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 

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.

This week, the Prosper emergency department has seen a record number of patients. Most patients are being admitted for either RSV, pneumonia or asthma.

The surge in hospital visits is due to a sharp spread of RSV and Mycoplasma pneumoniae (walking pneumonia) cases in the Dallas-Fort Worth area. While the rise of respiratory cases happens each year around this time, RSV cases spiked more quickly than usual this year, said Medical Director for Emergency Services Taylor Louden, M.D. Across the system, 23% of patients tested for RSV last week tested positive. 

“You know, we've seen over 1,100 patients in the last two days and through the ER, so it's been very difficult for us to manage this volume all at once,” Dr. Louden said. 

Of the 972 patients tested at Cook Children’s Medical Center-Fort Worth from Nov. 10 to Nov. 16, 224 tested positive for RSV. Out of 624 patients tested for walking pneumonia at Cook Children’s Medical Center - Fort Worth, 99 tested positive. 

What is RSV and when should I seek emergency care? 

RSV typically impacts kids under the age of two most and can cause a build-up of mucus and congestion that makes it difficult for kids to breathe. Parents should take precautions to limit further spread of the virus. Stay home if you are sick and keep kids home if they are showing symptoms. RSV vaccines are available for pregnant women, babies and elderly people. 

If your child is sick, parents and caregivers can help reduce stress on the emergency services system by knowing when to bring a child into the emergency room and when to schedule an appointment. Limiting emergency room traffic to true emergencies helps keep the hospital system from being too overwhelmed. 

If your child is sick but not experiencing severe issues such as trouble breathing or obvious dehydration, consult with your pediatrician and, if possible, schedule an urgent care appointment for your child instead of visiting the emergency room. 

If your child is in respiratory distress, you should call 911. In respiratory distress, a child might turn blue around the nose and mouth, have labored and rapid breathing, have severe shortness of breath or have a rapid heart rate.

RSV is treated by monitoring and treating symptoms; there is no cure for the virus. Many viral respiratory illnesses can be treated at home through rest, plenty of hydration and electrolytes. For congestion, parents and caregivers can use nasal saline to thin the mucus and suction it out with a bulb syringe. 

What is walking pneumonia? 

Walking pneumonia cases have been consistently high since this summer, Louden said. From Nov. 10 to Nov. 16, 99 kids tested positive for the illness. Last year at this time, Cook Children’s reported less than 10 cases of walking pneumonia between August and December. 

Walking pneumonia typically impacts school-age children. Some of the symptoms include: low-grade fever, fatigue and cough. Most atypical pneumonia cases can be treated with antibiotics, but if your child has pneumonia and has had a fever for more than five days and/or having difficulty breathing, seek emergency care. 

Pneumonia, RSV, the flu and COVID-19 can all have similar symptoms. Flu and COVID-19 may also include sore throat, headaches, body aches, chills and change/loss of taste and smell. 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. 

In many cases, physicians can assess and treat a patient via a virtual health appointment. Download the MyCookChildrens app to schedule a virtual health/telemedicine appointment. 

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 

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.
 

There is a new line of defense against the leading cause of pediatric hospitalizations, and doctors are hopeful it will decrease the spread and severity of a virus that affects nearly two-thirds of all infants during their first year of life.

In 2023, the U.S. The Food and Drug Administration (FDA) approved the first respiratory syncytial virus (RSV) vaccine for pregnant women, known as Abrysvo. The vaccine transfers immunity to newborns, similar to how the pertussis vaccine for moms protects infants from whooping cough.

Respiratory syncytial virus is an infection that can lead to severe respiratory illness in infants and children, especially those under 2. In mild cases, children may experience a runny nose, cough, fever and wheezing. Serious cases can lead to inflammation of the airways and pneumonia, which could require hospitalization for difficulty breathing.

“Respiratory syncytial virus has been a major scourge for babies and pediatricians for a long time,” said Kaitlin Williamson, M.D., an infectious disease specialist at Cook Children’s Medical Center. “It's not a new thing. We're just hearing about it more because now there's something we can do about it. Truly up to 3% of all children are hospitalized in the first year of their life with RSV. That means 1 in 33 babies could be hospitalized their first year for the virus. That's an astronomical number.”

