof.
• If your car is parked in an area that is flooding, don’t go after it.

Children shouldn't play in the water that remains after a heavy rain. Any toys exposed to flood or heavy rain water should be disinfected. Have your child wash their hands frequently. Remind your children to wash their hands with soap and water, while singing "Happy Birthday" twice.

“There are various risks to exposure to flood waters or standing waters,” said Chris Curtis, a registered nurse who works in Cook Children's Urgent Care Center in Fort Worth. “Parents should talk to their children to make sure that kids avoid eating or drinking anything contaminated by flood water and practice good hand hygiene after contact with the water.”

If a family member has open wounds that have been exposed to the flood water, the wounds should be cleaned with soap and water and then covered with waterproof bandage. The exposed wound should be monitored for swelling, redness or infection. If the wound does look infected, seek immediate medical attention.

Curtis also reminds us that chemicals and electrical shock also can cause serious injury or death if a child is playing in the water. The risk of injuries with sharp objects also increase because they have been moved around by the rushing waters.

To learn more about how to protect yourself during a flood, visit the American Red Cross' flood safety page.

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

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

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

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

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

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

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

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

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

Of those drownings, 26 were backyard or community pools.

If you believe swim lessons are nothing more than a fun summer activity, think again. The skills children learn in swim classes could make the difference in life and death.

During swim lessons, kids get used to the water and learn important water safety skills. According to Safe Kids Tarrant County, led by Cook Children's, children who don't know how to swim or who are being supervised by adults who can't swim are eight times more likely to drown or fatally drown.

"Children as young as 2 to 3 years old develop the ability to self-rescue during swim lessons, which means that if they fall into a swimming pool, they can turn around in the water and either float on their back until rescued or use the skills they have learned to swim to the side of the pool," said Tyler Emler, action team chair for drowning prevention for Safe Kids. "The sooner children get in the water, the sooner they become comfortable with swimming. If you wait until children are 6-8 years old to begin swim lessons, they won't have the same comfort level as children who have been in the water since they were younger."

Which swim class is best?

When choosing swim lessons for your child, visit local health clubs and recreational centers to meet with swim instructors and educate yourself on the classes offered. 

According to Emler, the most successful classes teach a love for water while also building necessary swimming and water safety skills.

While swim classes should have accommodations in place to assist children who don't acclimate to the water or who aren't reaching swim class goals, Emler notes that parents can help their child's progress by spending family time in the pool and stopping any pressure a child may feel to master skills more quickly. 

Young children who take swim classes in late spring or early summer should return for indoor winter refresher courses every year until they reach 6 or 7 years old. This way, coordination and muscle memory has a chance to develop, allowing children to maintain skills for longer periods of time.

For more information

Learn more about drowning prevention and water safety here. This page gives helpful information on keeping your kids safe during swim season, including proper fit for life jackets, pool safety videos and fences/alarms information.

Since Oct. 1, 2014 to present, 40 drownings have been seen here and three of them have been fatal.

Those numbers are chilling and once again place an emphasis on water safety in the area.

Dana Walraven, community health outreach manager for Cook Children’s, wants to make sure that parents are prepared for warm weather and children in the water. She said the safety begins with making sure a grownup is watching the kids in the water at all times.

“Active adult supervision and layers of protection such as door alarms and a fence can lower the risk for your child,” Walraven said. “The majority of these water-related incidents happen in the child’s own backyard pools and to children 4 years old and younger. Drowning prevention around the pool starts with adult supervision.”

Children are protected by layers of protection by using these safety techniques whenever children are around the pool:

· Always have adult supervision present when children are swimming or around pools.

· A fence with a locking gate should surround the pool.

· Install door alarms to alert adults when a child is entering the pool area.

· Require life jacket use for non-swimmers.

· Enroll children in swimming lessons.

· Parents and caregivers should undergo CPR training.

In nearly nine out of 10 child drowning –related deaths, the parent or caregiver said the child had been with them in the house or pool within five minutes of the accident. Walraven says she knows it is difficult to supervise children 100 percent of the time. She said the levels of protection provide barriers in case the child should slip out of supervision.

