The current season, which began Sept. 28, 2025, and runs through May 23, 2026, continues to see a steady increase in cases across Cook Children’s Health Care System, primarily within primary care and urgent care offices. 

During the first week of February, the positivity rate for the flu hovered at approximately 30% in urgent care clinics, according to Kara Starnes, D.O. medical director of Urgent Care at Cook Children’s. 

Pediatricians encourage caregivers and families to take preventive steps, noting that a previous infection does not mean immunity for the season. 

“Even if you have already tested positive for the flu this season, it is worth getting your flu shot to protect against other strains,” said Phillip Scott, M.D., pediatric hospitalist, medical director for the Nelson Ku High Risk Asthma Clinic. 

While Cook Children’s Medical Centers in Prosper and Fort Worth have not seen a significant spike in hospitalizations, the system reports an increase in visits for the common cold. 

Don’t Let the Flu Stall Your Spring Break 

With Spring Break just a few weeks away, medical experts share tips to ensure families spend their vacation making memories instead of making visits to urgent care.  

“If you are traveling and will be in large crowds such as at the airport or at a large event, it is worth getting your flu shot for protection against the flu,” said Dr. Scott. 

Beyond prevention, the flu vaccine can significantly reduce the severity of symptoms if an individual does become sick, lowering the risk of hospitalization. 

Pediatricians also recommend the following: 

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

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 who can help you decide whether the level of sickness escalates 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.  

Related Stories: 

• Is it Flu? What Parents Need to Know This Flu Season
• Know When to Use Telemedicine, Urgent Care, or the ER for Kids
• Top 10 Questions Parents Ask About Vaccines 

 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 

Researchers leading the U.K.-based ELVIS-Kids trial found that children who were given hypertonic saline nose drops when they developed a cold had fewer sick days than those who did not use the drops. Of the 407 children ages 6 and under in the trial, 301 of them developed a cold. Of these, 150 participants received three drops of hypertonic saline per nostril at least four times daily. They experienced symptoms for an average of six days, compared to eight days for those who received standard cold care without saline drops. In addition, fewer households reported family members catching a cold, according to the study.

Saline drops and nasal rinses have long been recommended by physicians for cold symptom relief, usually in the form of isotonic saline, which has a salt concentration of 0.9%. This is similar to the natural salt content of the body. Hypertonic saline has a higher salt concentration of 2.6% or more. Both are safe and effective methods for reducing congestion by flushing and moisturizing nasal passages, according to Amy Stockhausen, M.D., a pediatrician at Cook Children’s Pediatrics Carrollton.

Trial investigators suggest the higher salt concentration of a hypertonic solution helps to increase the production of hypochlorous acid within the cells lining the nose. In turn, the hypochlorous acid helps to suppress viral replication, leading to fewer sick days and faster relief of symptoms. Dr. Stockhausen says this is a good theory for why it works, but other mechanisms could be at play. 

“I think that they are taking the body's natural physiologic mechanisms and assuming that that's what's going on, but it’s not clear to me from the article itself that we know that for certain, but it makes some sense,” Dr. Stockhausen said.

Even so, she says, the results are promising.

“This particular study gives us some interesting insight that what we've been recommending for symptomatic treatment may actually make you better faster,” she said. “That's pretty exciting if they can actually show that that's true.”

Both hypertonic and isotonic saline drops are safe, inexpensive and can be purchased over-the-counter. Dr. Stockhausen recommends isotonic saline drops to her patients for symptom relief with any upper respiratory virus that causes congestion and runny nose. With its higher salt concentration, hypertonic saline may sting or cause some discomfort to the lining of the nasal passages. Dr. Stockhausen recommends dropping down to isotonic saline if you experience discomfort with a hypertonic solution.

She also cautions parents about applying too much force when using a saline spray or mist.

“If you are forcibly pushing salt water into the nose, you can end up causing some pressure injury to the eustachian tubes or the back of the nose. So you have to be careful that it’s under low pressure,” she said.