Two Doctors, One Decision

Anne Kirk, M.D, a pediatric hospitalist at Cook Children’s Medical Center, often treats children hospitalized due to RSV and is enthusiastic about this preventative breakthrough. This past year, her excitement became personal while pregnant with her now 8-month-old son. She chose to receive the maternal vaccine Abrysvo.

Abrysvo works by stimulating the mother’s immune system to create RSV-fighting antibodies that are then passed on to the baby in utero. Clinical trials demonstrate an 81% reduction in severe RSV-related illnesses requiring hospitalization in infants within the first 90 days after birth, and a 69% reduction up to six months of age, compared to a placebo.

Still, Dr. Kirk was not automatically offered the vaccine by her obstetrician.

“During one of my winter visits with my OB, I asked if their clinic would have the maternal RSV vaccine or if I’d need to get it at a local pharmacy,” Dr. Kirk said. “I was surprised my OB hadn’t brought it up and a little surprised the clinic wouldn’t be carrying the vaccine as well. This was last year so it was the first season where the maternal RSV vaccine was offered, so the newness of it likely contributed to this, but I think it’s important for all OBs to encourage their pregnant patients to get this important vaccine.”

Dr. Kirk has seen enough to know the potential impact the vaccine could have on children and the medical community. She takes care of hundreds of sick patients hospitalized for RSV every winter. While every season is different, she says, doctors have seen a trend towards much sicker babies as a result of RSV over the last several years.

For her, getting the vaccine gave her a sense of empowerment as a mom.

“Being a new mother, you quickly realize that a lot of things are out of your control,” Dr. Kirk said. “As my OB said early on in my pregnancy, ‘As long as you remember that the baby is in charge, you’re good.’ This applies to labor and delivery and especially once the baby has arrived. By getting the vaccine while I was pregnant, I felt that I was doing as much as I could to keep my baby healthy by giving him RSV immunity from me. I think doing as much as I could to protect my baby made me feel better as a new mom."

Dr. Williamson also chose to get the maternal vaccine while recently pregnant.

“It was just so incredibly exciting to me that there was something I could do to offer my daughter some protection against it,” Dr. Williamson said. “I was so excited to be one of the first women to be able to get it.”

Dr. Williamson did not experience any side effects from the vaccine, but notes that, although a small effect, safety trials suggest a possible risk of preterm birth, particularly among women who received the vaccine before 32 weeks gestation.

One Virus, Two Protective Options

For women not eligible for the maternal vaccine or who are concerned about this risk, there is another option. Last summer, the FDA also approved Beyfortus, a monoclonal antibody therapy designed to prevent severe RSV infections in infants and young children.

Unlike a vaccine that teaches the immune system to fight a disease by generating its own antibodies, Beyfortus is an injection given to babies that directly delivers preventative antibodies they lack due to their immature immune systems. It can boost a baby’s immune system against severe RSV for up to five months.

“It’s really empowering for women to have that choice for their baby,” Dr. Williamson said. “Some women don’t want their newborn to get a shot for any reason and would rather take it for them. Whatever makes you feel like you’re offering the protection that makes the most sense for you and your baby is what you should do. I encourage and celebrate women picking whatever option works best for them since they’re both really safe and really effective.”

Who is Eligible?

Pregnant women in their 32nd through 36th week of pregnancy are eligible for Abrysvo. It is offered seasonally from September through January. For maximum protection for the baby, the vaccine should be given at least two weeks prior to birth.

It should be noted that Abrysvo is also used to protect older adults from RSV. While it is the same vaccine, it has different eligibility criteria. For older adults, it is given to those aged 60 and older with a higher risk for RSV complications, such as those with chronic lung disease, heart disease, weakened immune systems or other comorbidities.

The Centers for Disease Control (CDC) recommends Beyfortus for infants under 8 months of age born during or entering their first RSV season, as well as children younger than 20 months of age who remain at high risk of severe RSV disease during their second RSV season.

For more information about either of these protections against severe RSV, it’s important to visit with your obstetrician and/or pediatrician.

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Medication to Prevent RSV

It’s a dose of antibodies that works right away to help fight off severe RSV infection for at least five months. Getting the shot in October – just before RSV season -- provides an infant with extra antibodies to build their immunity during the fall and winter months.  

