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 

Children and teens need up-to-date shot records to start the new school year, and the doctors at Cook Children’s are eager to help get students caught up on their routine immunizations.

Alice Phillips, M.D. at Cook Children’s Pediatrics Cityview said vaccines can prevent contagious diseases such as hepatitis, measles and mumps from spreading through the classroom and to family members at home.

“We can look back at history and see stories about polio and whooping cough and the toll that that took on our kids and on our society. We do not want to go back to that,” Dr. Phillips said. “Vaccines are safe. They work. And they are tried and true and proven over many decades.”

But the latest annual immunization report by the Texas Department of State Health Services identified a drop in overall vaccination coverage among kindergarteners during the 2021-2022 school year. The report also cited a high number of seventh-graders behind on shots for meningitis and Tdap (tetanus, diphtheria and pertussis).

In the report, the COVID-19 pandemic was listed as the main reason more children missed out on their required vaccines last year. Additional barriers to immunization include lack of transportation, missed opportunities, lengthy wait, and lack of culturally appropriate educational materials, according to the state health department.

Dr. Phillips pointed out that only 85% of Fort Worth Independent School District kindergarten students were current with their measles shots last school year. To reach herd immunity, and limit transmission, the rate should be 90-95%, she said.

Many families were afraid to come to the pediatrician for their child’s annual checkup during the early months of the pandemic in 2020, Dr. Phillips said. Most of her patients have since received any overdue vaccines.  

Heather Miller, M.D. at Cook Children’s Neighborhood Clinic Northside also saw a trend of families not making appointments -- or canceling, or not showing up -- for well-child visits because of COVID-19 concerns during the past two years. To make up for the shots they missed, some 6-year-olds are now coming in for vaccines normally given at age 4.  

Dr. Miller has good news for children and teens who fell behind: There are combination vaccines that can be given in most cases, meaning “fewer pokes,” as she puts it.

Most of the patients that Dr. Miller and her colleagues see at the Neighborhood Clinic Northside are on Medicaid or the Children’s Health Insurance Program (CHIP), which is available to those who can’t afford private health coverage. She wants parents to know that the Texas Vaccines for Children Program provides vaccines to eligible children from birth through age 18.

Dr. Miller says getting back-to-school vaccinations will help protect children from potentially serious complications from those diseases. “That’s why we’re here,” she said, “to help keep children healthy.”

Cook Children’s families can go to the MyCookChildren’s patient portal to schedule an appointment or access the immunization records needed for school registration. Dr. Miller said the staff at the neighborhood clinics can help their families navigate the portal or print out a copy of immunization records. 

In addition to the delays the pandemic caused, Dr. Phillips believes vaccine hesitancy also played a role in the 2021-2022 drop in the immunization rate.  She invites parents to ask questions and talk to the doctor about any concerns.  

“Let me discuss with you what I know – the science, the data – to tell you why these vaccines are safe for your child and why they are effective at preventing illness for not only your child but all of their friends and the community,” said Dr. Phillips, who describes a team partnership of trust between the physician and patient families working together to keep kids healthy.

“I truly believe after 25 years of doing this, that what’s absolutely best for their child is to be fully immunized and protected, because these diseases are still out there,” Dr. Phillips said.

Vaccines Checklist

Because many vaccines are typically given in the first 12-18 months of life, an incoming kindergartner might not have received a vaccine since her first birthday. Between the ages of 4-6, these additional vaccines are due:

• MMR (measles, mumps and rubella)
• DTaP (diphtheria, tetanus and pertussis)
•  IPV (inactivated poliovirus)
•  Varicella (chickenpox)

And an incoming seventh-grader might not have received a vaccine since he was a preschooler. Between the ages of 11-12 years, these additional vaccines are due:

• MCV4 (meningitis)
• Tdap (tetanus, diphtheria and pertussis)
• HPV (human papillomavirus)

A booster of the meningitis vaccine is also recommended at age 16.

Cook Children’s follows the vaccine schedule adopted by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

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For 10 key facts about immunizations, including why it’s important to follow a vaccination schedule, go to Vaccine and Immunization (cookchildrens.org)

To view the recommended ages for shots from birth through the teen years, go to cook-childrens-vaccinefacts2.pdf (cookchildrens.org)

Meet Heather Miller, M.D.

Dr. Miller’s desire to become a doctor took root as she grew up in the Piney Woods of East Texas. She earned a Bachelor of Arts in Biology from the University of Texas at Austin, then attended the University of Texas Medical Branch for medical school and residency. Along the way she proudly served in the U.S. Air Force for three years as a General Medical Officer at Lackland Air Force Base in San Antonio. After fulfilling her military commitment and completing pediatric residency training, she started her career at Cook Children’s Northside Clinic in 2002. Then came a 10-year journey following other career opportunities in San Antonio, Mississippi and New Mexico.

With a happy heart, this native Texan returned to Fort Worth and rejoined the Northside Neighborhood Clinic. Reconnecting with Cook Children’s has been a wonderful homecoming. She feels blessed to have this opportunity to provide care for the children and families of North Texas once again. Her special interests in pediatric care include safety and prevention as well as behavior and development

With her husband Steven and son Andrew, Dr. Miller enjoys exploring the world and taking trips by train.

Learn more about Dr. Miller here.

The AAP (American Academy of Pediatrics) and the Centers for Disease Control’s ACIP (Advisory Committee on Immunization Practices) stated, “Health care providers should not use live attenuated influenza vaccine (LAIV) in the upcoming 2016-2017 season due to poor effectiveness.”

The first thought that went through my head was this: my kids have to get the injectable flu vaccine next year AND I have to convince them that it’s a good thing. (I may be a pediatrician, but I’m still a dad.)

The committee looked at data from the last three flu seasons showing that the nasal vaccine had limited to no effectiveness for preventing flu.

Here are 4 facts you need to know:

1. Even in bad years, the flu vaccine continues to provide the best layer of protection against this deadly disease. Last year’s injectable flu vaccine was 50 percent effective in preventing disease which means thousands of people were protected.
2. Assuming there’s no new information or guidance, your pediatrician should not offer your child the nasal flu vaccine. Even if we hear something new, I would choose to do the injectable vaccine and I will do so for my kids.
3. The committee is hopeful that this early decision will help prevent any issue with the vaccine supply. However, there are flu vaccine supply issues nearly every year so I recommend getting in to get your shot early.
4. There’s a committee out there who is looking at this data and making the best recommendations possible based on the latest information. Is it frustrating that we were giving a vaccine that didn’t work? Of course. Am I glad that I won’t do it for another year? Definitely.

Stay tuned for more information about flu and flu vaccines as we get closer to September when flu vaccine supplies start arriving at your Cook Children’s pediatrician’s offices.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the fall of 2016.

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