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 

Last week, Cook Children's saw more than 900 positive flu cases at its medical centers in Fort Worth and Prosper. Mostly driven by Influenza A cases, this flu season is quickly shaping up to surpass the past several years.

This surge in illness is also triggering high volumes of patients across the health care system, and that means high wait times. 

“When large numbers of children are coming into the emergency department, wait times go up,” said Natalie Carpenter, director of Emergency Services at Cook Children's. “We have to treat patients in order of the severity of their illness, so that means kids with mild symptoms may be in the waiting room for long periods.”

On Monday, Jan. 27, the emergency department in Fort Worth saw 696 patients, while 1,030 patients were seen across Cook Children's seven urgent care locations. For context, an average of 379 patients are seen during a normal day in Cook Children's Fort Worth emergency room.  

“Unfortunately, this is a trend we’re seeing year after year,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “The rates of respiratory illness among children in our community continue to rise. Many of these children need medical attention to control their symptoms.”

Dr. Whitworth encourages parents to practice prevention when it comes to flu and other viruses:

• Keep your child home when they are sick
• Avoid close contact with people who are sick
• Wash hands frequently
• Avoid touching nose, eyes and mouth
• Get a flu vaccine for you and your child

“The flu vaccine is the best prevention we have against the virus,” said Dr. Whitworth. “It’s not too late to get your vaccine. With the flu season ramping up, now is the time to get vaccinated if you haven’t already.”

There is some good news regarding RSV, the respiratory virus that was hitting kids hard this past fall. Last week we saw 124 RSV cases at the medical centers in Fort Worth and Prosper, a significant drop from the more than 400 cases per week reported in December.

Norovirus is also circulating, but not as widespread as RSV and flu. There were 36 cases of norovirus at Cook Children's - Fort Worth last week. 

Managing Symptoms at Home When Possible

If your child is sick, your first call should be to your pediatrician. They can help you decide if your child needs to come into the 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 (avoid ibuprofen in infants younger than 6 months) can help reduce fever and discomfort.

Maintaining hydration is crucial; encourage fluids and consider electrolyte drinks or popsicles. Saline nasal drops and a cool-mist humidifier 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.

"It is safe to manage your child’s symptoms at home as long as they are not displaying signs of severe illness, respiratory distress or dehydration," Dr. Whitworth added.

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.

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

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

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

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

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

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

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

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

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

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

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

¿Qué es neumonía ambulante?

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

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

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

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

¿Cuándo acudir la sala de emergencia?

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

Síntomas

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

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

Síntomas en bebes y niños mayores de 6 meses:

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

¿Cómo prevenir?

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

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. Usually during cold and flu season, most children will experience very mild symptoms that normally self-resolve within a few days, said Cook Children’s hospitalist Laura Romano, D.O.

Flu activity is considered widespread in Tarrant County, according to Tarrant County Public Health. This flu season, we are admitting larger numbers of older, previously healthy children with difficulty breathing and flu-related pneumonia at the Cook Children’s Medical Center - Fort Worth, Dr. Romano said.

Most are requiring supplemental oxygen and some require ICU admission. While this has not been uncommon during prior flu seasons, this is now becoming the norm for admissions rather than the exception, Dr. Romano said.

“Overall, it seems that the flu is not going away anytime soon this season,” Dr. Romano said.

From Feb. 4 to Feb.10, out of 1,593 tests conducted, 16% were positive for flu A and 21% were positive for flu B, according to lab data at Cook Children’s Medical Center - Fort Worth.

This is a decrease compared to the prior week (Jan. 28 to Feb. 3), which showed a 22% positivity rate for flu A and 24% positivity rate for flu B.

High Patient Volume

Cook Children’s Urgent Care Centers and the Emergency Department at Cook Children’s Medical Center - Fort Worth are experiencing high volumes from circulating viruses such as COVID, flu and respiratory syncytial virus (RSV).

From Jan. 9 to Feb. 5, Cook Children’s Urgent Care Centers saw 6,806 patients, and the Emergency Department in Fort Worth saw 3,437. These numbers are almost double what they were in early January and leading to crowded medical facilities and long wait times.

On Friday, Feb. 9, our UCCs saw 760 patients in 24 hours and the Emergency Department at Cook Children’s Medical Center – Fort Worth saw 435 patients.

“We are seeing tons of flu,” said Kara Starnes, D.O., medical director of Cook Children’s Urgent Care Centers. “I have three kids of my own, so I know having a sick child can bring some anxiety but, in many cases, children with upper respiratory illnesses like COVID, flu and RSV do just fine being cared for at home and do not require a visit to urgent care or the ER.”

Dr. Starnes says it is safe to manage your child’s symptoms at home as long as they are not displaying signs of respiratory distress or dehydration. Reserving visits to urgent care or the emergency department for truly urgent needs will help reduce wait times, conserve resources and limit your child’s exposure to other viruses.

Signs and Symptoms

COVID-19, flu and RSV 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

There are a few things you can do to keep your child comfortable while the illness runs its course.

Over-the-counter medications such as ibuprofen and acetaminophen can help reduce fever, aches and pains. Ibuprofen should not be given to infants younger than 6 months.

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. Otherwise, it’s safe to manage fever at home.

Keep your child hydrated by encouraging fluids every few hours. Electrolyte drinks can be helpful if you suspect your child is dehydrated or at risk of becoming dehydrated. If they aren’t interested in drinking, have them suck on a popsicle.

To help reduce congestion, keep the sinuses moist with saline drops and a cool-mist humidifier. This is especially helpful during sleep times.

If your child appears to be in respiratory distress or severely dehydrated, it’s time to go to urgent care or the emergency department.

●      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
• A 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 (Your child should be producing urine 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, ears, genitals and anus)
• Sleepy and unresponsive

Of the more than 800 patients tested for RSV last week at Cook Children’s, more than 200 (29%) were positive. Four percent of those tested for COVID-19 were positive. The Emergency Department (ED) at Cook Children’s in Fort Worth is treating more than 500 patients a day. An additional 800 patients a day are seeking treatment at one of Cook Children’s seven Urgent Care Centers (UCCs). The influx is leading to over-crowded waiting rooms and long wait times across the board.

These numbers are expected to climb as we move closer to peak respiratory illness season, typically December through January.

Parents and caregivers can help reduce the stress on the system by knowing when to call your child’s physician and when to seek emergency care. Doctors say following these guidelines can reduce traffic to EDs and UCCs, reduce wait times for patients and reduce your child’s exposure to viruses.

Many viral respiratory illnesses can be treated at home with rest and lots of hydration. If you are concerned, call your pediatrician first if your child is experiencing mild symptoms without difficulty breathing or dehydration, or for illness-related symptoms (ear pain, sore throat, diarrhea or vomiting, rash, cough or other non-urgent health concerns). The pediatrician’s office can help you decide what steps to take.

In many cases, physicians can assess and treat a patient via a virtual health appointment. Not only is this a convenient option that saves time, but it keeps you and your child out of a waiting room where they could pick up another virus on top of the one they already have.

Download the MyCookChildrens app to schedule a virtual health/telemedicine appointment here.

Parents should not go to Urgent Care or the Emergency Department for an RSV, flu or COVID test. Your pediatrician can test for all of these.

When to Seek Immediate Care:

●      Any temperature greater than 100.4 in an infant under two months of age is considered a medical emergency. If your child has a fever for more than three days, contact your pediatrician or visit an urgent care center. 

●      Concerns for dehydration. In dehydrated babies, parents will see fewer wet diapers or a lack of tears. Their flat spot can also appear more sunken.

●      Your child is breathing faster than usual or you can see the skin between the ribs being sucked in.

●      If your child is requiring frequent use of their albuterol rescue inhaler or is having worsening asthma symptoms.

Signs and Symptoms

Symptoms of RSV in infants younger than 6 months may include:

●     Irritability

●     Poor feeding

●     Lethargy

●     Episodes where they stop breathing

●     Fever

Infants and children over 6 months may experience:

●     Runny nose

●     Loss of appetite

●     Cough

●     Sneezing

●     Fever

●     Sometimes wheezing

Flu and COVID-19 share similar symptoms as RSV and may also include sore throat, headaches, body aches, chills and change/loss of taste and smell.

Practice Prevention

When it comes to respiratory illnesses, prevention is always the best medicine, especially as we approach the holidays and the many indoor gatherings they bring. Vaccines can help reduce the spread and severity of illness and prevent hospitalization. It’s not too late to get your child’s flu shot or COVID vaccine. Call your pediatrician to make an appointment.

Remind your children to practice healthy habits such as washing their hands and coughing into a tissue or their elbow. If you or your child feels sick, stay home to prevent spreading illness, take time to rest and stay hydrated with lots of fluids.

As COVID-19 cases rise at Cook Children's, the Food and Drug Administration has approved an updated COVID vaccine.

The Centers for Disease Control and Prevention recommends that anyone 6 months and older should get the new shot to protect against serious illness.

COVID cases at Cook Children’s Medical Center have been steadily increasing since early July. From the week of Sept. 17 through Sept. 23, the positivity rate is 10% or 69 positive cases out of 679 patients tested.

The new vaccines from Pfizer and Moderna are matched to protect against the most common COVID variants circulating now. Please contact your pediatrician's office to schedule an appointment.

The fall and winter months are a common time for respiratory illnesses to spread in our community; in addition to COVID-19, there is typically a rise in flu and RSV cases.

Schedule you and your child’s flu shot as soon as possible to help prevent severe illness and spread of the flu.

Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. It is the leading cause of hospitalization for infants, who are much more susceptible to the disease.

This year, infants will have a better chance of protection if they receive the new monoclonal antibody injection for the prevention of severe RSV, which has been shown to reduce the risk of hospitalization and health care visits in infants. This one-time injection was recently approved by the FDA and recommended by the CDC. The treatment will be available at Cook Children's pediatrician offices soon.

Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center, answers some of the top questions from parents regarding these respiratory illnesses, treatment and prevention.

COVID

What are COVID cases like right now? Why should my child get the new COVID vaccine?

Positive COVID cases at Cook Children’s Medical Center have been steadily climbing since the end of June and early July. Across the country, there are higher rates of COVID hospitalizations in both adults and pediatrics. Your child should get a yearly COVID vaccination because we know that this will protect them. People who are vaccinated against COVID have a significantly decreased risk of hospitalization, ICU admission, and death.

What are the symptoms of most COVID cases right now?

Symptoms are mainly upper respiratory symptoms (cough, nasal congestion, sore throat). It’s also causing fevers, muscle aches, and fatigue. And yes, these symptoms are very similar to the flu! 

Should my children and I be wearing face masks? 

You should consider wearing a mask if you, your child, or anyone in your home is at high risk for severe COVID-19 infection. This includes people who are 65 years and older and people with certain medical conditions such as heart conditions, lung disease, diabetes, sickle cell, or a neurologic condition.

During flu, RSV, and COVID-19 seasons, it is very reasonable to wear a mask whenever you are in crowded indoor spaces. This includes pediatric office and emergency room waiting rooms!

My child is involved in many in-person activities this fall. What can we do to protect against COVID?

• Consider wearing a mask
• Get the latest vaccine
• Stay home if you are sick

My child’s classmate tested positive for COVID. What should I do?

• If your child is having symptoms, test immediately. If the initial test is negative, repeat in 48 hours if your child is still symptomatic.
• If your child does not have symptoms, wait five days and take another test.

If my child received a COVID vaccine more than six months ago, should they get the new vaccine?

Yes, they should! The CDC recommends that anyone 6 months and older who is two months out from their last COVID vaccine get the new vaccine.

Will it protect my child against the latest variant?

Yes, the newest vaccine was designed for the currently circulating variants so it should help protect your child.

FLU

What are flu cases like now? When is flu season?

Flu cases are currently low at Cook Children’s. Flu season typically begins in the late fall and stretches into the winter. However, last year we saw unprecedented numbers of influenza very early in the season.

Why should my child get a flu shot?

 Flu vaccines help protect against severe cases of the flu. If your child gets the flu vaccine, they may still get the flu, but they will have more mild symptoms and should not need to be hospitalized with a severe infection.

When will flu shots become available?

Flu shots are currently available at many Cook Children’s pediatrician offices. Check with your pediatrician’s office. Many local pharmacies have them as well.

RSV monoclonal antibody shot

What age groups can get the RSV monoclonal antibody injection?

Infants under 8 months during their first respiratory season and children who are at high risk up to 24 months of age. Talk to your pediatrician about your child’s risk, especially if they have a history of prematurity, heart disease, or chronic lung disease.

What should parents consider with this antibody treatment?

Our babies and infants are the most vulnerable population during cold and flu season so this will give them some protection and lower the chances of having a severe infection.

RSV can cause symptoms ranging from a runny nose to respiratory failure, requiring an ICU admission. It usually causes mild, cold-like symptoms, but it can be serious, especially for infants.

RSV causes bronchiolitis, which can be very serious and sometimes fatal in babies. The new antibody treatment has been shown to reduce the risk of hospitalization by nearly 80%, according to the CDC.

When will the new antibody be available?

The new antibody treatment will be available soon. For newborns, it may be given in the nursery prior to your infants discharge after birth. For older infants, families should reach out to their pediatrician about availability.

Will my child show symptoms once they receive the antibody shot?

Your child may still get symptoms of RSV after receiving the treatment but they are expected to be less severe.

Your doctor will monitor for any signs of a reaction during the infusion and after with your assistance.

How long is it effective?

Since this is an antibody and not a vaccine, it is designed to provide a temporary boost in immunity only. It will provide short-term protection lasting about 5 months which should cover the 2023-2024 RSV season.

If my child previously had RSV, do they have antibodies?

Yes, but the antibodies your body’s immune system makes to RSV last only two to three months. It is very possible for a child to get RSV multiple times in one respiratory season.

Related stories:

• Fighting RSV: Physicians Say New Antibody Shot Could be Game Changer 
• CDC Recommends RSV Shot for Infants. Infectious Disease Doctor Shares What Parents Need to Know 
• Curious About Health and Safety Requirements at Day Care? We Have Answers
  
   

As cases of the flu and RSV decline at Cook Children’s, we are experiencing an increase in positive cases of COVID-19. Families are encouraged to remain vigilant against respiratory illnesses and make sure their children have the latest COVID booster vaccines, especially as a new dominant subvariant appears to be more contagious.