In November 2023, Cook Children’s saw a spike in RSV at our Urgent Care centers and Emergency Departments, the highest volume of cases in recent years.   

“RSV is one of the most common winter viruses. All of us catch RSV in the first couple of years of life," said Mary Suzanne Whitworth, M.D., Medical Director of Pediatric Infectious Diseases at Cook Children’s.

In older children, RSV typically causes cold-like symptoms such as cough and runny nose. But babies under 12 months don’t have fully developed immune systems, Dr. Whitworth said. They tend to get sicker with RSV, a leading cause for wintertime hospitalization in infants.

Severe RSV in infants tends to impact the lungs. Infants should be seen by a doctor if they’re struggling to breathe. If your baby is sick, Dr. Whitworth said, watch for rapid breathing, flared nostrils, airway congestion, wheezing or a rattle you can hear or feel in their chest. Other concerning signs are excessive sleepiness, lack of appetite and trouble feeding.

The Food and Drug Administration (FDA) approved the preventive medication, called nirsevimab, in 2023 after clinical trials showed it reduces the risk of hospitalization for RSV by 75%.

Every infant under age 1 needs the medication ahead of RSV season, Dr. Whitworth said. Some older babies need the shot too if they have certain underlying health conditions. Here’s the breakdown. 

Stopping RSV Two Ways

The first option Pfizer's Abrysvo, given during weeks 32-36 of pregnancy.  Maternal antibodies are passed to your baby and protect against RSV for about six months after birth.   

Infants who don’t have maternal antibodies should get a dose of nirsevimab shortly before the RSV season. Infants born from October to March should receive the medication within one week of birth, according to the U.S. Centers for Disease Control and Prevention (CDC).

The CDC also recommends nirsevimab for certain young children shortly before their second RSV season. This higher-risk group includes children who were preemies, or those with chronic lung disease, compromised immune systems or cystic fibrosis.

The injection delivers safe and effective antibodies, Dr. Whitworth said, and the most common side effect is soreness from the needle stick. She encourages parents to ask their baby’s pediatrician for the shot in October, before hospitalizations for RSV start climbing in infants.

“They are going to be exposed to RSV. It is a virus we are exposed to regularly all winter long.” she said. “The immediate benefits of the shot are huge.”

Cook Children’s has the RSV shot available at our seven Neighborhood Health Centers in the Fort Worth area and more than 40 pediatric offices from Aledo to Willow Park.

Additionally, the Tarrant County Health Department is offering this product to infants ages 2 – 8 months with state-funded insurance or no insurance and infants 8 – 19 months with a qualifying diagnosis.   

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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.

Respiratory illness is on the rise, causing a jam of patients at the Cook Children’s Emergency Department (ED) and Urgent Care locations.

In the last 24 hours, our Urgent Care sites across North Texas saw 731 patients, many with respiratory syncytial virus (RSV) and other seasonal illnesses. That compares to 684 visitors the previous day.  

At the same time, our ED was treating 524 patients, up from 448 one day earlier. That’s nearly a patient checking in every three minutes.

Swabs for the virus came back positive on 29% of the 834 patients who were tested at Cook Children’s Medical Center – Fort Worth during the week of Oct. 29-Nov. 4. That’s an increase from the 25% who tested positive for RSV one week earlier. Numbers for COVID-19 and influenza, meanwhile, are running much lower at the current time.

RSV is a common respiratory virus that usually causes mild, cold-like symptoms such as runny nose, cough and fever. But it can be serious when it turns into bronchiolitis and pneumonia. RSV sends anywhere from 58,000 to 80,000 children under 5 years old to the hospital each year, according to the Centers for Disease Control. Infants are particularly vulnerable if they were born premature or have weakened immunity or heart or lung conditions. 

Our ED and Urgent Care centers are crowded, and wait times are longer for non-emergency illnesses and injuries. How do you know if your baby with RSV needs medical attention – and where to go? The doctors at Cook Children’s have answers.

Your Pediatrician

Go to your primary care physician if your child is experiencing mild respiratory symptoms but is not having difficulty breathing. Your pediatrician can test for RSV, COVID or the flu.

