Written by Marc Mazade, M.D., MPH, medical director of Infection Control and Prevention at Cook Children's

My high school basketball coach insisted that we get a flu vaccine every year. He knew that flu is much more than just a cold.

Flu is like getting hit by a train. He knew that recovery could take a couple of weeks.

Flu vaccines might make you feel bad for a day, but feeling bad is a sign that our immune systems are working. That’s much better than getting knocked out of the game, missing a week of band competition, missing the big trip, or staying in bed while others exchange holiday gifts and treats.

Flu season can run from November to May, so getting the flu vaccine in fall provides the longest protection from flu.

During the last flu season, nearly 6,000 kids came to the emergency department and nearly 600 kids were hospitalized with flu at Cook Children’s Medical Center in Fort Worth (some would say an average season).

Keeping folks out of the hospital is the main benefit of getting a flu vaccine, but not the only one. Because flu is passed between friends at school then spreads to family members, immunizing kids is key to controlling flu outbreaks.

Closing hard-hit schools worsens hospital staff shortages as working parents must take off work to be with their kids, even when their kids aren’t sick. That can mean longer waiting times for patients and more shifts for exhausted health care workers.

In 2025, the seasonal flu story got more interesting. An escape virus erupted onto the scene like a flash fire!

Scientists found that “Subclade K” is a strain of influenza A (H3N2) that binds better to the membranes in our noses and is less sensitive to some antibodies (stuff that Infectious Diseases doctors love to chat about).¹ Improved viral fitness means that chances are good that this escape virus will keep coming back until it is knocked off by a more fit flu strain.

A big question last year was, “How effective are influenza vaccines going to be against the escape virus?”

Thankfully, vaccine protection against hospitalization was pretty good, even among adults. But something extraordinary happened in kids who took the vaccine. While the vaccine protected adults against mild, moderate and severe flu only 32-39% of the time, kids were protected 70-79% of the time.

It seems that children get more “bang for the buck” from influenza vaccine than adults. Also, for those who were not exposed to flu last year, this year’s influenza vaccines provide better protection against the escape virus.

My coach made sure we got our flu shots because he didn’t want us watching from the sidelines. Years later, the science supports that same advice. Children receive remarkable protection from influenza vaccination, helping them avoid serious illness, stay out of the hospital and remain where they belong: in school, with their friends and families, and in the game.

¹Al-Natour, L.M. 16 June 2026. Emerging Influenza A (H3N2) Subclade K: A narrative review. Natural Resources for Human Health, 6(3s). Pages 678-687. https://nrfhh.com/index.php/journal/article/view/522

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 

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.

“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 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.

Some estimate that children will have 8-12 upper respiratory infections (coughs and colds) per year. Because many of those will be clustered in the winter and viral respiratory infections can last 1-2 weeks, it’s possible your child might seem to be sick “all winter long.”

Anytime a child seems to be sick off and on for months at a time, people will search for answers. Anytime people search for answers, they will start to make connections where connections don’t really exist…

So, now it’s time for: Winter Weather Health Myths

Myth No. 1 - Feed a cold and starve a fever.

I don’t care if you decide to feed a cold. If a child is hungry and not vomiting, let them eat but starving a fever doesn’t make sense. Besides, the major thing is that you need to monitor a child’s drinking when they are sick more than their eating. Dehydration is frequently what causes a child with a cold or flu to get sicker and require medical attention. You should encourage (“force”) your child to drink small, frequent sips of whatever fluid they will drink. Pedialyte or Gatorade are good options but milk is fine too (yes, even with fever).

Myth No. 2 – It’s been too cold for my child to exercise.

Maybe, for like two weeks in late January, it’s too cold for your child to exercise OUTSIDE. Otherwise, buy you and your child a sweatshirt and go for a walk. During those two weeks, you can walk circles around the house together or just do some lunges or something. Even 10 minutes a day is better than zero.

Myth No. 3 – Going outside to the cold (wet head or not) will make your child sick.

Cold weather and getting cold doesn’t actually make you sick. Getting sick is the result of being exposed to an infection that makes you sick not by getting cold. We think that viruses tend to increase in activity during winter due to the fact that people are more likely to be crowded inside.

Myth No. 4 – Taking Vitamin C (or a multivitamin or Zinc or essential oils) will protect your child from colds and flu.