From Dec. 25 to Dec. 31, Cook Children’s saw a COVID positivity rate of 9.2%, which has been increasing since November. From Jan. 1 to Jan. 7, the positivity rate increased to 11.2%.

As children return to school from the holiday break, there could be an increase in respiratory viruses and illnesses over the next two weeks and beyond, so it’s important to remain watchful and proactive. If your child is feeling sick, keep them at home from daycare or school and wear a face mask when in public to stop the spread.

Influenza A and B cases have declined since November. From Jan. 1 to Jan. 7, we had a positivity rate of 9.9% for Influenza A. This doesn’t mean that the flu season is over, it’s possible to see another increase in cases, so be sure to get vaccinated against the flu. The flu vaccine works to prevent you from catching the flu – or, reduce the severity if you do come down with the illness.

“It is very encouraging to see cases decline,” said Laura Romano, D.O., hospitalist at Cook Children’s. “However, this does not mean that RSV and flu season is over. There is a very likely possibility of a second peak occurring later this winter.”

Respiratory syncytial virus (RSV) cases are declining compared to high cases in October and November. We currently have a RSV positivity rate of 7%. There are limited treatments for RSV. Right now, there is no vaccine available to prevent RSV. Synagis, a monoclonal antibody, can be given to prevent severe infections but this is reserved for premature infants, etc. We are also seeing positive cases of rhinovirus and adenovirus in our patients.

COVID-19 Subvariant

The World Health Organization said that it’s concerned with how quickly the XBB.1.5 subvariant of COVID is spreading in the northeast U.S. The subvariant makes up 40% of submitted specimens to the national SARS-CoV-2 surveillance system. There's still a lot that is unknown about this subvariant.

“This subvariant may be able to slip past our immune defenses and might be more contagious, but it is not clear yet if it causes more severe disease or if the vaccine can effectively prevent severe infections from this strain,” said Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children’s. “We do know that masking and good handwashing will still be helpful to avoid infection.”

The Centers for Disease Control and Prevention tracks the community spread of COVID-19. For the week of Jan. 1, Tarrant County is rated “high” transmission spread.

Prevention & Precautions

The biggest thing the community can do to help is to take precautions against COVID-19, including masking indoors if you or your child feel sick, frequent hand washing, and getting the COVID-19 vaccine and booster.

Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If you or your child is sick, wear a mask in public.
• If your child is sick, keep them home from daycare or school. Make sure your child drinks lots of liquids, gets plenty of sleep and takes over-the-counter meds to alleviate symptoms.

Flu vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

There’s no guaranteed way to avoid the flu. But getting the vaccine every year can help. At Cook Children’s, we believe that flu vaccinations are the safest, easiest way to protect everyone age 6 months and older from serious flu symptoms. And a flu vaccination during pregnancy helps protect your newborn baby from flu for several months after birth.

Flu immunizations, COVID-19 immunizations and other services are available at Cook Children’s neighborhood clinics and primary care sites across Fort Worth and beyond. Find a location near you: Primary Care Offices/Neighborhood Clinics (cookchildrens.org)

For COVID, at-home tests and community testing locations are also great options.

From Nov. 27 to Dec. 3, there were 533 flu A cases, a positivity rate of 33.8%. Protect yourself and your family by getting vaccinated against the flu and COVID. The flu vaccine works to prevent you from catching the flu or by reducing the severity if you do come down with the illness.

In addition to causing respiratory symptoms, the flu can also cause myositis, which results in significant muscle pain and requires admission for IV hydration and pain management. The best way to prevent influenza-associated pneumonia and influenza-induced myositis is to get your flu vaccine.

Respiratory syncytial virus (RSV) cases are declining compared to previous weeks, but remain high. We are also seeing positive cases of COVID and rhinovirus in our patients.

“There are not any current treatments for RSV,” said Laura Romano, D.O., Hospitalist at Cook Children’s Medical Center. “There is also currently not a vaccine available. We can use Synagis, a monoclonal antibody, to help prevent severe infections but that is reserved for certain patients such as our premature infants, our infants with congenital heart or lung disease, infants with compromised immune systems, or some infants with certain neurological conditions."

Cook Children’s has expedited our winter staffing plan in preparation for peak flu season. Our census is full, including beds, the Emergency Department and Urgent Care Centers. Wait times are extremely long. We ask parents and caregivers to contact their pediatrician unless their child has a moderate or severe illness or injury.

Patient Census

In the last 24 hours, 560 patients went to the Emergency Department, which is equivalent to one check in every 2 minutes. This is causing long wait times (8-10 hours) to transfer patients to the Pediatric Intensive Care Unit.

Across our seven Urgent Care Centers, we saw 654 patients on Friday, 653 patients on Saturday, 677 patients on Sunday and 528 patients in the last 24 hours.

There are steps families can take to avoid getting sick. Parents and caregivers can remind their children to continue the healthy habits learned in the pandemic, including hand hygiene, coughing into a tissue or your elbow and staying home if you or your child feel sick. Face masks add increased protection, especially in public spaces.

Last year, more people were wearing face masks and children were more likely to stay home while sick. This year, parents are sending their children to daycare and school for the first time following two years of the pandemic, Dr. Romano said. Children who haven’t been previously exposed to respiratory viruses are among the many children who are getting sick.

Positive Influenza A cases at Cook Children’s Health Care System:

Oct. 9 – Oct. 15: 47 cases

Oct. 16 – Oct. 22: 75 cases

Oct. 23 – Oct. 29: 170 cases (14.6% positivity rate)

Oct. 30- Nov. 5: 333 cases (22.6% positivity rate)

Nov. 6 - Nov. 12: 483 cases (27.5% positivity rate)

Nov. 13 - Nov. 19: 630 cases (35.4% positivity rate)

Nov. 20 - Nov. 26: 812 cases (42.3% positivity rate)

Nov. 27 - Dec. 3: 533 cases (33.8% positivity rate)

RSV cases at Cook Children’s Health Care System:

Oct. 2 – Oct 8: 210 cases (24% positivity rate)

Oct. 9 – Oct. 15: 288 cases (29% positivity rate)

Oct. 16 – Oct. 22: 246 cases (24% positivity rate)

Oct. 23 – Oct. 29: 263 cases (23% positivity rate)

Oct. 30 - Nov. 5: 337 cases (23% positivity rate)

Nov. 6 - Nov. 12: 342 cases (19% positivity rate)

Nov. 13 - Nov. 19: 267 cases (15% positivity rate)

Nov. 20 - Nov. 26: 222 cases (12% positivity rate)

Nov. 27 - Dec. 3: 174 cases(11% positivity rate)

Pediatrician Offices

Call your pediatrician first if children are experiencing mild symptoms or injuries (ear pain, sore throat, diarrhea or vomiting, rash, cough or other non-urgent health concerns). The pediatrician’s office can help you decide what steps to take.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

RELATED: Doctor's Note is Not Required for Excused Absence at Fort Worth ISD

Urgent Care Centers

If your child is ill, please contact your pediatrician's office first if it is not a moderate or severe illness or injury. If you cannot get to your provider’s office or it’s after hours, go to an urgent care center. Urgent care centers manage the same problems as your regular health care provider plus services such as X-rays, stitches and splints.

Understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. Staff are overwhelmed and they’re encountering a lot of frustrated parents. Please be nice to the people working – they need kindness!

Emergency Department

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

Seek immediate medical care if your child is experiencing:

• Persistent fever for more than two or three days. However, any temperature greater than 100.4 in an infant under two months of age is considered a medical emergency.
• Concerns for dehydration.
• In dehydrated babies, parents will see fewer wet diapers or a lack of tears. Their flat spot can also appear more sunken.
• Breathing faster than usual or can see the skin between the ribs being sucked in.
• If your child is requiring frequent use of their albuterol rescue inhaler or is having worsening asthma symptoms.
• Please understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. 

Preparation/Prevention

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If you’re sick, wear a mask in public and stay home.

RELATED: 

• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

Cook Children’s has expedited our winter staffing plan in preparation for peak flu season. Our census is full, including beds, the Emergency Department and Urgent Care Centers. Wait times are extremely long. We ask parents and caregivers to contact their pediatrician unless their child has a moderate or severe illness or injury.

Be sure that you and your family are vaccinated against the flu and are updated on the latest COVID vaccines and booster shots. The flu vaccine works to prevent you from catching the flu – or, reduce the severity if you do come down with the illness.

“We are seeing increased cases of flu admissions, particularly influenza infections associated with pneumonias,” said Laura Romano, D.O., Hospitalist at Cook Children’s Medical Center. “In addition to causing respiratory symptoms, the flu can also cause myositis, which results in significant muscle pain and requires admission for IV hydration and pain management. The best way to prevent influenza-associated pneumonia and influenza-induced myositis is to get your flu vaccine.”

Respiratory illnesses, like flu and RSV, are typical for this time of year; RSV is a very common respiratory virus. Some children require hospitalization for RSV, but most do not. We are also seeing positive cases of COVID and rhinovirus in our patients.

There are limited treatments for RSV; most are available for premature infants, infants with other lung diseases, infants who are considered immunocompromised, or patients with a congenital heart disease.

“RSV cases continue to decline but we are still seeing children, particularly our most vulnerable patients, becoming significantly ill with symptoms,” Dr. Romano said. “Our most at-risk patients include those less than 12 weeks, any pre-term infant born at less than 34 weeks, or any baby with congenital lung disease or congenital heart disease.”

Patient Census

In the last 24 hours, 533 patients went to the Emergency Department, which is equivalent to one check in every 2 minutes. This is causing long wait times (8-10 hours) to transfer patients to the Pediatric Intensive Care Unit.

Across our seven Urgent Care Centers, there were 814 patients seen on Monday and 722 patients seen in the last 24 hours.

There are steps families can take to avoid getting sick. Parents and caregivers can remind their children to continue the healthy habits learned in the pandemic, including hand hygiene, coughing into a tissue or your elbow and staying home if you or your child feel sick. Face masks add increased protection, especially in public spaces.

Last year, more people were wearing face masks and children were more likely to stay home while sick. This year, parents are sending their children to daycare and school for the first time following two years of the pandemic, Dr. Romano said. Children who haven’t been previously exposed to respiratory viruses are among the many children who are getting sick.

RSV cases at Cook Children’s Health Care System:

Oct. 2 – Oct 8: 210 cases (24% positivity rate)

Oct. 9 – Oct. 15: 288 cases (29% positivity rate)

Oct. 16 – Oct. 22: 246 cases (24% positivity rate)

Oct. 23 – Oct. 29: 263 cases (23% positivity rate)

Oct. 30 - Nov. 5: 337 cases (23% positivity rate)

Nov. 6 - Nov. 12: 342 cases (19% positivity rate)

Nov. 13 - Nov. 19: 267 cases (15% positivity rate)

Nov. 20 - Nov. 26: 222 cases (12% positivity rate)

Positive Influenza A cases at Cook Children’s Health Care System:

Oct. 9 – Oct. 15: 47 cases

Oct. 16 – Oct. 22: 75 cases

Oct. 23 – Oct. 29: 170 cases (14.6% positivity rate)

Oct. 30- Nov. 5: 333 cases (22.6% positivity rate)

Nov. 6 - Nov. 12: 483 cases (27.5% positivity rate)

Nov. 13 - Nov. 19: 630 cases (35.4% positivity rate)

Nov. 20 - Nov. 26: 812 cases (42.3% positivity rate)

Pediatrician Offices

Call your pediatrician first if children are experiencing mild symptoms or injuries (ear pain, sore throat, diarrhea or vomiting, rash, cough or other non-urgent health concerns). The pediatrician’s office can help you decide what steps to take.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

RELATED: Doctor's Note is Not Required for Excused Absence at Fort Worth ISD

Urgent Care Centers

If your child is ill, please contact your pediatrician's office first if it is not a moderate or severe illness or injury. If you cannot get to your provider’s office or it’s after hours, go to an urgent care center. Urgent care centers manage the same problems as your regular health care provider plus services such as X-rays, stitches and splints.

Understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. Staff are overwhelmed and they’re encountering a lot of frustrated parents. Please be nice to the people working – they need kindness!

Emergency Department

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

Seek immediate medical care if your child is experiencing:

• Persistent fever for more than two or three days. However, any temperature greater than 100.4 in an infant under two months of age is considered a medical emergency.
• Concerns for dehydration.
• In dehydrated babies, parents will see fewer wet diapers or a lack of tears. Their flat spot can also appear more sunken.
• Breathing faster than usual or can see the skin between the ribs being sucked in.
• If your child is requiring frequent use of their albuterol rescue inhaler or is having worsening asthma symptoms.
• Please understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. 

Preparation/Prevention

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If you’re sick, wear a mask in public and stay home.

RELATED

• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

To get an excused absence due to illness, please:

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

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

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

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

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

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

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

RSV and Other Illness Guidelines for Parents

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

Call your pediatrician if:

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

Seek immediate medical care if:

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

Prevention:

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

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

RELATED

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

The Cook Children's Health Care System census is full across the board, including beds, the Emergency Department and Urgent Care Centers. The sheer volume has made finding a bed for our patients a daily logistical puzzle.

In the last 24 hours, 487 patients went to the Emergency Department, which is equivalent to one check in every 2 minutes. This is causing long wait times (8-10 hours) for patients to be transferred to the Pediatric Intensive Care Unit and is putting unnecessary strain on the health care system.

Across our seven Urgent Care Centers, there were 763 patients on Friday, 668 patients on Saturday and 754 patients on Sunday. Cook Children’s has expedited our winter staffing plan in preparation for peak flu season.

We ask parents and caregivers to contact their pediatrician first if it’s not a moderate or severe illness or injury. Other hospitals and children's hospitals around the country are also experiencing high number of RSV and respiratory illnesses.