Jonathan Nedrelow, M.D., associate chief medical officer for the Medical Center, said infants should be seen by a doctor if they’re struggling to breathe. Watch for faster breathing than normal, flared nostrils, airway congestion, wheezing or a rattle you can hear or feel in their chest. Other concerning signs are excessive sleepiness, lack of appetite and trouble feeding.

“If parents notice their infant’s breathing is hard or labored, they need to be evaluated,” Dr. Nedrelow said. “RSV is not the only virus that can cause these symptoms, so it’s good to be checked out.”

Urgent Care

If you can’t get in to see your child’s primary care physician for mild difficulty breathing or wheezing, then Urgent Care is the next best place to go, said Kara Starnes, D.O. medical director of Cook Children’s Urgent Care Services. Decreased fluid intake (not as many wet diapers) is another sign to watch for. 

“There is no medication to treat RSV,” Dr. Starnes said. “Treatment for mild to moderate RSV involves frequent saline and suction of the nose and supportive care for fever as well as increased fluids. Cough and cold medications are not recommended.”

Virtual Care Visits

Cook Children’s primary and urgent care locations both offer virtual visits that can be accessed from the comfort of your home. Cook Children’s Virtual Care appointments can help you avoid packed waiting rooms and allow you to see a physician at your convenience. This is also a great option if you need a doctor’s note for school. Visit our website to learn more.

Hospital Emergency Department

Call 911 if your child is having severe difficulty breathing, is turning blue or has become lethargic. Don’t seek RSV treatment at the ED unless you see signs of struggling to breathe, such as the muscles sucking in between the ribs, or if your child can’t stay hydrated.

“If your child has mild symptoms such as cough, congestion, or low-grade fevers, we recommend following up with your pediatrician or urgent care, please do not come to the emergency department,” said Taylor Louden, M.D., in pediatric emergency medicine at Cook Children’s.

Severe cases of RSV typically need supplemental oxygen until the virus runs its course. IV fluids may also be necessary.

Preventing RSV

RSV season typically runs from October through early spring. These steps help avoid catching the virus or passing it along:

• Wash your hands frequently
• Cover your sneezes and coughs
• Stay home when you’re sick

And a new antibody-boosting injection, called nirsevimab, helps prevent severe RSV by providing a temporary boost to the immune system. The medication is in short supply nationwide, and available doses are reserved for patients at highest risk. Additional doses are on order at Cook Children’s, so check with your pediatrician for availability.

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• CDC Recommends RSV Shot for Infants. Infectious Diseases Doctor Shares What Parents Need to Know 
• Clinic Watches out for Respiratory Trouble After Prior RSV Care

A new shot that helps prevent respiratory syncytial virus (RSV) is in short supply nationwide and Cook Children’s is following guidelines to prioritize infants at the highest risk of illness.  

Like other health care organizations across the country, Cook Children’s has limited doses of the new medication, called nirsevimab. Eligible patients are receiving the antibody injection as it arrives at Cook Children’s locations.

“While availability remains limited, patients may find their offices intermittently out of the product,” said Alice Phillips, M.D., at Cook Children’s Pediatrics Cityview. Additional doses are on order and Cook Children’s sites remain in contact with supply sources to maximize access for high-risk infants. 

Meanwhile, cases of RSV are on the rise at Cook Children’s, including at the Emergency Department (ED) and Urgent Care locations. At Cook Children’s Medical Center – Fort Worth during the week of Oct. 22-Oct. 28, tests for the virus came back positive on 25% of the 764 patients who were tested. That compares to a 6% positivity rate for COVID-19 tests and 1% positivity for influenza A.

Jonathan Nedrelow, M.D., associate chief medical officer for the Medical Center, said infants should be seen by a doctor if they’re struggling to breathe. Watch for faster breathing than normal, flared nostrils, airway congestion, wheezing or a rattle you can hear or feel in their chest. Other concerning signs are excessive sleepiness, lack of appetite and trouble feeding.

“If parents notice their infant’s breathing is hard or labored, they need to be evaluated,” Dr. Nedrelow said. “RSV is not the only virus that can cause these symptoms, so it’s good to be checked out.”