The supplement industry has become big business for both adults and children as people look for anything to prevent illness. Unfortunately, study after study show that they simply don’t work. Essential oils are one of the latest to promote the ability to “boost” the immune system but studies are still lacking to show benefit in children. For now, our best bets are simple things like washing hands, covering coughs and getting the flu vaccine (I know it’s not perfect but at least it’s something).

Myth No. 5 – If you don’t like the weather in Texas, wait 5 minutes.

While not technically a myth, because weather can change fast in Texas. Good evidence is the last week. But, we’re not alone. Most of the United States believes that the phrase “If you don’t like the weather in ____, wait 5 minutes” applies to their state. A Google search ranking for this phrase puts Texas at number 8 on the states where this phrase was searched for (behind Massachusetts, New York, Georgia, Pennsylvania, Maine, South Carolina and North Carolina).

Don’t buy into the winter weather myths. Here are some tips for preventing winter weather 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).

Are we there yet? “No. 5 more minutes.”

Are we there yet? “No. I will tell you when we get there!”

Did anyone hear this or something like it last week?

We’ve been asking a similar question to our favorite Cook Children’s microbiologist, Morgan Pence, Ph.D.

Is it here yet? No.

Flu season should be just around the corner, but it’s not here yet. Currently, there are only two regions showing Influenza activity across the state of Texas. Tarrant County is not one of those regions.

Flu season usually starts sometime in late October or November but occasionally we have later seasons. It appears that we are going to (knock on wood) make it till December before we see our first case at Cook Children’s this year.

There are few theories about why flu follows a seasonal pattern:

1.As weather gets colder and people are trapped indoors, the virus can more easily spread from person to person.

2.Colder temperatures lead to drier air. Dry air causes our noses to be drier which may make their defense against flu weaker.

3.Cold temperatures may allow the flu virus to live longer on surfaces.

Based on these theories, it’s possible that our warmer fall has caused a delay in the onset of flu season. With the colder temperatures last week, we may be reporting our first case soon.

Dr. Pence reports that our lab tested 74 specimens last week but none were positive for flu. She states, “Currently we are mostly seeing children with rhinovirus and RSV.” Rhinovirus causes the common cold. RSV can cause cold-like symptoms as well, but can be more severe in babies, especially those who were born premature.

What does this mean for you and your child?

1.If you haven’t yet, there’s still time to get your flu shot. (Even if the year starts late, it could still be a bad one).

2.Continue to teach your children to cover coughs and to wash hands.

3.Be aware if your child tests positive with a rapid flu screen, it may not be correct until flu activity is higher.

For now, Dr. Pence will still have to play the role of lab-mom.

Is it here yet? “No.”

Is it here yet? “No, probably 2-3 more weeks.”

Is it here yet? “No, but you’ll be the first to know!”

The short answer is yes because your child is still more protected than without one.

Donald Murphey,M.D., medical director of Infectious Disease at Cook Children’s, was on a conference call with the CDC the morning of Thursday, Dec. 4, to discuss the advisory.

The dominant influenza strains at present in the US are influenza A, H3. There are two of these strains present this year:

• One is a good match for the vaccine currently in use.
• The second, accounting for about half of the samples tested, is a new flu A, H3 strain that was not seen until March 2014.

This new strain is not included in the current vaccine, but Dr. Murphey says it will likely be included in the vaccine for next year.

“This strain has drifted from other similar strains seen in the last few years. This new flu A could be associated with more severe influenza cases, and a more severe flu season in general, Dr. Murphey said.

But he stresses that parents and their children should still get a flu shot.

The CDC recommends:

• Treatment with antivirals for influenza more emphatically this season in hopes of preventing severe disease, hospitalization and death. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu in your body. Antiviral drugs are not sold over-the-counter. You can only get them if you have a prescription from your doctor or health care provider. Antiviral drugs are different from antibiotics, which fight against bacterial infections.

• Staying home if you have flu-like symptoms.

• Cover your cough.

• Frequent hand washing.

“We should still be using flu vaccine, as it is our best way to prevent this potentially serious illness,” Dr. Murphey said. “People's best chance of avoiding influenza and complications of influenza is to be immunized every year. That’s how we build up a community that can protect themselves from new strains, even when we did not have a vaccine for it yet.”

More resources:

• Six ways to protect your family from the flu
• The danger of the flu
• It's only the flu that killed her
• Fever, headaches and tummy aches: when you should be concerned
• Is your child afraid of shots?
• CDC's flu page
• What You Should Know for the 2014-2015 Influenza Season
• Seasonal Influenza Q&A