RSV cases at Cook Children’s Health Care System:

Oct. 2 – Oct 8: 210 cases (24% positivity rate)

Oct. 9 – Oct. 15: 288 cases (29% positivity rate)

Oct. 16 – Oct. 22: 246 cases (24% positivity rate)

Oct. 23 – Oct. 29: 263 cases (23% positivity rate)

Oct. 30 - Nov. 5: 337 cases (23% positivity rate)

Nov. 6 - Nov. 12: 342 cases (19% positivity rate)

Nov. 13 - Nov. 19: 267 cases (15% positivity rate)

Positive Influenza A cases at Cook Children’s Health Care System:

Oct. 9 – Oct. 15: 47 cases

Oct. 16 – Oct. 22: 75 cases

Oct. 23 – Oct. 29: 170 cases (14.6% positivity rate)

Oct. 30- Nov. 5: 333 cases (22.6% positivity rate)

Nov. 6 - Nov. 12: 483 cases (27.5% positivity rate)

Nov. 13 - Nov. 19: 630 cases (35.4% positivity rate)

Urgent Care Centers

If your child is ill, please contact your pediatrician's office first if it’s not a moderate or severe illness or injury. If you can’t get to your provider’s office or it’s after hours, go to an urgent care center. Urgent care centers manage the same problems as your regular health care provider plus services such as X-rays, stitches and splints.

Understand that kids with more severe issues will be seen first and that means long wait times for those with minor illness. Staff are overwhelmed and they’re encountering a lot of frustrated parents. Please be nice to the people working – they need kindness!

Emergency Department

Bring your child to the emergency room if they have trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition. Please understand that kids with more severe issues will be seen first and that means long wait times for those with minor illnesses. 

Pediatrician Offices

Call your pediatrician first if children are experiencing mild symptoms or injuries (ear pain, sore throat, diarrhea or vomiting, rash, cough or other non-urgent health concerns). The pediatrician’s office can help you decide what steps to take.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

Preparation/Prevention

The increase in RSV and influenza began much earlier than usual this year, but we have yet to reach peak flu season. With Thanksgiving approaching, we want to help parents understand what they can do to prevent the spread of illnesses.

As we prepare for the flu season to worsen, make an appointment with your pediatrician to get updated flu and COVID vaccines. Vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization. Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

Remind your children to continue the healthy habits learned in the pandemic, including hand hygiene, coughing into a tissue or your elbow and staying home if you or your child feel sick. 

There is a nationwide shortage of RSV tests. RSV testing doesn’t change the way in which most children are treated/managed.

RELATED: 

• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

A surge in flu cases is often correlated with Thanksgiving and the approaching holiday season, so it’s important that everyone 6 months and older get the flu vaccine now. Along with a spike in RSV cases, North Texas is currently a hotspot for flu activity.

“The influenza vaccine is a very safe and effective way to avoid getting sick with the flu,” said Mary Suzanne Whitworth, M.D. “One quick shot can potentially prevent a week of fever and feeling miserable. This is a no brainer.”

Parents and caregivers can remind their children to continue the healthy habits learned in the pandemic, including hand hygiene, coughing into a tissue or your elbow and staying home if you or your child feel sick. Face masks add increased protection, especially in public spaces. 

Be sure that you and your family are updated on your COVID vaccines. As flu cases increase due to the holidays and travel, COVID cases often go up as well. Patients are still experiencing COVID. On Oct. 18, the rolling 7-day average was 2.3% positivity rate.

Why should I get the flu vaccine in response to the spike in RSV cases?

Our goal is for our community, our patients and our patient families to stay as healthy as possible. Our Emergency Department and Urgent Care Centers are currently overwhelmed with patients and resulting in extremely long wait times.

Vaccination against the flu helps prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccine reduces the risk of hospitalization.

Our emergency department is seeing more than 500 children each day. Our Urgent Cares are seeing nearly 800 children each day. This is the equivalent of a child being checked in to see a provider every 2 minutes and is resulting in extraordinarily long wait times for those who are not severely ill.

Additionally, Cook Children’s pediatric ICU remains near capacity with about half of patients diagnosed with RSV.

Parents should not go to Cook Children’s Urgent Care Centers or Emergency Department for only a flu or a COVID test. See your pediatrician, who can test for flu, RSV, strep throat and COVID. You can also use at-home COVID tests or tests from a pharmacy.

What are flu cases like now?

At Cook Children’s, flu cases are increasing earlier this year; the flu numbers we are currently seeing are equal to what we saw near the end of November 2021. There were 47 cases of Influenza A and one case of Influenza B at Cook Children’s Health Care System during the week of Oct. 9 – Oct 15.

RSV cases at Cook Children’s Health Care System:

• Oct. 2 – Oct 8: 210 cases
  • (24% positivity rate)
• Oct. 9 – Oct. 15: 288 cases
  • (29% positivity rate)
• Oct. 16 – Oct. 22: 246 cases
  • (24% positivity rate)

Influenza A cases at Cook Children’s Health Care System:

• Oct. 9 – Oct. 15: 47 cases
• Oct. 16 – Oct. 22: 75 cases

Most of the United States is seeing an early increase in seasonal flu activity, according to the Centers for Disease Control and Prevention. The southeast region and south-central region, which includes Texas, are reporting the highest levels of flu activity, the CDC said.

Everyone ages 6 months and older should get a flu vaccine. The flu vaccine is the best way to protect your child and family from potentially serious complications from flu.

Texas is at a high activity level for respiratory illness, including fever plus a cough or sore throat. The map shows ILI (influenza-like illness), which includes patient visits due to other pathogens that cause similar symptoms. The cases reflected in the map are not all confirmed flu cases.

RELATED: 

• Prepare Now for Flu Season with Vaccine Protection
• Get Immunized for a Healthy School Year (checkupnewsroom.com)
• Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

Getting a flu shot every year is the best way to fight off the influenza viruses that can cause serious complications, especially for children ages 5 and younger.

The flu vaccine works to prevent you from catching the flu – or, reduce the severity if you do come down with the illness. Adults and children as young as 6 months old are urged to get the flu shot by the end of October.   

Brandi Falk, M.D. at Cook Children’s Pediatrics McKinney emphasizes the importance of coming in for a flu vaccine before the flu typically starts spreading. Flu season generally extends from November through May. Shots are available now by appointment at pediatrician offices, neighborhood clinics and pharmacies.   

“The flu is a virus, and we actually pass it through tiny droplets that we make when we cough or sneeze or talk,” Dr. Falk said. “It's important that parents know that everyone is at risk.”

Flu is a contagious respiratory infection that can cause fever, chills, headache, muscle aches, dizziness, loss of appetite, tiredness, cough, sore throat, runny nose, nausea or vomiting, weakness, ear pain or diarrhea. Dr. Falk pointed out that it can last two weeks or more, and it’s worse than having a cold. Sinus problems, ear infections, dehydration and difficulty breathing also can develop, potentially requiring hospitalization.

“A question I get asked from parents a lot is, ‘Why do I need to do the flu vaccine?’ I tell them that it can lead to life-threatening symptoms like pneumonias and inflammation around your heart, around your brain and your muscles,” she said.

In the 2021-2022 flu season, the U.S. Centers for Disease Control and Prevention (CDC) recorded 31 pediatric deaths caused by flu. Most of those cases -- ranging in age from 2 months to 16 years -- involved at least one underlying medical condition that put those patients at higher risk for flu severity, such as asthma, heart disease or weakened immune system.

Last year saw a drop in the percentage of children and teens protected against the flu. The CDC reports that 55.3% of those eligible received their flu shots, down from 57.3% previously. 

Dr. Falk explained a few key points: 

• You can’t catch the flu from the flu shot. “The flu shot is an inactive vaccine. So that means that the viruses inside it are killed.”
• Potential side effects, usually mild, include soreness, redness or swelling in the arm or leg where the injection went in. The vaccine might also cause brief headaches, fever, nausea and muscle aches. 
• After the vaccine, it takes two weeks to build up the antibodies that fight off the flu. That’s why it’s important to get immunized early. “By the time the flu starts getting more prevalent, you're already protected,” Dr. Falk said.

It’s important for the whole family to receive a flu vaccine annually, she said. Patients can receive the vaccine in combination with other vaccines at their checkup or by scheduling a nurse visit. First-timers who are younger than age 9 will need two doses, a month apart.  Kids 9 and older need only one dose.

For those who want to avoid needles, the nasal spray flu vaccine might be an option.  The flu mist cannot be given to children under age 2 or to people with asthma, certain chronic illnesses or weakened immune systems.

Flu vaccines protect against two influenza A viruses, and two influenza B viruses. The vaccine’s composition is updated each year to protect against what is expected to be the most common viruses in circulation.   

In addition to vaccination, Cook Children’s recommends these hygiene practices for flu prevention:

• Wash hands with soap thoroughly and often, especially after using the bathroom, after coughing or sneezing, and before eating or preparing food.
• Never share cups and eating utensils.
• Cover your mouth and nose with a tissue when you cough or sneeze, then put the tissue in the trash.
• Cough or sneeze into your upper arm, not your hands, if a tissue isn't handy.

And … If your child is sick, stay home from daycare or school. Make sure your child drinks lots of liquids, gets plenty of sleep and takes over-the-counter meds to alleviate symptoms.

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There’s no guaranteed way to avoid the flu. But getting the vaccine every year can help. At Cook Children’s, we believe that flu vaccinations are the safest, easiest way to protect everyone age 6 months and older from serious flu symptoms. And a flu vaccination during pregnancy helps protect your newborn baby from flu for several months after birth.

Immunizations and other services are available at Cook Children’s neighborhood clinics and primary care sites across Fort Worth and beyond. Find a location near you: Primary Care Offices/Neighborhood Clinics (cookchildrens.org)

RELATED: Get Immunized for a Healthy School Year (checkupnewsroom.com)

Does My Kid Have Allergies, COVID, a Cold or the Flu? (checkupnewsroom.com)

Flu Makes a Return (checkupnewsroom.com)

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

Here’s what we know:

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

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

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

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

Spring is officially here! Along with the start of spring, allergies are starting back up again as well. However, at Cook Children’s there has been an increase in flu cases at CCHCS this past month and the cold season isn’t over just yet along with the COVID-19 pandemic.

Let’s figure out how to tell if your child has a cold, the flu, allergies or COVID-19.

Right now, your child’s sneezing, cough or fever may just scratch the surface as to which of the four it could be.

“Even though it’s spring, parents need to keep in mind some of those winter viruses are still circulating. There are a lot of respiratory viral illnesses still going around that we associate with the wintertime,” said Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Haslet Office said. “In Texas, the weather is not full on spring, it is still cold outside some days.”

Allergies

Allergies are caused by pollen and the environment.

“Allergies usually do not have any of the symptoms that viruses usually cause fever, body aches, or overall general ill feeling,” Dr. Soria-Olmos said. “Most kids with allergies are going about their normal day other than the nuance of symptoms. The overlapping makes things confusing.”

Cold, Flu or COVID?

Symptoms of the common cold, the flu and COVID are very similar. The main way to tell the difference is through testing.

Each of these is a virus that affects the body and can affect the way kids act. A fever is the most common symptom to monitor between the cold, flu and COVID-19.

Cold and flu typically come with additional symptoms such as a decrease in appetite, fatigue, chills, etc. Sometimes you can have a cold without fever. Flu typically causes an increase in temperature.

Parents of children under the age of 2, should contact their pediatrician if the fever continues for more than 48 to 72 hours. This is to help determine if the doctor should see the child and or if a parent can continue supportive care at home.

Although we have seen fewer COVID-19 cases in the community, it is still something to think about as a cause of fever, cough and nasal congestion or sore throat.  

“Testing is the main way to help us determine between different causes of similar symptoms,” Dr. Soria-Olmos said.

Dr. Soria-Olmos encourages parents to speak with their pediatrician on how to treat their child and identify the cause of their symptoms.

“On Friday, 60% of my sick patients were positive for flu A,” said Bianka Soria-Olmos, D.O., a physician at Cook Children’s Pediatrics Haslet. “Our health system’s numbers are still significantly lower for percent positivity compared to usual flu seasons but, as omicron comes down, it will be interesting to see what flu does.”

Symptoms of flu include fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches and tiredness. Vomiting and diarrhea with flu is more common in children than adults.

So how do you know if your child’s symptoms are the result of flu, COVID-19 or the common cold? A cold typically won’t come with fever and chills. As for flu versus COVID-19, Dr. Soria-Olmos said testing is the only way to tell.

“The hard part about this winter is that you have to have a high level of suspicion for both flu and COVID even though COVID numbers are coming down,” Dr. Soria-Olmos said. “Both still have to be on the list because there isn’t one symptom that tells either apart. That’s why we rely on testing to identify the virus.”

While there are no COVID treatments currently approved for kids younger than 12, there are treatments for flu, like Tamiflu. To get the full benefit, Tamiflu needs to be administered within 48 hours of the onset of symptoms.

“I want to tell the viruses apart because if you are flu positive and you're within the window of time, then Tamiflu is an option,” Dr. Soria-Olmos said. “But also, isolation guidelines for flu and COVID are a little bit different. So the reason I would want to know COVID from flu is not just treatment recommendations, but also isolation recommendations.”

Most children will recover from the flu in a few days with rest and lots of fluids, but anyone can develop a complication. Children under two or those with an underlying health condition like asthma, diabetes or heart disease are at higher risk for complications than others. Complications can include anything from a minor sinus or ear infection to a serious case of pneumonia. That’s why Dr. Soria-Olmos recommends the flu vaccine for children 6 months and older.

“You may still get the flu if you are vaccinated, but the likelihood that you’ll have severe illness will decrease,” Dr. Soria-Olmos said.

If your child is sick with the flu or a flu-like illness, the most important thing to do is keep them hydrated. Dr. Soria-Olmos said parents should watch the color of their child’s urine. If the urine is dark or decreasing in amount, that is a sign they may be dehydrated. Parents can use fever-reducing medication like acetaminophen and ibuprofen to manage fever and discomfort. But if your child’s fever lasts more than four to five days, they are struggling to breathe, their cough continues to worsen or they’re experiencing a lot of pain, they need to be seen by their physician.