Safe Kids Tarrant County, led by Cook Children’s, also offers Water Watcher tags to anyone or group who will use or distribute them. These are especially helpful at parties around the pool or lake to help designate adults that are watching the water. After 15 minutes, the tag is given to another responsible adult – letting everyone enjoy the party while ensuring that the kids are being properly watched. To receive a Water Watcher Tag, call 682-885-4244.

In large pools, it’s ideal to split up in groups and take sections of the pool.

“If you are somewhere where children are in the pool, insist that an adult be on watch,” Walraven said. “It should be done by a sober adult and that should be his or her only focus during their time watching the kids.”

Aside from supervision, four-sided isolation fencing with self-closing/self-latching gates is the best protection for your child and pets. It could prevent 50-90 percent of childhood drowning and near-drowning incidents. This type of fencing goes beyond the yard, to fencing in the pool itself, preventing direct access from the house.

Door and gate alarms give another signal that a child may have access to the pool area without supervision. The tendency is to disconnect it – especially at parties where people are going in and out. But these are also the times when small children are the most vulnerable for injury because of the confusion.

Learning CPR can save a child’s life by restoring breathing and circulation until advance life support can be given by health care providers.

Swim programs for children should teach good water safety behaviors in and around the pool but should not be seen as the sole way to decrease the risk of drowning.

Use a U.S. Coast Guard approved lifejacket with children who can’t swim. It should fit snugly when the child is buckled in and should not go beyond the top of the ears when lifted at the shoulders. Many air-filled, float-type toys are thought to be lifesavers but are not.

Check your pool and spa for cracked or broken drain covers on a regular basis. The suction around the drain can catch hair or clothing, pinning the child underwater. Anti-entrapment drain covers are available for as low as $40 and serve as another level of protection.

Since beach balls, noodles and other toys are attractive to curious young children – put them away when not at the pool.

For more information

Cook Children's has many resources on drowning prevention, beginning here. Click the links below with downloadable information in both Spanish and English, as well as videos. 

• Drowning prevention tips - English
• Drowning prevention tips - Spanish
• Water safety resources
• Drowning prevention education (English and Spanish)

Videos:

• Pool safety video step 1: Supervision
• Pool safety video step 2: Fencing
• Pool safety video step 3: Pool and spa covers
• Pool safety video step 4: Alarms
• Pool safety video step 5: Safety drain covers
• Pool safety video step 6: Swimming lessons
• Pool safety video step 7: Learning CPR
• Safe Kids Tarrant County Drowning Prevention Tips
• Safe Kids Tarrant County sugerencias de prevención de ahogamientos 

Ensure school-age children know when to wash - before eating and after playing on a playground at recess, using the restroom, and coming into contact wiht friends and classmates. Teach kids that it's important not to chew their fingernails or touch their faces.

"Hand-to-mouth transmission is a major way children are infected by viruses," said Vanessa Charette, M.D., a Cook Children's pediatrician in Fort Worth. "Keeping hands out of the mouth is a difficult behavior for certain children to master, but it's important that they do."

Little hands can pick up a lot of germs. At any given time, you have close to 150 different bacteria living on your hands, and 80 percent of illnesses are spread by direct human contact. For kids, stomach bugs, strep throat and other bacterial illnesses can spread quickly, particularly in environments such as schools and day cares.

"I also tell young children to keep their hands below their neck. They don't rub their eyes, such their fingers or pick their nose," said Kim Mangham, M.D. a Cook Children's pediatrician in Keller. "Kids can have all the germs in the world living on their hands, but they don't put their hands in their mouth, nose or eyes, they won't get sick."

Having trouble convincing your children to get with the hand hygiene program? Let them know that fighting the spread of germs can be pretty cool. A recent study published in the American Journal of Infection Control concluded that fist bumping transmits far few bacteria than handshaking.

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

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

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

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

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

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

Thalasso Bath Method

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

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

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

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

Water Neck Floatie Things for Babies

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

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

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

About the author

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

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

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

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

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

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

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

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