Parents should also be careful about making their own saline solution at home. Using iodized salt from the baking shelf is not recommended as it can irritate the nose, and tap water should never be put into the nose. It contains chemicals and bacteria that can damage the inside of the mucous membranes and cause serious harm. Always use distilled water when mixing a saline nasal rinse.

In addition to saline drops, Dr. Stockhausen offers these tips for relieving cold symptoms:

• Moist air in the form of a steamy bathroom or a humidifier next to the bed helps keep mucus thin and wet, so it’s easier to expel. You can add Vicks to the steam or vaporizer if you choose. 
• Honey has natural mucus reducers and anti-inflammatories that help break up mucus in the throat and quiet coughs naturally without side effects. Give a spoonful of honey as often as needed to children over 12 months of age. It can also be given in warm liquids such as tea or apple juice. It should not be used in infants under 12 months.
• If your child is old enough to gargle, warm salt water gargles can help with throat symptoms.
• Use over-the-counter pain and fever medications like acetaminophen or ibuprofen as needed if your child's symptoms are causing discomfort or changes in their eating/drinking and sleeping patterns.
• Encourage fluids to stay hydrated, and get lots of rest to allow the immune system as much energy as possible for fighting off the illness.
• Over-the-counter cough and cold multi-symptom remedies for children are generally not recommended. They are often ineffective, can cause multiple side effects like elevated blood pressure and irritability, and can excessively dry up mucus making it difficult to expel. Additionally, data is limited on their safety, especially in young children.

Last week, Cook Children’s saw 1,342 positive Influenza A cases at its medical centers in Fort Worth and Prosper. Across Cook Children’s seven urgent care centers (UCCs), 60% of the flu tests performed were positive for Flu A.

The influx is leading to over-crowded waiting rooms and long wait times across the board.

On Tuesday, Feb. 4, the emergency department in Fort Worth saw 534 patients, while 995 patients were seen at the UCCs. 

“This year is by far worse than previous years in regard to the flu,” said Stephanie Felton, D.O., associate medical director of the Cook Children’s Emergency Department. “Last year, we peaked at 800 positive patients in the month of January. This January we saw 1,200 positive patients. Please keep in mind how contagious the flu is.”

The flu is an infection of the respiratory tract (nose, throat, and lungs) that is caused by a virus. It can spread easily from person to person. Roxana Narat, M.D., a hospitalist at Cook Children’s Medical Center – Prosper, says flu symptoms include fever, cough, congestion, fatigue and body aches.

Kara Starnes, D.O., medical director of Urgent Care at Cook Children’s, encourages parents to practice prevention when it comes to flu and other respiratory illness:

• 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 shot

“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.”

Managing Symptoms

If your child is sick, call your pediatrician first. They can help you decide if your child needs to visit their office or go to an urgent care or 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. 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
• Chest appears to sink in with each breath
• Head bobbing when breathing in
• Change in alertness  

Signs of dehydration:

• Urine output significantly below the child’s normal (at least once every 8 hours)
• Not producing tears when crying and 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 wait times for everyone, conserves resources, and limits your child’s exposure to other viruses.

Along with vaccinations, hand-washing is one of the most effective ways to prevent flu. Alcohol based hand sanitizers are not effective against enterovirus 68, only good, old fashioned hand-washing.

Hand hygiene is especially important while children are attending school, where nearly every interaction carries the possibility of transmitting viruses.

“Children should wash their hands before and after going to the bathroom, as well as before eating or drinking,” Frank McGehee, M.D., a Cook Children's pediatrician in Fort Worth, said. “They should work the soap into a good lather and scrub for at least 20 seconds—the amount of time it takes to hum ‘Twinkle, Twinkle, Little Star.’ Have them scrub especially well around fingernails and jewelry.”

It’s also a good idea to have children wash their faces frequently during flu season.

Sometimes it's difficult to make your child take the time to wash his or her hands. How do you get your children to wash their hands? We would love to hear from you.