Keep children home while they have symptoms. Kids should be fever-free for 24 hours without fever-reducing medications before returning to daycare, school and other activities.

Most importantly, remind your kids to wash their hands regularly and to catch their sneezes and coughs in a tissue. These simple tasks go a long way in preventing the spread of the flu bug and keeping kiddos healthy.

Positive cases now account for 31% of tests throughout Cook Children’s Health Care System, about 600 a day. It’s the highest number seen at Cook Children’s since the pandemic began in March 2020 and surpassing the height of the delta surge in September. As of Tuesday, 33 patients were hospitalized, with three being treated in the Pediatric Intensive Care Unit (PICU).

The latest explosion in COVID-19 cases may be fueled by both the omicron and delta variants at work, according to a report released last week by the Centers for Disease Control and Prevention (CDC). As of the week ending Dec. 25, omicron appeared as the dominant variant, but the delta variant still comprised roughly 40% of reported cases, the report states.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s, was interviewed on “CBS Mornings” this week. She says the hospital’s pediatricians and clinics have seen children and teens of all ages testing positive.

“It’s really anywhere on the spectrum,” she says of the recent spike. “We’ve had some babies who were only a few weeks old.”

Other children’s hospitals in Texas and across the country have seen a similar uptick in sick children overwhelming the health care system. More than 325,000 positive cases were reported during the week ending Dec. 30, the American Academy of Pediatrics reported, adding it was the nation’s highest increase in child COVID cases since the pandemic began. The unprecedented number represents a 64% jump from reported cases the previous week.

Top health officials in the country have voiced predictions that a surge may continue as a result of holiday gatherings and vacations but expect it to peak by the end of January based on how the omicron variant behaved in South Africa last month.

With numbers of child cases still on the rise, parents are grappling to address all things COVID. Here’s what families need to know:

How can you tell the difference between COVID and the common cold or the flu? Basically, it’s tough to distinguish between them.

Similar to a cold, the most common symptoms of the omicron variant (found to be much more transmissible) are sore throat, cough, fatigue, congestion and runny nose. The delta variant (thought to cause more severe illness) also generally presents with common cold-like symptoms, such as cough, fever or headache, but also may cause a significant loss of smell.

To complicate matters, COVID-19 also shares some common symptoms with the flu, according to the CDC. Both can show a wide-range of symptoms, including sore throat; fever and chills; headache; cough; shortness of breath or difficulty breathing; fatigue; runny or stuffy nose; body or muscle aches; vomiting and diarrhea; and a change or loss of taste or smell, though that appears more prevalent in COVID.

Since it can be difficult to distinguish between the cause of these symptoms, a test is the best way to determine what it is. COVID testing can be done at home (although tests may be difficult to find right now), at a laboratory or at a test site provided in your area.

 “At this point, it’s probably best to assume you are positive until you are proven otherwise,” says Marc Mazade, M.D., director of Infection Control at Cook Children’s. If family members are having symptoms, they should get tested as soon as possible, which may take longer than usual.

See the CDC website for additional guidelines on who and when someone should get tested.

 Are vaccines the best way to keep my kids from getting seriously ill with COVID-19?

Yes. As it stands, COVID-19 vaccinations are highly effective at preventing severe illness, hospitalizations and death, the CDC reports. And the emergence of the highly contagious variant omicron and its ability for breakthrough infections further emphasizes the importance of vaccination and boosters, the report states.

Children ages 5 and up are eligible for COVID-19 vaccines. This week the Federal Drug Administration (FDA) approved an additional Pfizer booster shot for children ages 12-15, and an additional dose for certain children ages 5-11 if they are immunocompromised.

Cook Children’s pediatrician Diane Arnaout, M.D., encourages eligible children to get COVID-19 vaccines and boosters.

“Don’t let the number of shots worry you,” she says to parents who may have concerns. “There are lots of vaccines that require boosters, and I give them to your kids throughout their early years at timed intervals to make sure they’re protected into adulthood.”

The second, third and fourth shots do what their name says, Dr. Arnaout says. They boost the antibody response to a certain antigen and assure a large portion of the population develops immunity, she says.

“Some shots give us long-term immunity with just two doses and others with five. It just depends on the nature of the vaccine,” she says. “Sometimes viruses mutate so quickly, we need a slightly adjusted vaccine every year to help us fight what’s circulating that year, like the flu shot.”

Although it’s difficult to know at this point, she says, the COVID vaccine may someday become like the annual flu shot.

“Again, we are building this boat as we float in it,” Dr. Arnaout says. “I admire and thank all the scientists, doctors and data collectors who are helping us with this guidance.”

There’s been a ton of surprises related to the COVID pandemic and skipping flu season last year was another one I never saw coming.

Masks and social distancing definitely played a role but the absolute lack of cases was still shocking.

So, will we get lucky again this year?

I doubt it.

And here’s 3 reasons why:

1. Social distancing and masking are going away or gone. And we all want to get to that place…but it does mean we’re likely to have flu cases spread among classmates and families.
2. Skipping a flu season last year may make individuals more vulnerable to flu this year. Our bodies haven’t seen flu for almost two years. And just like our other colds went wild in kids this fall, flu could do the same this winter.
3. A mild or absent flu season last year may make people more likely to skip their flu shot this year. “Do we really need one after last year?” is a common question I have been asked.

What can you do to protect your child and their friends?

Get them their flu shot. Now’s not the time to get cute. Just do it.

Start to work with your child on hand-washing and covering their coughs. We need to protect ourselves and others.

Keep your child home if they are sick. If something seems to be brewing, give it a day to develop at home.

As of Dec. 5, hundreds of children have been tested for flu and RSV at Cook Children’s Medical Center, and none have come back positive. Ramon Kinloch, M.D., a pediatrician at Cook Children’s, believes this has to do with social distancing and masking due to COVID-19.

“A lot of it does have to do with the precautions we have been taking for COVID-19. When we are wearing a mask, we are less likely to spread those respiratory droplets that transmit RSV and flu viruses,” Kinloch said.

Dr. Kinloch says another reason he believes there haven’t been cases is that people aren’t around each other as much right now. With limited contact with those outside of our family units, the physical spread of the virus’ droplets is less likely to happen.

Though there haven’t been any cases yet, Dr. Kinloch believes infections will begin to rise, especially with families gathering for the holidays.

“We are beginning to see people get a little more relaxed, especially with there being a COVID-19 vaccine on the horizon. With that, we will probably begin to see a rise in the flu and RSV numbers,” Dr. Kinloch said.

Dr. Kinloch explained that in years past, Cook Children’s typically sees a slow start and then a huge spike of infections, and he doesn’t expect this year to be any different.

If you believe your child has the flu or RSV, you should look for symptoms such as a fever for more than two or three days, body aches, running or stuffy nose, and coughing. For infants specifically, one sign that could indicate RSV is fast breathing and retractions.

Dr. Kinloch says differentiating between the flu, RSV and COVID-19 can be tricky. While the symptoms are very similar, one distinguishing factor is the loss of taste and smell, which primarily accompany the COVID-19 virus.

“If a child says, “I can’t smell anything,” we have to distinguish if that’s a stuffy nose or if they literally can’t smell or taste anything. If that is the case, we would more likely be dealing with a COVID-19 situation,” Dr. Kinloch said.

The only way to know for sure if you or your child has either illness is by getting tested. Dr. Kinloch says even testing has its limitations and it all comes down to when you get tested, what symptoms you have, and your exposure. He warns that each case is different and parents should always reach out to their physician if symptoms are worsening and fever will not break.

“They are with them and they know them better than we do. If a parent is uncomfortable with how their child looks or they have a gut feeling, it’s always important to call their doctor and have them evaluated. I believe that parents are equipped to know when something is wrong with their child,” Dr. Kinloch said.

So how do I know if my child needs to be seen? Call your pediatrician if your child:

• Has more than three or four days of fever (temperature over 100.4 degrees)

• Has any type of sustained and fast breathing

• Is lethargic or limp

Dr. Kinloch says his best advice is to ensure you’re following all CDC guidelines and to remember, it’s about keeping each other safe. He advises all families to get the flu vaccine, wash your hands, and be sure to remember the guidelines amid the pandemic.

And while I’m confident that we’ll get through it together, I need your help.

Ruling out COVID-19 for kids with symptoms (some mild, some more severe) has become the biggest reason for kids visiting our office. We’ve already seen kids getting sick as they go back to school and that makes me nervous about what the upcoming flu season is going to look like.

Because the symptoms of flu overlap with COVID-19 so much, it’s going to be difficult to tell whether flu or COVID-19 is causing your child’s flu-like illness. And, there’s no guarantee that a child can’t get both at the same time.

So with the flu season nearing, you probably have a lot of questions that need to be answered about this possibility:

• Does every child with flu-like illness need to be tested for both?
  • Probably.
• Does getting COVID-19 and the flu at the same time mean your child will be more at risk for severe illness?
  • Probably.
• Will we have enough COVID-19 testing available to continue avoiding unnecessary quarantines?
  • I hope so, but every time we test a child for COVID-19 because they have flu-like illness, we have fewer tests available.

Here are some things you can do to help your child and yourself (and me):

1. Get your child their flu shot. ASAP. The effectiveness of the flu shot does vary from year to year. It’s not perfect. But, it’s the best we have. And even decreasing the amount of flu by 60% this year will change the lives of those children: Avoiding not one but two tests. Avoiding the worrying during the waiting time and wondering if your child has flu, COVID-19 or something else.
    
2. Start practicing hand washing. Children need to be taught to wash their hands adequately and often.
    
3. Wear your mask, even in situations where you think it might not be necessary. It will not only protect against COVID-19, it will protect against the flu as well. We, as a health care provider and a society, cannot afford to have a terrible flu season this year.
    
4. Keep yourself and your child home if you are sick. This is important…every…single…year. But it is especially important this year. Don’t be the family that knocks over the first domino. Even if you aren’t seen by a doctor, waiting a day can be helpful to see if your simple symptoms progress or go away.

Let’s all do our part.

We can do this!

Well…there’s no doubt about it. 2020 is going down in the record books as a real dumpster fire of a year.

We have a new enemy. The novel coronavirus has slithered its unpredictable and sometimes deadly tentacles into every aspect of our lives.

But I’m not here to talk about the new enemy. 

I’m here to talk about a well-known OLD enemy. Influenza. The grandfather of respiratory illness. The master of the mutation game, he comes back every year to infect us. And sometimes unpredictably, he can kill.

I’m here to tell you why this is the most important year yet to get your flu vaccine.

Let’s take a second to learn why I choose to vaccinate my family each year:

• Our goals for the flu shot are not to NOT catch the flu (although it is estimated to prevent 5+ million cases of flu in the United States each year). It is to avoid potentially devastating flu-related illness and death.
• The flu shot has been shown to reduce influenza-related deaths by 51% in kids with underlying health conditions and 65% in healthy kids.
• The flu shot has been shown to reduce flu hospitalization of pregnant women by 40%.
• The vaccine reduces hospitalization and death for those with cardiac disease, diabetes, and chronic lung disease.
• The flu shot reduces overall deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized flu patients. (Sources for these statistics are at bottom of article)

Okay, the science is there, obviously. The flu shot is an effective way to try to not get really, really sick with the flu.

Why is it so important this year? Well, if you haven’t noticed, a new villain is in town.

In 2020, the novel coronavirus (as of the date this was written) has infected over 5 million Americans, and has killed over 167,000 Americans.

During the 2019-2020 flu season, 39-56 million Americans were infected, 400-700K were hospitalized, and there were 24-62,000 deaths related to the flu.

Look at these numbers. They’re huge. What happens when we add them up? Things start looking very grim.

Remember those hospital beds and ventilator numbers we’re keeping an eye on? They get used, in large quantities, by flu patients every winter. Especially vulnerable are older and younger people, and people with underlying health conditions. We need those hospital beds. We need the ventilators and staff.

The flu seems to be more deadly to children (as far as we know…let’s remember we’ve not done this whole COVID-19 thing with full classrooms around the country yet). Every year we see kids sickened, hospitalized, and killed by the flu. During the 2019-2020 season, 187 children were killed by the flu. In 2020, COVID-19 has been responsible for the deaths of 49 kids under age 14 (as of 8/8/20).

What happens when you combine influenza and COVID-19 in a community? What happens when people start getting infected with both? The answer is…we don’t know.

The southern hemisphere’s winter happens during our summer, and during their recent flu season, many medical clinics closed, schools closed, and travel and social restrictions were imposed. So knowing how bad the flu season was, and whether or not flu and COVID co-infection creates a monstrous burden of disease, was unable to be studied very accurately under “normal” conditions down there.

In the U.S., we’re opening schools. Winter approaches, and we don’t know what it will bring. COVID-19 is here to stay for awhile, and the flu is coming. There is so much unknown, and so much we can’t control. What we CAN control? Lowering our risk for severe illness, hospitalization, and death by getting a flu shot. It’ll be more important this year than ever before.

My hope is that our newfound love for masks, distancing, and handwashing will lead to a quieter flu season. But unfortunately, season after season, the flu seems to always find a way.

Sources:

• https://www.cdc.gov/media/releases/2017/p0403-flu-vaccine.html
• https://www.cdc.gov/flu/prevent/vaccine-benefits.htm
• https://www.cdc.gov/flu/prevent/benefit-publications.htm
• https://www.sciencemag.org/news/2020/08/how-will-covid-19-affect-coming-flu-season-scientists-struggle-clues
• https://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html
• https://www.cdc.gov/mmwr/volumes/69/wr/mm6932e3.htm?s
• https://downloads.aap.org/AAP/PDF/AAP%20and%20CHA%20-%20Children%20and%20COVID-19%20State%20Data%20Report%208.6.20%20FINAL.pdf
• https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Sex-Age-and-S/9bhg-hcku

“With a flu season that could be prolific, if that leads to greater hospitalizations coupled with the hospitalizations that we’re seeing for COVID-19, you can easily see how hospitals in this region, as well as across Texas, will be completely overrun,” said Abbott.

