The Tarrant County Public Health Department reports an increase of 17.5% of cases for adults and children. Denton County Public Health Department has reported 318 positive flu cases and 35 hospitalizations as of Dec. 27, 2025. While the state has not reported any pediatric deaths, there have been eight in the United States. 

 Cook Children’s pediatricians are sharing what parents should know when it comes to the flu and other respiratory illnesses.  

Signs and Symptoms 

Flu, RSV and COVID-19 are caused by different viruses, but all are upper respiratory illnesses that share similar symptoms such as: 

• Fever
• Cough
• Fatigue
• Sore throat
• Runny or stuffy nose
• Muscle pain and body aches
• Headache
• Vomiting and diarrhea
• Loss of appetite, taste, or smell
• Shortness of breath 

Managing Symptoms 

If your child is sick, call your pediatrician first. They can help you decide whether to take your child to the doctor's office, urgent care, or the emergency room. For many children, viral illnesses like the flu, RSV, and COVID-19 can be managed at home with supportive care. Over-the-counter medications like acetaminophen or ibuprofen can help reduce fever and discomfort. Avoid ibuprofen in infants younger than 6 months. 

Maintaining hydration is crucial. Please encourage your child to drink fluids and consider giving them electrolyte drinks or popsicles. Saline nasal drops and cool-mist humidifiers can help alleviate congestion. 

A fever is defined as a temperature of 100.4 or above. A temperature above 100.4 in babies less than 2 months old is a medical emergency and needs to be evaluated in the emergency room. Any fever lasting longer than four to five days, or one that continues to climb and does not break with fever reducers, should be evaluated by a physician. 

When to Seek Medical Attention 

While most cases can be managed at home, it's essential to recognize the signs of respiratory distress or dehydration, which require immediate medical attention. 

Signs of respiratory distress: 

• Increased number of breaths per minute
• Increased heart rate
• Bluish color around the mouth, on the lips, or on the fingernails
• Pale or grayish skin
• Grunting sound during exhale
• Nose flaring
• The chest appears to sink in with each breath
• Head bobbing when breathing in
• Change in alertness  

Signs of dehydration: 

• Urine output is significantly below the child’s normal (at least once every 8 hours)
• Not producing tears when crying and the eyes appear sunken
• In infants, the soft spot on top of their heads looks sunken
• Dried mucus membranes (lining within the nostrils, mouth, throat)
• Sleepy and unresponsive  

If your child exhibits any of these signs, seek immediate care at an urgent care facility or the emergency department. Reserving visits to urgent care or the emergency department for truly urgent needs helps ensure timely care for those who need it most, reduces waiting times for everyone, conserves resources, and limits your child’s exposure to other viruses. 

Prevention is key 

Kara Starnes, D.O., medical director of Urgent Care at Cook Children’s, encourages parents to practice prevention. Dr. Starnes says one key way to prevent the flu is vaccination.

“The flu vaccine provides the best chance at preventing the more serious complications of the flu,” said Dr. Starnes. “While a flu vaccine may not always completely prevent the flu, it typically makes the illness much less severe and of a shorter duration. It is not too late to get a flu shot, even if you or your child has had the flu.”

• Keep your children at home and away from public areas if they are not feeling well
• Wash your hands
• Cover your nose and mouth when sneezing and coughing
• Avoid touching your nose, mouth and eyes
• Avoid close contact with people who are sick
• Get a flu vaccine for you and your child 

Five years later, we reflect on all that has occurred and changed since March 4, 2020. We asked Cook Children’s employees to reflect on their experiences during the COVID-19 lockdown and how they experienced growth, loss, and change.

Burleson Mayor Ken Shetter's frustration speaks for many physicians, nurses and other health care providers too. 

Shetter spoke at a news conference announcing that face coverings will be required in all area Tarrant County businesses and outdoor gatherings of 100 people or more, as part of an executive order.

Tarrant County Judge Glen Whitley stated the  order goes into effect at 6 p.m. Friday and will stay in effect through 6 a.m. Aug. 3.

The executive order came as recent cases continue to surge, locally and throughout the state.

As of June 24, 2020, 215 people have died in Tarrant County from COVID-19, with a total of 9,846 positive cases and 460 new cases. More than 4,600 people have recovered after getting the virus.

The news across the state is not good either. The Texas Department of State Health Services reported on the same day that the state would surpass 5,000 new cases in a single day for the first time.

This recent surge in COVID-19 cases means doctors, nurses, and other health care providers won’t get what they hoped for: a chance to catch their breath before the flu season arrives.

The Centers for Disease Control and Prevention (CDC) estimates there were between 24,000 – 62,000 flu deaths from October 1, 2019, through April 4, 2020 (last flu season).

In contrast, the Johns Hopkins University & Medicine's Coronavirus Resource Center reports more than 122,000 COVID-19 related deaths in the United States as of June, 25, 2020.

“It appeared things were getting better in the latter half of May. However, throughout June, things began to climb,” Dr. Whitworth said. “We have to do a better job right now, taking care of one another, and returning to the basics.”

Those basics include staying home, social distancing, not touching your face, washing your hands frequently, and wearing masks.

Masks are a courtesy to others. They protect those who may be more vulnerable to the disease, such as the elderly or those with chronic illnesses such as cystic fibrosis or diabetes. Masks should cover the mouth and nose to keep others safe.

As the cases increase, the overall outlook for children with COVID-19 remains good.

At Cook Children’s, 125 kids have tested positive. Six of those patients are currently at the medical center, but that’s compared to more than 4,700 patients receiving negative results. The majority of children testing positive have not required medical intervention.

Up to this point, children make up a small percentage of hospitalizations and death in the United States as a result of COVID-19.

Nationally, children represent about 3.7% of all hospitalizations related to COVID-19 and only 0.7% of deaths. Data shows that infants, less than 1 year of age, have had the most severe disease in the pediatric age group.

“We’ve been very fortunate in pediatrics with the COVID-19 disease,” said Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “One of the things we know about children is that they are less likely to be as ill as adults who contract COVID-19. It’s thought that 50% or less of children who have COVID have a fever. They may not show any symptoms of the disease, or may just have a cough.”

And while the risk to kids is lower, it’s not zero. So even if you don’t want to take precautions for yourself, do it for those around you that are high risk and for children who may be affected by the virus.

“We know now that people are contagious, probably for about two days before they develop symptoms. So, they don’t know they’re sick, and some people never get symptoms. And they still have this virus coming out when they are talking, or coughing or sneezing. That’s what this cloth mask does. It keeps it in. So even if you feel ambivalent and you’re not worried that you’re going to get COVID and you think I’m not going to wear a mask and if I get it, I get it, please remember, the reason you wear the cloth mask out in public is to protect others who are worried about catching it, to protect high-risk populations and to protect the public in general. That’s why it’s important to wear a mask.”

Important Links:

• Tarrant County Public Health COVID-19 (Coronavirus) Site
• Johns Hopkins University & Medicine's Coronavirus Resource Center 
• Checkup Newsroom COVID-19 Information
• COVID-19 Resources & Education (cookchildrens.org)
• Medical Director of Infectious Diseases Urges Us All To Wear Our Masks
• 'Because We Are All Taking an Amazing Handwashing Journey Together, Aren't We?'
• Why It's Important To See Your Pediatrician During a Pandemic and What To Expect During Your Visit
• Cook Children’s Pediatricians Welcome Patients Back to Clinic Visits. The Plan to Keep You Safe.