The Centers for Disease Control and Prevention on Oct. 23 advised health care providers to allot any available doses for patients most susceptible to severe RSV. That group includes:

• Premature infants
• Infants 6 months and younger
• Children younger than 2 years old with chronic lung disease or congenital heart disease
• Children with weakened immune systems
• Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

In July 2023, the Food and Drug Administration (FDA) approved nirsevimab, a monoclonal antibody to prevent severe respiratory disease due to RSV infections in infants and young children with underlying medical conditions. An injection provides a temporary boost to a child’s immunity to get them through the worst of the RSV season, typically the fall and winter months.

Cook Children’s pediatrician offices, neighborhood clinics, specialty clinics and Medical Center -- Fort Worth are navigating the shortfall by following the CDC advisory until the supply improves. At the Medical Center, supply is reserved for the highest risk patients such as infants admitted to the neonatal, cardiology and pulmonology units.

“All areas of Cook Children’s are working diligently to provide this product and to keep our families up to date with the most current information on supply and recommendations,” Dr. Phillips said. “Cook Children’s Health Care System remains actively engaged to provide this important preventative medication to our most vulnerable infants.”

The medication comes in single-dose syringes of 50mg and 100mg. The smaller dose is meant for infants weighing less than 5 kilograms (11 pounds). High-risk infants weighing more than 5 kilograms would receive the larger dose, which is especially scarce.

“Many infants pass this weight by 1-2 months of age, so careful consideration and early administration are key,” Dr. Phillips pointed out.

The CDC also recommended that doctors not give nirsevimab to children who are eligible for another medication, called palivizumab, instead. 

It’s important for parents to talk with their child’s health care provider to find out which medications are appropriate and available. And follow these key tips to prevent the spread of RSV: Wash your hands frequently, cover your sneezes and coughs, and stay home when you’re sick.

Background on RSV

RSV is a common respiratory virus that usually causes mild, cold-like symptoms such as runny nose, cough and fever. Virtually all children will be infected by RSV by the time they are 2 years old. Most recover in a week or two.

But RSV can be serious when it turns into bronchiolitis and pneumonia. RSV sends anywhere from 58,000 to 80,000 children under 5 years old to the hospital each year, according to the CDC. Dr. Nedrelow said those with severe cases typically need supplemental oxygen until the virus runs its course.

Taylor Louden, M.D., in pediatric emergency medicine at Cook Children’s said the recent increasing number of RSV patients has led to longer wait times in the ED. If your child has only mild symptoms -- including cough, congestion, or low fever -- please do not come to the ED, Dr. Louden said. 

“For milder symptoms we recommend frequent nasal suctioning at home, appropriate hydration, and follow up with your child’s pediatrician,” he said.

If you can’t get in to see your child’s primary care physician, then Urgent Care is the next best place to go, said Kara Starnes, D.O., medical director of Cook Children’s Urgent Care Services. Call 911 if your child is having severe difficulty breathing, is turning blue or has become lethargic, Dr. Starnes said.

Boosting Immunity

Clinical trials show that nirsevimab reduces the risk of hospitalization for RSV by 75%. Research and clinical trials show the medication is safe and causes only mild side effects. The injection is neither a vaccine nor a treatment.

This particular use of monoclonal antibodies for the prevention of severe RSV is new even though a similar type of RSV protection has been on the market for more than a decade. Nirsevimab needs just one injection to provide a period of protection that lasts about five months. The older medication requires an injection each month during the RSV season.

RELATED STORIES:

• CDC Recommends RSV Shot for Infants. Infectious Diseases Doctor Shares What Parents Need to Know 
• Cook Children’s | Medication to Prevent RSV 

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
  
   

Last year, Cook Children’s Medical Center experienced the worst respiratory syncytial virus (RSV) season since before 2017, with the peak hitting in October 2022 when hospital admissions for RSV rose above 300. At the same time, Cook Children’s Emergency Department and Urgent Care Centers were overwhelmed with RSV cases, seeing 500+ patients a day. Nationally, RSV sends anywhere from 58,000 to 80,000 children under 5 years old to the hospital each year, according to the Centers for Disease Control.

But future RSV seasons could look different, thanks to a new tool in fighting the virus.