Thankfully, COVID-19 hospitalizations among children have remained low, but that doesn’t mean parents should let their guard down. Nicholas Rister, M.D., pediatric infectious diseases physician at Cook Children’s, says now is a good time to set a reminder to get the entire family vaccinated against the flu as soon as immunizations become available, likely mid-September.

“It is a little more concerning than your average flu season because COVID-19 is still very prevalent in our area,” Dr. Rister said. “Both of these viruses trigger respiratory illnesses and the symptoms are very similar so it’s going to be difficult to tell the two apart without testing.”

To add insult to injury, it is possible to get both COVID-19 and the flu at the same time. Dr. Rister says if that happens, it would likely make symptoms worse.

“By in large, children have luckily been spared from the most severe effects of COVID-19,” Dr. Rister explained. “Unfortunately, the same does not hold true for the flu. Kids can become very ill from the flu and end up in the hospital. That’s the last thing we want to happen.”

In addition to pushing Texans to get their flu shot, Governor Abbott said COVID-19 cases are decreasing in Dallas/Fort Worth. But he warned the illness is still spreading heavily among family and friend gatherings.

"There may be this sense that if you're gathering with family, you're not really transmitting COVID-19, but that has been disproven," Abbott said. "Anybody anywhere has both the ability to spread or contract COVID-19." 

So while we wait for vaccines to arrive for both viruses, these are steps you can take to protect you and your family:

• Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing or sneezing. If soap and water are not available, use an alcohol-based hand sanitizer with at least 60 percent alcohol.
• Avoid touching your eyes, nose and mouth with unwashed hands.
• Wear a mask.
• Avoid large gatherings.
• Keep social distance.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe
  • Before disinfecting surfaces, clean with soap and water to remove dirt and other residue
  • Follow by using a household spray or wipe disinfectant that is labeled "Kills 99.9% of viruses and bacteria."
  • Wipe the surface down and allow 5 minutes to dry before using the surface.
  • The CDC offers alternatives to commercial disinfecting solutions on their website, as well as tips for cleaning your home. 

“Wear shoes outside.”

“Put on your hat.”

Does any of this really matter? Is any of it true?

Between well-meaning friends and family members and the wealth of websites devoted to health, parents are bombarded with tips and tricks to keep their kids healthy year round, but especially during the winter. This can make separating fact from fiction difficult.

Not all old wives’ tales are fictitious – some are grounded in truth. However, if you have questions or hear health advice that doesn’t make sense to you, always ask your children’s pediatrician before acting on the information or simply believing a statement is true.

Let’s take a look at the facts on these weather health myths.

Myth 1: Sudden changes in the weather make you sick

One day you are wearing shorts and the next day you are dragging out all of your winter gear. Welcome to Texas. So doe the fluctuating weather make you sick? In general terms, the answer is no. I know no matter how much science I use in my answer, many of you won't believe me. The truth is there's no scientific proof that changes in the weather will make you sick or keep you from getting better. 

But as usual there are exceptions. The changes in the weather can be really hard on your child's skin. Moisturizing children's skin during the winter is important and that includes wearing protective lip balm. Also, make sure your child uses sunscreen when playing outside whether it's cold or hot outside. 

The other concern would be kids with asthma. People have different triggers for their asthma. The most common ones tend to be weather changes, viral infections and exposure to certain allergens. Cold, dry air can cause bad flare-ups and viral infections are the most common trigger this time of year. Parents should stress to their children the importance of handwashing, especially this time of year.

Myth 2: If children go outside with wet hair or without shoes, they’ll get sick.

Many people believe that cold temperatures are responsible for the spike in illness that typically occurs during late fall and the winter months. People get sick in the winter because they spend more time in close proximity to one another, not because they’ve been exposed to cold weather.

The truth is it’s not really going to matter that much if your kids go outside without socks and shoes – except maybe if you don’t want dirty feet or if it’s extremely cold, your child runs the risk of frostbite.

It’s true we do see more colds, flu and flu-like viruses during the winter. Both the life cycle of common viruses and the fact that people are more likely to be clustered inside their homes and schools when it’s cold outside, which causes viruses to circulate, contribute to this increase.

Myth 3: People lose most of their body heat throughout their heads, so children should wear hats while playing outside in cold weather.

This tale originated in response to several studies conducted by the United States Army in the 1950s. Further research has since debunked this claim, but it’s true that your face, chest and head get colder faster when you’re exposed to winter weather.

Your face is particularly sensitive to the cold. If your children’s faces are cold while playing outside, they should wear warmer clothes. But colds come from germs – not cold temperatures – so children aren’t going to get sick if they don’t wear a hat.”

Myth 4: Feed a cold and starve a fever.

We’ve all heard this and probably most of us can’t even keep the saying straight. But there’s no scientific evidence to support the idea that children should fast when running a fever. Children who are sick should eat when they feel up to it and drink plenty of fluids to prevent dehydration.

Even if children don’t feel hungry, we ask parents to encourage their kids to drink as many liquids as they can. I’ve also heard an old wives’ tale that says you shouldn’t drink milk if you’re running a fever, but milk works as well as other fluids when it comes to keeping kids hydrated. Other good choices include water, Pedialyte and Gatorade.

Myth 5: All fevers should be treated with medicine because high fevers are dangerous.

As parents, it’s only natural to rush to the medicine cabinet at the first sign of a high temperature, but fevers aren’t always a cause for concern. In fact, they help your child’s body fight infection. According to the American Academy of Pediatrics, children’s demeanors are often better indicators of illness severity than the numbers on the thermometer. If children aren’t fussy or complaining of feeling badly, there’s no need to treat a fever unless their doctor says otherwise.

Myth 6: You can’t prevent your child from catching a cold.

While there’s no cure for the common cold, you can take steps that will reduce your child’s risk. In this case, grandma is right. These are the same steps she told you. Wash your hands after you sneeze. Wash your hands after you blow your nose. Wash your hands after you eat. See a theme? Children should sneeze into the crook of their elbow and not their hands. They should blow their nose to get rid of the mucus. For children too young to blow their noses, parents should use a blue bulb syringe and drain the child’s nose with salines. If a cold lasts longer than a week, bring your child in to see his or her pediatrician. It could possibly be a sign of acute sinusitis and may need to be treated differently than the common cold.

Don’t buy into the weather myths. Here are some tips for preventing health issues:

• Help your child eat healthy and get good sleep.
• Get your child up and active in some way every day.
• Teach your child to wash their hand and cover their coughs.
• Get your child a flu shot (it’s still not too late).

1. The Centers for Disease Control and Prevention (CDC) is closely monitoring the current outbreak caused by a novel (new) coronavirus first identified in Wuhan, Hubei Province, China.
2. Coronaviruses are a highly contagious type of respiratory virus that will sometimes cause outbreaks in regional areas (if you remember SARS, think along those terms).
3. Human coronaviruses are common throughout the world. The CDC states there are seven different coronaviruses that scientists know of, that can make infect people and make them sick.
4. A current strain of the coronavirus caused hundreds of cases in China. Symptoms typically are runny nose, cough, sore throat and fever.
5. Because the virus replicates and causes high levels of infection in the lungs, it can spread rapidly to a large number of people.
6. Because it’s so new, there’s no specific treatment for coronavirus, but exposed individuals should be monitored for upper respiratory symptoms and worsening breathing problems.
7. For now, most of us in the U.S. are at low risk for coronavirus, but care should be exercised for anyone traveling to or from the impacted areas of China.

We will continue to monitor the CDC and other health organizations. If there’s something new to report, we will be sure to let you know.

*Image Credit: NIAID

Is it strep or the flu? Maybe, both?

Strep and flu are two very different things, although they may have similar symptoms at times.

First, let’s distinguish between the two.

The flu is a viral infection that impacts the nose, throat and lungs. A flu, or cold, can make the throat sore and scratchy

Strep is a bacterial infection. Strep causes the throat to be very sore and it becomes very painful to swallow and they typically don’t eat, or only eat very soft things. With a cold or flu, children usually eat fine or if not the reason is appetite not pain with swallowing.

They both can cause a fever, sore throat, chills, muscle aches and even nausea.

So how do you tell the difference?

Even for a pediatrician, it’s difficult to distinguish strep from the flu by a quick look inside a child’s throat. Studies have been done that shows that without the proper tests, physicians can’t tell the difference half the time.

Strep can cause white spots, but rarely does. Usually the throat is somewhat red and can have the red spots which are petechia. The body aches in strep are also less severe in strep and one of the defining symptoms of flu.

The only accurate way to diagnose strep is through a strep screen or a throat culture.

Strep throat symptoms include:

• Red, sore throat with white patches
• Headache
• Swollen, sore glands in the neck
• Fever
• Red spots on the roof of the mouth
• Painful, difficult swallowing
• Chills
• Fatigue
• Nausea and possibly vomiting
• Decreased appetite
• Rash
• Muscle aches, especially in the neck, and abdominal pains, especially in younger children
• Swelling in back of mouth

We will take more tests to confirm the diagnosis that may include a throat culture, rapid DNA test or rapid antigen strep throat.

Most strep will get better in about a week to 10 days.

Your doctor will prescribe antibiotics to treat the infection. Although the symptoms may fade, the infection may remain. Please make sure to take all the antibiotics prescribed.

You may be surprised to find out that about 30 percent of people have strep in their throat at all times and it does not cause symptoms. To help reduce your child’s chances of strep, follow these tips:

• Wash your hands
• Don’t share food or drink
• Avoid exposure to other people with strep
• Replace your child’s toothbrush after starting antibiotics

Flu symptoms include:

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

We advise everyone to get the flu shot. However, if you or your child are sick with the flu, stay home, rest and avoid contact with other people. The Centers for Disease Control and Prevention recommends staying home for at least 24 hours after the fever is gone (except for medical care or other necessities). The fever should be gone without the use of fever-reducing medicine.

In some cases of the flu, you may be prescribed antiviral drugs that are prescription medicines. These aren’t sold over-the-counter and you can only get them with a prescription. The drugs aren’t antibiotics which fight against bacterial infections (strep for instance), but they fight against the virus.

You may hear someone say that their child got strep and flu at the same time. This can happen, but it’s very uncommon. Both are increase in the winter months, and symptoms such as sore throat, fever, etc. can overlap, which is likely why children are being treated for both.

Strep and flu two are entirely different things. Colds and flu always cause a sore throat, but strep is never the cause of cold symptoms.

So if your child has cold symptoms and a sore throat and gets tested for strep, it could be a false positive or it could just be a coincidence. For instance if your child has a cold or flu, then they go to the doctor or to school and are exposed to someone with strep throat. Now he or she has both. But they aren’t related.

And remember because they are different, they would each have to be treated differently and separately.

I hope this helps. We’ve been asked a lot about it lately. Stay healthy.

Dr. Bradley Mercer is pediatrician at Cook Children's Pediatrics (Fort Worth). To learn more about him and his practice, click here.

Last week (Dec. 22-Dec.28, 2019) at Cook Children's Medical Center, 1,457 children tested for the flu. Five hundred forty-six patients tested positive for Influenza B, and 169 more were positive for Influenza A. Another 258 kids tested positive for RSV. The report is only for those tested at the medical center and does not include the dozens of primary care offices at Cook Children's.

Already this flu season, two pediatric flu deaths in Tarrant County have been confirmed. The first death in early December was the first reported pediatric flu death in Tarrant County since 2015.

Flu B typically follows Flu A and is usually found at much lower levels. What makes this season unusual is that Flu B appeared first and in much higher numbers than Flu A. During the week of Dec. 23, 2018, 1,141 children were tested for the flu at the medical center with 484 kids testing positive for Influenza A and none for Influenza B.

Doctors at Cook Children's say Flu B causes the same general symptoms as Flu A – fever, upper respiratory symptoms and body aches. Generally, Flu B seems to be a little less severe but should still be taken seriously.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s, says it’s hard to predict what’s next when it comes to the flu season. But normally, pediatricians in the area expect to see an uptick in flu a couple of weeks after kids go back to school following their winter break.

“The kids are bringing their germs with them and coming in contact with many other kids once they are at back at school,” Dr. Whitworth said. “It’s so important to stress good hygiene such as handwashing and covering your cough. And, I can’t stress enough to keep your child home if they are sick to prevent other children from getting the flu too.”

Dr. Whitworth said kids should stay home until at least 24 hours after their fever has gone away without the help of fever-reducing medicine. But if your child is still feeling the side effects of the flu even after the fever has gone away, she suggests they stay home for another day or so.

With so many children sick right now, Cook Children’s is currently under a “Facility Alert” due to an extremely high census. Between the Emergency Department and Urgent Care Centers, staff is seeing an average of more than 1,200 kids per day.

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

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

Other quick facts about Flu B include:

• Flu B is spread via droplets like Flu A, so washing hands and covering coughs are essential to prevention.
• The vaccines contain Flu A and Flu B strains.
• Even if you get flu in the season where you get the flu vaccine, it's not for nothing. It may prevent more serious illness and complications as well.
• Treatment with Tamiflu is an option. Families and doctors must weigh the benefits vs. side effects. Talk with your doctor if you have any questions.
• Secondary infections (such as pneumonia) can occur after any strain of the flu. So be on the lookout for increasing fever or recurrence of symptoms after your child has begun to recover.

More On This Topic:

• Influenza/Flu Information
• Let's Learn About The Flu
• Is It Strep Throat or The Flu?
• What Parents Need To Know About RSV
• Let's Learn About Fevers

“Because of the sensitive nature of the information, we can’t share any other details, other than to say that the child had underlying health conditions,” said Tarrant County Public Health Director Vinny Taneja. “The patient tested positive for Influenza B which is circulating early and predominately this season.”

Tarrant County Public Health stated there has been a “sharp rise in flu activity this season, trending nearly a month ahead of the previous two years.”

Taneja added, “We want to remind everyone to get their flu shot. It’s definitely not too late, and the vaccine offers you the best protection against the flu.”

Last week at Cook Children’s (Nov. 24 through Nov. 30), 964 children were tested for the flu at the medical center. Of those children, 231 tested positive for Influenza B and 24 more for Influenza A.

