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 

Cook Children’s Medical Center – Fort Worth continues to see more than 900 positive influenza A cases, a record high compared with previous years. 

More than 1,900 patients were tested for influenza A, B, and RSV during the week of Feb. 2 - 8. At Cook Children's Medical Center at Prosper, 310 patients have been tested for influenza A with 41.9% testing positive.

While data shows a slight decline, the positivity rate for influenza A remains at 47%. On Feb. 11, Cook Children's Emergency Department in Fort Worth saw 410 patients. The department's average daily patient volume is 379.

Cook Children’s encourages families to take precautions, as flu cases remain high.

Flu and Respiratory Illness Prevention Tips:

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

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 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.

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)

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

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.”

With the upcoming season, now is the time to get your child’s flu vaccines.

Only flu shots will be given this year to protect kids from becoming sick. This is due to recommendations from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) after last year’s FluMist was found to have failed against certain strains of the flu.

But parent’s shouldn’t worry, Cook Children’s has increased its doses of the Quadrivalent Influenza Vaccine (flu shot) for its primary care offices.

“Even in bad years, the flu vaccine continues to provide the best layer of protection against this deadly disease,” said Justin Smith, M.D., a Cook Children’s pediatrician. “Last year’s injectable flu vaccine was 50 percent effective in preventing disease which means thousands of people were protected.”

The AAP recommends children ages 6 months and older be immunized against influenza every year. Previously, the CDC and AAP had recommended either form of flu vaccine – the inactivated influenza vaccine (IIV) that is given by injection and is approved for all patients older than 6 months, or LAIV which is given by intranasal spray and was approved for healthy patients ages 2 through 49 years. But that is no longer the case. Only the injection is recommended.

To find a Cook Children's pediatrican in your area, click here.