In July, the U.S. Food and Drug Administration approved Beyfortus™ (nirsevimab-alip), a one-time monoclonal antibody injection for the prevention of severe RSV.

The injection is not technically a vaccine, as it does not provide lifetime immunity, nor is it a treatment. Beyfortus is a temporary antibody boost to a child’s immunity to get them through their highest RSV risk period, according to Nicholas Rister, M.D., an Infectious Diseases physician at Cook Children’s Medical Center. The American Academy of Pediatrics recommends Beyfortus for infants 8 months old and younger entering their first RSV season and children up to 19 months at increased risk for severe RSV and entering their second RSV season. In Texas, the RSV season typically begins in the fall and stretches through the winter months.

Cook Children’s doctors say the new RSV monoclonal antibody shot could be a game-changer when it comes to reducing severe infections and hospitalizations, and it's been a long time coming.

“The last time someone tried to develop an RSV treatment for infants that was preventative, I had not even started medical school,” Dr. Rister said. “So the fact that we now have a treatment option for infants for the first time in like 20 years for one of the most prominent diseases on the planet. That's so huge.”

While this particular use of monoclonal antibodies for the prevention of severe RSV is new, Dr. Rister says monoclonal antibodies have been used for hundreds, if not thousands, of indications for over a decade.

Clinical trials of Beyfortus show it reduces the risk of hospitalization for RSV by 75%, which could take a huge burden off of hospitals during peak respiratory virus season.

“We're talking about a disease that, during some respiratory seasons, is more than half of the admissions to the hospital,” Dr. Rister explained. “If you even drop that by half, which this is claiming to be able to do more than that, we're talking about massive reductions in the number of children getting sick enough to end up in the hospital, and massive reductions in the burden at the hospital during respiratory seasons, which hopefully will lead to even better care for the community at large.”

A welcome relief

It’s a welcome relief for Karen Schultz, M.D., medical director of Pulmonology at Cook Children’s. During peak RSV season, it’s not unusual for her to consult on five to 10 new babies with RSV each day in the Pediatric Intensive Care Unit (PICU). The new antibody shot could drop that number significantly.

“It’s good for our clinicians’ work-life balance during these very busy months, but it’s even better for these babies and families to not have to be in the PICU,” Dr. Schultz said.

As a neonatologist in Cook Children’s Neonatal Intensive Care Unit (NICU), Darryl Miao, M.D., cares for babies at particularly high risk for severe RSV due to their prematurity, underdeveloped lungs and other risk factors like congenital heart disease. He says the new antibody shot gives him more confidence that the babies discharged from the NICU won’t end up back in the hospital with RSV.

“I'm excited that all the data shows that there's less hospitalizations, less morbidity, and makes babies better able to fight off RSV in their first year of life.” Dr. Miao said. “I do expect to see less hospitalizations all across the board, including from our NICU population after discharge. That part is really exciting.”

When Vanessa Charette, M.D., a pediatrician at Cook Children’s Pediatrics Fort Worth – Magnolia, had her first child 17 years ago, RSV was one of her top concerns for her baby. As a physician, she knew all too well how sick the virus can make little ones.

“As much as I had the ability to control things, I tried to have him so he would not be a newborn in the winter during RSV season,” Dr. Charette said. “I was so concerned about him getting the virus in the first month of life that I tried to have a baby that would be delivered in the spring rather than later in the year.”

As both a mom and physician, Dr. Charette is thrilled that the new RSV monoclonal antibody can potentially release parents from this burden.

“We’ve been waiting on something, and I think many families have been waiting on something, like this,” she said. “Maybe they’ve had an older child who had RSV and now they’re having their third baby and maybe they’re worried about their new baby getting RSV. It can be the most severe respiratory illness that babies have in their first year of life, and to finally have a tool to prevent it, that’s exciting.”

What parents need to know

We asked each of these physicians to share with us the most important thing they want parents to know about the RSV monoclonal antibody injection when considering it for their child. Here’s what each of them had to say.

Dr. Miao: “I would say, first of all, that it's not a vaccine. It's actually an antibody, and a similar mode of protection against RSV as one that has been on the market and used for NICU babies for 10+ years. The difference between the two is Beyfortus is one injection that will last about five months, which is usually the entirety of the RSV season, as opposed to a monthly injection of the other throughout RSV season. Beyfortus is also recommended for healthy children, unlike the other which is reserved for our highest risk NICU babies.”