“The flu vaccine is still the best form of protection we have to fight off getting sick,” said Justin Smith, M.D., a pediatrician at Cook Children’s in Trophy Club. “The vaccine is especially important for children aged 6 months to 5 years. They are at the highest risk for serious flu-related complications, including death. Even if you do get the flu, people who are vaccinated generally get a milder and less dangerous form of the illness.”

You may remember the spray shot wasn’t previously available for children because it didn’t work as well. The newer versions appear to work as well as the shot. So the vaccine can be given this year either by a shot or nasal spray, depending on the child’s age and general health. Both protect against four types of influenza viruses: Influenza A (H1N1), Influenza A (H3N2) and two influenza B viruses.

The nasal spray is approved for use in people 2 years through 49 years of age. People who are pregnant or have certain medical conditions (such as asthma) should not receive the nasal spray influenza vaccine.

Based on guidelines from the CDC and the American Academy of Pediatrics, people with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving a flu vaccine. It is now recommended that people with a history of severe allergic reaction to egg (any symptom other than hives) can now be vaccinated in an inpatient or outpatient medical setting, under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.

"All children with egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for all vaccines," the AAP wrote in the September 2018 edition of Pediatrics as part of its "Recommendations for Prevention and Control of Influenza in Children, 2018-2019."

Backing up the AAP and CDC, is recent research in the Annals of Allergy, Asthma and Immunology, which found the flu shot to be safe and recommended its use for people who are allergic to eggs.

Jason Terk, M.D., a Cook Children’s pediatrician in Keller, said previous recommendations on egg-allergic individuals not receiving a flu vaccine were based on the fact that most of the flu vaccine currently available is created from viral cultures in chicken embryos. Experts theorized there was a risk because of the concern that small amounts of the egg that the viral cultures come from could end up in the vaccine.

“After years of study and observation, it was found that no significant increased risk for reactions occured in egg-allergic people,” Dr. Terk said. “The recommendation to avoid flu vaccine for egg-allergic people has been removed. No medical intervention is without risk. But the risk of influenza and the complications arising from it far exceed the infinitesimal risk of influenza vaccination.”

If you have concerns, Dr. Terk said your pediatrician should be happy to answer questions about your child and why the flu vaccination should be given.

Influenza, commonly known as "the flu," is a highly contagious viral infection of the respiratory tract. It affects all age groups, though kids tend to get it more often than adults.

What The Flu Is

The flu is a respiratory illness.

The flu happens every year. It hits hard from December through March (and other months, but those primarily). There are deaths every year. Kids, healthy people, old people, babies and folks with chronic illness die every year. This year we're trending lower at Cook Children's than in previous seasons. I really, really, really hope it stays that way.

Overall, remember that the flu is usually a "mild" illness (I mean, you feel like you've been hit by a truck, but we call that "mild" in medicine, ha).

It hits fast and fevers can go high, which is worrisome. But with a lot of rest, fluids, pain and fever reducers, things usually get better after 3-5 days. The cough and congestion can last for 2 weeks.

Sometimes, rarely, it can get bad. Really bad. The flu can cause: Pneumonia. Sinusitis. Ear infections. Brain inflammation (encephalitis). Heart inflammation (myocarditis). Asthma attacks in asthmatics. Death. That escalated quickly.

You hear us talk a lot about Flu A and Flu B. They are just two different strains of influenza. They are the two types that circulate the globe each year. In the states, Flu A usually arrives first and in general is considered the more severe strain. But overall, there is little difference in how they present clinically and we can’t really tell them apart without a flu test.

What The Flu Isn’t

The flu is not a stomach bug. There is no "stomach flu." That's called gastroenteritis. Your child is throwing up, but doesn't have a runny nose or cough? It's not the flu.

How Do You Prevent The Flu?

Scared to vaccinate? Hear stories? Hate shots? Have an uncle who loves to talk up a good conspiracy theory? Know this: some years, you can still get the flu even if you get the flu vaccine. It depends on how well we predict what strains of the flu will be circulating the globe that year. And some years, it's not a good match.

BUT it's usually milder, if you do get it. It GREATLY reduces your chance for hospitalization and death. I get it every year for my kids and my family. If you ask any pediatrician or ICU doc what viruses put fear into their hearts, I'll bet you influenza tops that list. I always tell my patients, even if it’s a "bad match" year, isn't a 30 percent effective seatbelt better than no seatbelt at all?

We can't know how good of a match the vaccine was until the flu season is over in April. So ignore the dramatic news reports.

Tamiflu can help make it less severe sometimes, for some people.

WASH YOUR HANDS! The flu can live on some surfaces up to 24 hours in cold weather! Think about all those door handles you touch! The cash you get handed back from the cashier! The snot that flies from every person's sneeze can cover a 6 foot radius around them! Wash. Those. Hands!

How Long Are You Contagious?

You are contagious with the flu 1-2 days BEFORE you start showing symptoms. How sneaky is that?

You are contagious 5-7 days after you start to show symptoms. Your KIDS can be contagious up to 10 DAYS after they start to show symptoms.

You should keep your kids out of school for at LEAST 24 hours after their last fever. This means fever without the use of meds to keep it down. If it's financially feasible for you, I'd even try to keep your kids out at least 7 days after the first symptoms start.

When Should You Worry?

Call us (or your pediatrician) anytime if you're worried about the flu. We can walk you through what is normal and what isn't.

These are the reasons to worry:

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms that improve but then return with fever and worse cough

Stay Healthy Friends,

Dr. Diane

To Learn more about this topic:

• Infuenza/Flu Information
• Is It a Cold or the Flu?
• Pediatricians Say Kids with Egg Allergies Should Now Get The Flu Shot

Texas flu activity continues to rise and is at an above-average level, per the week’s DSHS flu report.

At Cook Children’s Medical Center, the lab tested 529 children for the flu during the week of Nov. 10-16, 2019. A total of 74 kids tested positive for the flu (63 with Influenza B and 11 with Influenza A) and 152 more were confirmed to have RSV.

“For more than 50 years, hundreds of millions of Americans have safely received season flu shots,” the agency wrote in its tweet.

“The flu vaccine is still the best form of protection we have to fight off getting sick,” said Justin Smith, M.D., a pediatrician at Cook Children’s in Trophy Club. “The vaccine is especially important for children aged 6 months to 5 years. They are at the highest risk for serious flu-related complications, including death. Even if you do get the flu, people who are vaccinated generally get a milder and less dangerous form of the illness.”

Two types of flu vaccine are available for the 2019-2020 flu season. Both protect against four types of influenza viruses: Influenza A (H1N1), Influenza A (H3N2) and two influenza B viruses.

You may remember the spray shot wasn’t previously available for children because it didn’t work as well. The newer versions appear to work as well as the shot. So either vaccine can be given this year, depending on the child’s age and general health.

The nasal spray is approved for use in people 2 years through 49 years of age. People who are pregnant or have certain medical conditions (such as asthma) should not receive the nasal spray influenza vaccine.

Last week, eight children tested positive the flu at the medical center, according to Laboratory results from Cook Children’s. What’s interesting is that seven children tested positive for influenza B and only one for the A strain.

Morgan Pence, Ph.D., a clinical microbiologist at Cook Children’s, says this occurrence is a bit odd because the A strain usually precedes B. Pence adds that the majority of flu cases reported nationwide have been influenza B.

Since Sept. 29, 2019, the Centers for Disease Control and Prevention (CDC), found that 68.1% (289) of positive tests gathered from clinical laboratories nationwide were for influenza B.

The good news is Flu B is usually less severe than Flu A. The bad news is the flu season is just beginning. And while it remains to be seen what the flu season holds in store for the area, one thing is for sure: it’s time to get your flu shot.

“It’s important for people to take care of themselves and others to prevent the spread of the flu as much as possible,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases. “The flu vaccine continues to be recommended for everyone 6 months of age and older. Make sure to practice washing your hands and please keep your children home if they are sick.”

Speaking about the early flu season, the CDC reports:

• Nationally, flu activity is low and similar to what has been observed during recent previous seasons at the same time, but Louisiana and Puerto Rico are experiencing high levels of influenza-like-illness.
• Severe flu outcomes have been reported, including the first two pediatric deaths of the 2019-2020 season.
• Flu vaccination is always the best way to prevent flu and its potentially serious complications. Most flu vaccines protect against 4 different flu viruses. Get vaccinated now.

Other flu prevention tips include:

• Try to avoid close contact with sick people.
• While sick, limit contact with others as much as possible to keep from infecting them.
• If you are sick with flu-like illness, the CDC recommends staying home for at least 24 hours after your fever is gone except to get medical care for other necessities. Your fever should be gone for 24 hours without the use of fever-reducing medicine.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands with soap and water. If soap and water aren’t available, use an alcohol-based hand rub.
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

And only time will tell for sure, but some indicators lean toward a potentially severe influenza season.

Clinical experts in the U.S. watch the Southern Hemisphere of the world for signs of what might be in store for us in the north.

In Australia, where winter recently ended, the Department of Health reported the flu season arrived earlier than normal. Of special concern to the experts is the type of flu season seen in Australia – Influenza A (H3N2). H3N2 is a more dominant strain of the flu and causes more illnesses.

How effective the flu vaccine is depends on how well experts predict what strains of the flu will be circulating the globe that year.

“The vaccine strains are chosen about nine months before flu season, based on circulating strains from around the world by epidemiologists who are geniuses and do this for a living,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases.

Locally, the first case of flu (Flu B) was reported at Cook Children’s Medical Center two weeks ago. Last week, no one tested positive for either strain.

NBC News reports that one pediatric flu death has already been recorded in the U.S. – a 4 year old in California who had underlying health problems.

Jason Terk, M.D., a Cook Children’s pediatrician and a national expert on immunizations, adds his voice to other pediatricians and global health experts who say the flu vaccine remains the best way to prevent influenza.

“The great news about the vaccine is that even when it’s not always a perfect match for prevention, the flu vaccine can reduce the severity of the illness, even if you do catch the flu that season,” Dr. Terk said.

To make an appointment for your child’s flu shot, contact your Cook Children’s pediatrician. The vaccine is currently available in many offices and a second shipment will be delivered next week.

“It takes two weeks for the shot to become most effective. Because flu can hit as early as late October or early November, we recommend getting the flu shot as soon as possible and definitely before the end of October,” said Justin Smith, M.D., a Cook Children’s pediatrician.

More On This Topic:

• Flu Shot Appointments
• Influenza/Flu Information
• Let's Learn About ... The Flu
• How To Tell If It's Strep, Flu, Rotavirus Or Norovirus
• Comfort Menu to Ease Pain, Anxiety for Children Getting a Shot
• Is It a Cold or The Flu?
• Pediatricians Say Kids with Egg Allergies Should Now Get The Flu Shot

Halley Hogan, M.D., a pediatrician at Cook Children’s newest location in Prosper, Texas, took some time to answer our questions about what’s going around.

What kind of bugs are you seeing in your office right now?

We’re seeing cases of Influenza B, norovirus and group A strep.

Is the flu season still in full swing or are we nearing the end? 

We are begining to see flu activity throughout the state of Texas. Flu activity will likely remain high for several more weeks.

What should parents know about the difference between the flu, norovirus and rotavirus? 

Norovirus is the virus that causes the “stomach bug.” It causes vomiting and diarrhea and can affect anyone.

Rotavirus most often affects infants and young children. It can cause fever, watery diarrhea and vomiting. What we worry about most with rotavirus is infants/young children becoming dehydrated. It is recommended that children get the rotavirus vaccine at 2 months, 4 months, and 6 months of age. Vaccinated kids are less likely to get sick from rotavirus and can have less severe symptoms if they do get rotavirus.

Flu is caused by the influenza virus. Flu affects the respiratory system, and can cause fever, chills, cough, sore throat, runny/stuffy nose, body aches, headache, and fatigue.

With many schools back in session after spring break last week, what does that mean for these illnesses? Are kinds more at risk being in school?

Flu is spread when people with the virus talk, sneeze, or cough, sending flu droplets to the people close to them. It can also be spread by touching a surface that has flu virus on it and then touching your nose, mouth, or eyes. If you have the flu, you are contagious one day before symptoms start and up to 7 days after becoming sick.

Norovirus can also spread easily. Kids can get norovirus by sharing food or drinks with someone who is sick, or by touching surfaces contaminated with norovirus and then touching their mouths. You are most contagious with norovirus while you have vomiting/diarrhea, but you can still spread it for two weeks after you are better.

Many times, children with flu or norovirus return to school while they are still contagious and this increases the spread of these illnesses and can cause outbreaks in schools.

Are there any questions or concerns you’re hearing from parents?

Yes, parents often ask “How can we decrease the chances of siblings/other family members/friends getting the flu?”

The best way to decrease your risk of flu is getting the flu vaccine every year. It is recommended for everyone 6 months of age and older. Wash your hands often with soap and water or an alcohol-based hand rub. Try not to touch your eyes, nose, and mouth. Cover your nose and mouth with a tissue when you cough or sneeze, and wash your hands after.

Meet Halley Hogan, M.D., Prosper Trail's Pediatrician

 

Dr. Hogan was raised in the Dallas area. After earning a Bachelor of Science degree in biochemistry from SMU, she attended the University of Texas Medical Branch in Galveston for her medical degree. She then completed her pediatric residency at University of Texas Southwestern in Austin. Dr. Hogan is board certified by the American Board of Pediatrics and a fellow of the American Academy of Pediatrics.

Dr. Hogan provides comprehensive health care to children of all ages. She has a passion for pediatrics and loves getting to know families, with the philosophy that providing the best primary care depends on developing personal relationships with her patients and their families. She has a special interest in preventative medicine and promoting healthy, happy childhoods for all children. Outside of work, she enjoys spending time with her husband and their two young sons, as well as reading and traveling. Make an appointment with Dr. Hogan here. 

Flu A usually arrives prior to the B strain and is usually more severe than Flu B.

Of the 1,141 children tested last week, 484 tested positive for Flu A, 165 had RSV and none had Flu B.

The good news is that this flu season is currently lower than in previous years.

By this date in 2014-2015, more than 2,100 kids had tested positive at the medical center. By the end of last season, there were more than 3,000 kids who had tested positive.

To date this season, there have been a total of 1,395 positive tests.

Morgan Pence, Ph.D., a clinical microbiologist at Cook Children’s, says we are most likely to have a flu season similar to 2014-2015.

“It’s not clear if this flu season has peaked, but if it hasn’t yet, my guess is that it will peak in the next week or two,” Pence said.

Although the numbers are a bit lower than previously, Cook Children’s pediatricians are prepared to be busy over the next couple of weeks once the holiday break is over and kids return back to the classroom to share their germs with one another.

“We typically see an uptick in flu A a couple of weeks after kids go back to school following the winter break,” said Jason Terk, M.D., a pediatrician at Cook Children’s in Keller.

Dr. Terk stresses that the lower numbers right now may not mean an increase in flu cases in the near future.

"This isn't a guarantee that the total numbers will be lower," Dr. Terk said. "We could still have a later arriving season than we've had in the past and right now we don't know how long the season will last."

Flu Prevention Tips

Along with the vaccine and flu antiviral drugs if prescribed by a doctor, the CDC recommends these everyday preventive actions to stop the spread of germs:

• Try to avoid close contact with sick people.
• While sick, limit contact with others as much as possible to keep from infecting them.
• If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone for 24 hours without the use of a fever-reducing medicine.)
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

“It’s important for people to take care of themselves and others to prevent the spread of the flu as much as possible,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Disease. “The flu vaccine continues to be recommended for everyone 6 months of age and older. Make sure to practice washing your hands and please keep your children home if they are sick.”

RSV has arrived at Cook Children's.

Last week, 178 kids tested positive for RSV, compared to only two who tested positive for Influenza A.

RSV is a virus. It’s short for respiratory syncytial virus. It causes a disease in young children (especially those less than 2 years) called bronchiolitis. The RSV season usually begins around mid-August and runs through March.

Bronchiolitis is a disease of the lower respiratory tract which causes children to wheeze. They are wheezy because their small airways have swelling and junk (mucous and cells from the lining of the airway) in them.

The smaller airways are similar to the area where a child with asthma has issues (which is why they wheeze). The difference is that children with asthma have a squeezing down of the walls of the airway (which is what a breathing treatment reverses). This is why breathing treatments in children with bronchiolitis usually don’t work.

Bronchiolitis is not just caused by RSV. There is a long list of viruses that can cause the same symptoms:

• RSV
• Rhinovirus (usually a cause of the common cold)
• Parainfluenza
• Human metapneumovirus
• Influenza (Flu)
• Coronavirus
• Human bocavirus
• Human polyomavirus

Here are some answers to the most common questions I hear from parents:

What are the symptoms of bronchiolitis?

Typically the child starts with runny nose and cough. This will progressively worsen over a few days and possibly develop into difficulty breathing and difficulty with eating. The symptoms typically last a total of about 5-7 days with the worst day being the day in the middle. It is not uncommon for the cough and runny nose from bronchiolitis to last 2-3 weeks.

How do we treat bronchiolitis?

In most children, treatment is done at home and consists of sucking snot (click here for more advice on this) and counting wet diapers. This isn’t very fancy but, unfortunately, until someone invents TamiRSV we don’t have anything more specific. As far as wet diapers go…I am looking for a wet diaper about every 6 hours.

Who goes to the hospital?

Getting admitted for bronchiolitis is usually based on: dehydration, severe difficulty breathing or low oxygen levels.

Children who can’t eat because they are breathing fast and are puking because of all the mucous draining into their belly are at risk for dehydration. Unfortunately, the only way to fix this is to put them in the hospital for intravenous (IV) fluids until they are able to drink better.

A child who is having severe difficulty breathing also needs to be observed in the hospital. Unfortunately, babies with severe bronchiolitis can get tired from all the heavy breathing they are doing and this can progress to needing ICU care. It is best to have those babies who are breathing that hard in the hospital so that they can be monitored closely by people who know what they are looking for…

Babies with bronchiolitis often need extra help keeping their oxygen level up by getting extra oxygen. We monitor these babies closely and I put them on oxygen for severe difficulty breathing or if their oxygen level is less than 90 percent.

Summary

1. Bronchiolitis stinks, it makes kids sick and I don’t have much to offer.
2. Whether it’s RSV or not often doesn’t matter.
3. Watch for difficulty breathing and decreased wet diapers.

For more information on bronchiolitis and RSV, read this post from one of our hospitalists.

Lots of RSV. Last week of the 422 kids tested at Cook Children's, 137 had RSV and six had Flu A. 

So there's probably lots of coughing at your house as you prepare for your Thanksgiving travels. But keep this in mind: Coughing is good. GOOD! Here's why:

1. We need it! Coughing helps us to perform the "clean-up" process with each and every cold. If you don't cough, the mucus gets in the chest, and that's how pneumonia happens. So...most of the time, cough is Ok! And you can expect it for at least 7-10 days with colds.

2. Sometimes if kids have a hard cough, they gag and puke. While this is scary, it's OK and sometimes a normal part of the process. Always let us know if this seems to be worsening/happening more often though. Or if your kiddo has a new fever with it, or seems more fatigued.

3. Coughing with viral illnesses (colds) tends to happen more at night and first thing in the morning. This has to do with the physics of the postnasal drip when we lay down, and in the mornings we do a lot of hacking to clean up all the sludge that settled in the airways overnight.

4. Sometimes, people worry about "feeling the cough in the chest". This is often due to how air rolls over mucus in the nose and tree trunks that go to the lungs (bronchi) and doesn't necessarily mean anything is wrong. If your kiddo is happy and playful and otherwise well, let it be.

5. Don't be frustrated if your kiddo coughs up some wet stuff, and then swallows it. People try really hard to get their kids to spit it out - it's OK if they don't. We cough, swallow that mucus, and then poop it out. This is why many people get looser stools with colds (adults and kids). 

Cook Children's medical staff saw its own cluster of patients in 2016 and has seen sporadic cases since then, as have other hospitals across the nation.

Acute flaccid myelitis (AFM) presents similar to polio in that it causes an abrupt onset of limb weakness an decreased muscle tone, which can have associated problems with urination and, in the worst cases, cause respiratory failure if the muscles involved in the breathing become weak.

“This is a very rare illness and we’re still not sure what causes AFM,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “It is mostly like caused by a virus or a genetic disorder. At this point, we must treat each child on a case-by-case basis, but the earlier a diagnosis is made, the quicker a plan of action can take place.”

The Centers for Disease Control and Prevention (CDC) says most patients will have a sudden onset of limb weakness and loss of muscle tone and reflexes. Some patients will also experience:

• Facial droop/weakness
• Difficulty moving the eyes
• Drooping eyelids
• Difficulty with swallowing or slurred speech

If you notice any of these symptoms, please notify your doctor immediately. Through thorough testing of the nervous system, doctors will be able to diagnose AFM.

The CDC recommends the following as means of prevention:

• Up to date on all recommended vaccinations, including the poliovirus.
• Protect yourself from mosquito-borne viruses such as West Nile by using mosquito repellent and staying indoors at dusk and dawn.
• Remove standing or stagnant water from properties to minimize the number of mosquitoes in your area.
• Wash hands with soap and water.
• Avoid close contact with sick people.
• Clean surfaces with a disinfectant, especially those that a sick person has touched.

Two children tested positive for the Influenza A virus from the week of Sept. 16 through Sept. 22, 2018, according to Laboratory results from Cook Children's.

For the week, 85 children were tested for the flu, with 83 tests coming back negative. Interestingly, the first case of the flu was confirmed during the same (Sept. 21) in 2017.

The goods news is that flu vaccines are available at our Cook Children’s pediatrician's offices now.

Getting the flu vaccine is one of the most important things you can do for your child this time of year. Yes, hand washing and avoiding ill contacts are good ideas but that’s not going to be what ultimately protects your child from flu.

No one likes getting a flu shot, kids and parents included, but it’s essential to your child’s health. Here are 5 important facts about the flu shot you should know:

1. Get your child the shot. The American Academy of Pediatrics is recommending flu shots for every child over 6 months of age. Children and elderly adults are the most at risk for serious illness, hospitalization and death from the flu. Children under 2 and those with chronic medical conditions are at higher risk, but healthy children are hospitalized and die from the flu every year!
2. Get your own flu shot. Getting yourself protected helps to prevent the spread of flu in your house. It will decrease the risk of you contracting it, even if someone in your house gets it … and taking care of sick kids while you are sick is one of the hardest things I’ve ever done as a parent. If you have a child under 6 months with whom you have frequent contact (who cannot receive the vaccination) it is extremely important.
3. Ignore any early data about the effectiveness of the flu vaccine. Last year, early data about flu vaccine effectiveness caused many to skip their shot. But, at the end of the year, protection rates ended up being average (and any protection is better than none). Just get it done.
4. Choose the injectable vaccine. Nasal flu vaccines will be available again at some offices this year. However, based on past years, I am strongly recommending that patients get the injectable vaccine. After giving nasal flu vaccine for years before studies showed it wasn’t working, I’m not taking that risk with my children or my patients until we know more about how it’s working over the next few years.
5. Go ahead and get your child scheduled. Pediatric studies have not shown a decrease in effectiveness during a flu season because of getting the shot done early. Getting the vaccine at least 2 weeks before the season starts is critical to making sure they are protected and we never know what vaccine supplies will be when the season hits.

All About the Flu

• Influenza (flu)
• Is it a cold or the flu?
• Is the flu vaccine a good idea for your family?
• Frequently asked questions about immunizations
• How can I comfort my baby during shots?
• Immunization schedule
• Is the Flu vaccine a good idea for your family?
• Your child's immunizations: influenza vaccine

Doctors agree that nothing fights off the flu better than the vaccine, including all children 6 months and older.

And thanks to  recommendations, based on research, that includes children who are allergic to eggs.

A study by the Centers for Disease Control and Prevention (CDC) found the rate of anaphylaxis after all vaccines is 1.31 per one million doses given.

Based on guidelines from the CDC and the American Academy of Pediatrics, people with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving a flu vaccine. It is now recommended that people with a history of severe allergic reaction to egg (any symptom other than hives) can now be vaccinated in an inpatient or outpatient medical setting, under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.

"All children with egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for all vaccines," the AAP wrote in the September 2018 edition of Pediatrics as part of its "Recommendations for Prevention and Control of Influenza in Children, 2018-2019."

Backing up the AAP and CDC, is new research in the Annals of Allergy, Asthma and Immunology, which found the flu shot to be safe and recommended its use for people who are allergic to eggs.

Jason Terk, M.D., a Cook Children’s pediatrician, said previous recommendations on egg-allergic individuals not receiving a flu vaccine were based on the fact that most of the flu vaccine currently available is created from viral cultures in chicken embryos. Experts theorized there was a risk because of the concern that small amounts of the egg that the viral cultures come from could end up in the vaccine.

“After years of study and observation, it was found that no significant increased risk for reactions occur in egg-allergic people,” Dr. Terk said. “The recommendation to avoid flu vaccine for egg-allergic people has been removed. No medical intervention is without risk. But the risk of influenza and the complications arising from it far exceed the infinitesimal risk of influenza vaccination.”

If you have concerns, Dr. Terk said your pediatrician should be happy to answer questions about your child and why the flu vaccination should be given.

You probably did, but hopefully that didn't prevent you from getting your child's flu vaccine.

New data from the CDC suggest that the vaccine was 50 percent effective for pediatric illness, which is actually a fair year. We’ve had better. We’ve had worse. But it's definitely way better than the 10-30 percent estimates that were being thrown around earlier this year.

In previous years, data have shown that nearly two-thirds of pediatric deaths have occurred in children who were not vaccinated. This data is even more significant as three-fourths of pediatric deaths have occurred in children who were not completely immunized (either no vaccines or only one vaccine in a baby who needs 2 for full protection).

Only 54 percent of children who died of flu had a condition that characterized them as high risk. This means that they were older, healthy kids who got the flu and died.

Is the flu shot perfect? No. Do I wish it were better? Yes.

But do any of these reasons for not getting one hold up?

"It doesn't sound like it's going to work very well this year anyway.""My kid's healthy, so I don't think they really need one.""We stay really careful to avoid others who are sick so we'll be good."

Nope. Nope. And, unless you live in a bunker from October to March: Nope!

It's actually still not too late. You can get protection from this year that will help and there is mounting evidence in adults that getting flu vaccines year over year may provide more protection than just for that season. We're still waiting on that evidence in kids, but logic says it could still apply.

The Fort Worth Urgent Care Center staff is seeing volumes in the 300s on a regular basis. Mansfield and Alliance UCC locations are seeing in the hundreds with the Southlake location seeing 60 to 90 patients regularly. Each site is seeing an increased volume, which is typical for the flu season. 

With that many children visiting the Urgent Care Centers, not all children are tested for the flu during their time at the Urgent Care Center.

So why are some children tested and some not being tested? There are a variety of medically sound reasons:

Currently, there is a national shortage on flu tests and stock is on backorder. The flu testing stock at each clinic is all the staff has left at this time.

The staff follows the Centers for Disease Control and Prevention and American Academy of Pediatrics recommendations on testing and treatment of the flu which is the following:

Children less than 2 years of age, should be treated for influenza. Additionally, any child at high risk from complications from the flu should be treated. Children with any of the following medical conditions are at high risk of complications such as pneumonia, central nervous system complications, exacerbation of chronic pulmonary diseases, and carditis.

a. Asthma

b. Neurological and neurodevelopmental conditions

c. Chronic lung disease

d. Heart disease

e. Blood disorders

f. Endocrine disorders

g. Kidney disorders

h. Liver disorders

i. Metabolic disorders

j. Weakened immune system due to disease or medication

k. Children who are receiving long-term aspirin therapy

“We have a finite number of flu tests and a finite amount of Oseltamivir which is the drug of choice for flu treatment,” said Parul Martin, M.D., medical director of Urgent Care Services. “As a result, the provider will determine if your patient has the flu by clinical criteria alone such as history and exam more often than a flu test. Additionally, the flu test is not always accurate. For example, I have had patients have flu exposure and flu symptoms, and have a negative flu test.”