Dr. Schultz: “The safety profile of the new antibody shot, when they have done comparative studies with a similar drug we’ve used for a lot of years and has been very safe, is the same. I know that's a big concern for any parent with a new medicine. What are the side effects? But they were really few and far between. They were mainly really mild things like redness at the injection site. There weren't any significant deterrent symptoms or side effects.”

Dr. Charette: “The main thing we hope to see is that the youngest babies, especially our babies less than six months, won’t be as sick and, therefore, won’t be as at-risk for needing hospitalization should they get RSV. They can still get RSV despite having gotten this injection but with much less severity. That is important, not only for the baby's health, but it also obviously helps alleviate parents' fears when their child is diagnosed with RSV.”

Dr. Rister: “I think the most important thing parents need to know is that they need to talk to their pediatrician about it. There is some nuance with this, even though it's generally being recommended for all children, so everyone needs to talk to their pediatrician about their child specifically. Does their child have extra risks? I would just hate to think someone's not having this conversation because it has such a big role in the safety and health of children going forward, especially those young infants, for the first time in decades.”

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The Centers for Disease Control and Prevention has recommended a new antibody shot to help prevent severe respiratory syncytial virus (RSV) disease in all infants.

RSV is a leading cause of hospitalization for infants. The use of nirsevimab (trade name Beyfortus) is a long-acting monoclonal antibody infusion, which has been shown to reduce the risk of both hospitalization and healthcare visits in infants by about 80%, according to the CDC.

The CDC recommends:

• One dose for all infants 8 months old and younger born during or entering the RSV season (fall through spring)
• One dose for children between 8 and 19 months old who are at an increased risk of severe RSV, including severely immunocompromised children

“This new antibody treatment, which has now received the Food and Drug Administration approval and CDC's Advisory Committee on Immunization Practices recommendation, will truly be a game-changer,” said Jason V. Terk, M.D. of Cook Children's Pediatrics Keller Parkway. “This will dramatically reduce the burden of this infection among infants in their 1st year of life and I am excited about that!”

What is RSV?

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Virtually all children will be infected by RSV by the time they are 2 years old. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults.

Every year, there are between 58,000 and 80,000 hospitalizations for RSV for children under 5 years old, according to the CDC.

RSV can also cause severe illnesses such as bronchiolitis and pneumonia. The risk is especially high for premature infants.

According to the CDC, those at greatest risk for severe illness from RSV include:

• Premature infants
• Infants, especially those 6 months and younger
• Children younger than 2 years old with chronic lung disease or congenital (present from birth) heart disease
• Children with weakened immune systems
• Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

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

Nicholas Rister, M.D., of the Cook Children's Infectious Disease team, shares what parents and caregivers need to know.

How severe can RSV be, if my baby is infected?

RSV is a very common infection for infants and young children. Most will only have a typical “cold” or “viral URI.” Although, given how many infants become infected, many children are admitted to the hospital and intensive care unit each year.

RSV infections can be very serious for some babies in particular. This includes very premature infants 36 weeks gestation or younger, but especially if younger than 32 weeks gestation. This also includes babies with congenital heart disease and babies who required several weeks of oxygen support after birth, such as ventilators or cannulas.

What is the difference between this antibody and a typical vaccine?

A vaccine is designed to trigger your body to produce its own antibodies to a disease. This provides both immediate protection and longer-term memory. An antibody infusion gives you protection immediately but has not trained your body to continue creating those antibodies. This leads to a quick but only temporary period of protection.

Many vaccines work well in older children but not infants. Providing antibody infusions can cover at-risk infants who would otherwise not create antibodies in response to a vaccine.

Can my baby show symptoms once they receive the antibody? Are there any side effects?

With any infusion of medication that was not created inside your baby’s body, there is always a chance their immune system will notice it and react. Thankfully young infants, due to their immune tolerance of recently living inside of another human body, develop these reactions less frequently. Your doctor will monitor for any signs of a reaction during the infusion and after with your assistance.

How long has this antibody been tested? How do I know it is safe for my child this fall?