If your child is healthy without the above listed medical conditions, the flu is self-limiting and does not require treatment. Bring your child in if he or she is having breathing difficulty, is not eating and drinking and is not urinating normally, looks sick when they do not have a fever or their fever has lasted longer than three to five days.

The best treatment for a healthy child that has the flu is not prescription medicines, but rather good old fashion TLC: rest, fluids, over the counter cough and cold medicines and Ibuprofen or Acetaminophen for the body aches, sore throat and headaches. Over the counter cough and cold medicines are only recommended for children 6 years of age and over.

“There’s a myth out in the community that fever will cause brain damage. This is not true,” Dr. Martin said. “Fever is our best friend and is the body’s natural defense mechanism. Allow the body to heal itself when your child has the fever. Do not treat the fever but rather treat the symptoms such as headache, decreased appetite or discomfort. Allow the fever to help fight the infection.”

For more information:

• Influenza/Flu Information

• Your child tested positive for the flu. But does she really have it?

• Guide for considering influenza testing when influenza viruses are circulating in the community

• Let’s Learn About Tamiflu

• 7 Facts To Help Parents Feel Less Scared About the Flu

Are you panicked about the flu? How do you know if your kid is getting worse? What about all these kids getting really sick, even dying?

Here's what I've been saying all day, every day in my office this week.

1. Healthy kids who get sick from the flu get really bad because they get dehydrated. Push fluids. If they don't want to eat, that's OK. But they have to drink. Monitor urine output. Kids should pee about every 6 hours. If they aren't, they need to be checked out.

2. Healthy kids also get sick from the flu because of respiratory complications. Monitor for signs of difficulty breathing, especially fast breathing or signs that they are working hard to breathe. Look under their ribs, is it sucking in and out heavily? If so, they need to be checked out.

3. Look out for kids whose fever gets better and then comes back. Many times parents write off those symptoms as just a little left over from the flu but they could be a sign of a secondary infection. Ear infections, sinus infections and pneumonia often frequently follow the flu. Once the flu is over and the kid is getting back to normal, they shouldn't come back.

4. Kids with chronic medical conditions should be watched closely for worsening of their condition. Asthmatics should be watched closely for breathing. Diabetics should have their sugars watched, etc.

The Urgent Care Centers at Cook Children’s are seeing more kiddos day in and day out than our Emergency Department (nearly double). The Fort Worth Urgent Care alone is seeing almost as many kids per hour than the ED on any given day.

Flu testing will be driven by the incredible experience of our Urgent Care providers. They are giving flu tests as needed, and they know best what flu looks like in North Texas and have the best skillset to determine appropriate treatment and testing. Click here to learn more about why your child may not be tested for the flu at one of our Urgent Care Centers.

While I think it's important you know how bad the flu can be, I'd like to give you a few quick facts and tips to make you hopefully feel better educated about it, and feel less scared.

1. The flu happens every year. It hits hard from December through March (and other months, but those primarily). There are deaths every year. Kids, healthy people, old people, babies, and folks with chronic illness die every year. We aren't sure if the rate of death is higher this year compared to years past. It may not be. But the media is certainly paying a lot of attention to it right now. Maybe that's both a good and a bad thing.

Remember that the flu is usually a "mild" illness (I mean, you feel like you've been hit by a truck, but we call that "mild" in medicine, ha).

It hits fast and fevers can go high, which is worrisome, but with a lot of rest, fluids, pain and fever reducers, things usually get better after 3-5 days. The cough and congestion can last for 2 weeks.

2. Scared to vaccinate? Hear stories? Hate shots? Have an uncle who loves to talk up a good conspiracy theory? Know this: you can still get the flu even if you get the vaccine.

BUT: it's usually milder, if you do get it. Studies have shown that the people (and children) who get very sick (think hospital, think death) are those who are largely unvaccinated.

"This study, which looked at data from four flu seasons between 2010 and 2014, found that flu vaccination reduced the risk of flu-associated death by half (51 percent) among children with underlying high-risk medical conditions and by nearly two-thirds (65 percent) among healthy children."

Get your kids vaccinated. It's not too late.

3. You are contagious with the flu 1-2 days BEFORE you start showing symptoms. How sneaky is that?

4. You are contagious 5-7 days after you start to show symptoms. Your KIDS can be contagious up to 10 DAYS after they start to show symptoms.

5. You should keep your kids out of school for at LEAST 24 hours after their last fever. This means fever without the use of meds to keep it down. If it's financially feasible for you, I'd even try to keep your kids out at least 7 days after the first symptoms start.

6. Call us (or your pediatrician) anytime if you're worried about the flu. We can walk you through what is normal and what isn't.

7. These are the reasons to worry:

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

Flu-like symptoms that improve but then return with fever and worse cough

Tamiflu can help make it less severe sometimes, for some people. I wrote another post about who needs it, when, and why. Click here to read it.

I know this is long, but I think the more education you get about it, the more prepared you feel, right?

And remember - WASH YOUR HANDS! The flu can live on some surfaces up to 24 hours in cold weather! Think about all those door handles you touch! The cash you get handed back from the cashier! The snot that flies from every person's sneeze can cover a 6 foot radius around them!

Wash. Those. Hands!

Hugs! Dr. Diane

Once school was back from the Christmas break, kids returned to share their germs with one another. To make things worse, the brutally cold weather when they got back ensured that everyone stayed in an enclosed environment. All a perfect storm to see our flu numbers climb higher.

“We typically see an uptick in flu a couple of weeks after kids go back to school following the winter break,” said Jason Terk, M.D., a pediatrician at Cook Children’s in Keller. “Right now, we are seeing an increase in Flu B, but still see plenty of Flu A cases. Our patient volumes are still very high.”

Last week, 403 flu cases were confirmed at Cook Children’s, up from 345 the week prior. What makes this week different is the amount of Flu B cases seen. Last week saw 104 confirmed Flu B cases, up from 60 a week earlier.

“It’s expected that Flu B will follow or peak after Flu A, but it’s still earlier than expected this season,” said Morgan A. Pence, Ph.D., clinical microbiologist at Cook Children’s. “This is the earliest we’ve seen Flu B in the last four flu seasons and it looks like Flu A and B are overlapping more this year than in the past.”

The good news is that Flu B is usually less severe than Flu A. The bad news is it means a continuation of a flu season that is already looking to be the worst since the 2014-2015 season. The Centers for Disease Control and Prevention reports the death of 30 children nationally as a result of the flu.The CDC stated that all U.S. States except Hawaii have reported widespread flu activity.

“It’s important for people to take care of themselves and others to prevent the spread of the flu as much as possible,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Disease. “The flu vaccine continues to be recommended for everyone 6 months of age and older. Make sure to practice washing your hands and please keep your children home if they are sick.”

These visits are most commonly a secondary infection with the flu and RSV.

“Actually, pneumonia has been what kills many people with the flu,” Audrey Rogers, M.D., a pediatrician at Forest Park, said. “The flu weakens your immune system and allows the bacteria to take hold and cause an infection in the air sacks of the lungs. That is what a classic bacterial pneumonia causes.”

Viruses cause inflammation of the air tubes more than the air sacks. But the bacteria cause a lot of damage and if it destroys enough of the air sacks it can be fatal. If your immune system is already weak it can be much worse. Infants, the elderly and immunosuppressed people are especially at risk if they have pneumonia. Classic pneumonia is usually diagnosed with a chest X-ray.

To learn more about this topic read:

Daughter's Pneumonia Gives Physician New Perspective as a Patient's Dad

“Our surveillance has indicated increased flu activity in recent weeks, and we anticipate high activity for the next several weeks,” says Juan Rodriguez, DCPH Assistant Director and Chief Epidemiologist. “It is important for residents to be proactive in practicing prevention through receiving the flu vaccine and taking action to prevent the spread of disease.”

DCPH recommends a three-pronged approach to fighting the flu:

1. Get vaccinated. The best way to protect yourself and your family from the flu is to get an annual flu shot, and the flu vaccination is recommended for everyone 6 months and older.

2. Remember that antiviral medications are a second-line defense against the flu. If you are experiencing fever, runny or stuffy nose, sore throat, cough, muscle aches and headaches, visit your doctor immediately, and take antivirals if prescribed. These remedies can help you recover quicker, and can potentially prevent you from being hospitalized with flu complications.

3. Take everyday preventive actions to help stop the spread of germs. Cover your cough and sneeze, avoid people experiencing flu symptoms, stay home when you feel sick and wash your hands often. These steps will help prevent respiratory viruses, including influenza, respiratory syncytial virus (RSV) and rhinovirus.

Corwin Warmink, M.D., medical director of Emergency Services at Cook Children’s, reminds parents if your child is sick or has a fever, to wait 24 hours before sending the child back to school. “It’s important to minimize contact with others, especially in close quarters,” Dr. Warmink said.

At Cook Children’s, the number of children who have tested positive for the flu has gone down over the past two weeks. Last week, 283 children tested positive for the flu. Two weeks ago, 429 tested positive.

All unvaccinated residents over six months of age are strongly encouraged to be immunized for the flu.

“We want to remind residents that it is not too late to get the flu vaccine,” stated Dr. Matt Richardson, Director of Public Health. “Getting vaccinated today will help protect families throughout the remainder of the season.”

DCPH reminds residents that getting vaccinated is a community effort that not only protects yourself, but also those at highest risk for flu complications, including:

• Pregnant women and women up to two weeks postpartum
• Children younger than 5
• Adults 65 years of age and older
• People living in long-term care facilities
• American Indians and Alaskan Natives
• People with chronic health conditions

For more information:

• Why Your Family Should (Still) Get a Flu Shot
• When Is The Flu an Emergency?
• 6 Tips To Help Your Child Get Through The Flu

“Should I even bother getting the vaccine,” I get asked.

“Yes. You should definitely still get your child’s flu vaccine.”

Here’s why.

Is it going to be a bad flu season?

Widespread influenza activity is present in 46 states, including Texas. Hospitalizations for influenza associated illness are on the rise, with nearly 4,000 reported. Children under 5 (as well as adults over 65) appear to be at the highest risk for hospitalization.

As of December 29, there were 13 pediatric deaths associated with influenza in the U.S. And it wasn’t just little babies either, six of those deaths occurred in children over 5 years of age. Only two of those children were known to have high risk conditions, which means that many of the deaths occurred in healthy children. 

One of the major concerns, regarding the severity of the season, is that much of the circulating Influenza A virus is of the type H3N2. In previous years where H3N2 has been common, we have seen increased numbers of cases and more severe disease. Last week, more than 237 children tested positive for Flu A at Cook Children’s. Two weeks ago, 380 kids tested positive for Flu by our lab.

Is the flu vaccine coverage going to be terrible?

Scientists often use the previous flu season from Australia to predict what type of flu season and vaccine effectiveness we are going to have. You might have heard early reports that suggested that this year’s vaccine might only have 10 percent effectiveness. But, the important point to remember is that meager 10 percent only reflected activity against H3N2 and truly predicting which strain will be most common is tricky.

Another important factor to consider is that flu activity is regional. Influenza A activity nationwide is showing H3N2 activity at 7,012 out of 7,754 overall cases, or 90 percent. But, in region 6 (of which Texas is a part), H3N2 was present in 466 of 589 or 80 percent of Influenza A cases. Still not great, but there’s plenty of vaccine preventable flu out there.

So, will the vaccine coverage be terrible? Maybe, but we won’t know for sure until the end of the year and I believe there is evidence to suggest that it will be better than the 10 percent estimates we were reporting earlier in the year.

Should I still get my child’s flu vaccine?

Flu vaccine is an important part of protecting our children from this terrible disease.

Your child will almost certainly be exposed to the flu this year, and probably multiple times. Flu causes serious illness, even death. Even if the coverage was only 10 percent (and I think it will be better), I would still recommend it. Flu vaccine has been proven, even in bad years, to prevent flu-associated death in pediatric patients.

Flu vaccine cannot cause flu. It is an injectable, killed virus which cannot cause infection. Side effects might include soreness at the injection site, low grade fever and mild body aches.

You still have time. We expect flu activity to be increasing over the next few weeks, possibly even into mid to late February. Once you get the vaccine, it takes about two weeks before your protection is up and going.

So, call and get the vaccine today…for you and your children.

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

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

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

Normal signs of the flu include:

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

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

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

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

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

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

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

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

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

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

UCC hours are the following:

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

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

Click here to see the story. 

Last week, 1,118 patients were tested for the flu at Cook Children’s and 429 tested positive (380 for Flu A and another 49 for Flu B).

Get your flu shot (go ahead, it’s not too late), wash your hands, say a prayer…all the things you should do to prevent you and your family from getting the flu. The flu season is in full force and you’ll want to protect your family as much as possible.

Unfortunately, despite all your efforts… you still might get the flu.

So, now what?

Here are 6 tips for helping your child get through the flu:

1. Push fluids, fluids, fluids. Healthy kids with flu often get sick and worsen because they get dehydrated. Kids with the flu should have something to drink beside them constantly. Water, Gatorade and Pedialyte are all good options. Watch to see how much they are peeing. They should pee at least every six hours.

2. Treat your child with a fever reducer. Using acetaminophen or ibuprofen can help with not only fever, but also the headache and body aches that come with the flu. Remember the goal is not dropping the number of the temperature, but making your child feel better.

3. Allow your child to rest as much as possible. This is not a time for strict adherence to screen time guidelines. Resting and taking it easy is a big part of getting through the flu.

4. Use a humidifier or steamy bathroom. Steam can help to loosen up the congestion and help your child breathe, it can also help with their cough.

5. If your kids are over 1, given them honey to help coat their throat and prevent coughing.

6. Follow your child’s chronic condition. Children with asthma should be watched closely for signs of wheezing and difficulty breathing. Children with diabetes should have their sugars monitored closely. Children with chronic conditions are more likely to need Tamiflu so call your doctor at the first sign of symptoms if you suspect flu.

I hope you all have a healthy and happy 2018 but when you do have problems, call your Cook Children’s pediatrician. We’re always here to help!