The use of RSV antibody infusions has been present and tested for over a decade. While this newer treatment provides more widespread application, the core safety of the treatments is well established.

What is the most important takeaway for parents of infants?

RSV is a highly prevalent disease and every family should talk with their pediatrician about the potential benefit of this antibody infusion for their child. While some children will clearly benefit more than others, it is an important conversation to have for all families.

How soon will it be available at pediatrician offices?

The CDC expects nirsevimab to be available this fall. Expectant parents and parents of infants under the age of 8 months, as well as those with older babies, should talk with their pediatrician

The first vaccine to protect babies from the respiratory syncytial virus (RSV) is one step closer to approval after the Food and Drug Administration’s advisory committee met to discuss the efficacy and safety of the vaccine.

If approved by the FDA later this year, this could be the first vaccine to protect infants from RSV, which is a leading cause of hospitalization for infants. The vaccine would be issued to expecting mothers during the second or third trimester of pregnancy to prevent RSV and prevent severe RSV from birth through six months of age.

The Centers for Disease Control and Prevention is also weighing recommendations for a monoclonal antibody for babies and toddlers, as well as a RSV vaccine for older adults.

Virtually all children get an RSV infection by the time they are 2 years old. RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV can also cause severe illnesses such as bronchiolitis and pneumonia. The risk is especially high for premature infants.

Some children require hospitalization, but most do not. Currently, there is no vaccine to prevent RSV infection. To prevent RSV infection, Cook Children’s encourages children to continue health habits learned in the pandemic, including hand hygiene, coughing/sneezing into a tissue and staying home if you or your child feel sick.

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

In fall 2022, Cook Children’s experienced an early spike in RSV and influenza A cases. Our Emergency Department and Urgent Care Centers were overwhelmed with patients. By November 2022, our patient census was full across the board due to many patients with flu, RSV and respiratory illnesses. If patients were inoculated with the RSV vaccine, this could help alleviate stress on our health care system by keeping children out of the hospital.

During the FDA’s advisory committee meeting, the discussions were complicated so the recommendations were split to vote on efficacy and safety. They unanimously approved based on the efficacy of the vaccine. However, based on available safety results, the decision was split (10 would approve, 4 would oppose).

The vaccine had serious safety concerns in the elderly patient trials that were submitted with 1 patient out of 2,500 having Guillain-Barre syndrome and another with acute disseminated encephalomyelitis (ADEM), both serious central nervous system diseases. Both diseases occur outside of trials in this population, but they are also known to be rarely related to both vaccines and due to the diseases they help prevent. There are post-marketing studies in place in elderly patients to further evaluate the exact risks of these diseases.

Additionally, a pregnancy trial was in progress but it was paused due to safety concerns. In addition to the diseases noted, there were more preterm births in the vaccine group. These were mostly babies born a week or two early which is generally safe, but due to the trend, the trial was paused while the safety is better assessed.

Nicholas Rister, M.D., of the Cook Children's Infectious Disease team, shares what parents and caregivers need to know.

Why should I consider getting the RSV vaccine? Is it safe?

Right now, the vaccine is only approved for elderly patients over the age of 60. People in this age range should talk with their doctor about the vaccine.

There is an ongoing discussion about making the vaccine available for pregnant women so that the antibodies it induces can be passed to their infants via the placenta. It has been difficult to develop an RSV vaccine for very young infants since they do not react readily to the vaccines that have been developed. However, young infants are the group most at risk for severe and prolonged disease with RSV so providing them protection via their mother is an important opportunity.

The safety questions are the issue here. Right now, the vaccine is not approved for pregnant women so it is not an option. However, the vaccine appears very effective so it may still gain approval in some form once the exact risks are better understood.

Importantly, this is not a vaccine that is going to be mandated for pregnant women. The ethical issues with having a person get a vaccine (the mother) to provide protection for someone else (the infant) and the risks assumed between them is going to make this a more nuanced discussion between OB/GYNs, pediatricians, and families.

How long and how strong is the protection against RSV infection if vaccinated?

Initial results from pregnancy trials showed 82% protection from severe RSV disease from 0-3 months of life and still 69% percent at 6 months of life. While this doesn’t prevent disease or even all severe disease, since RSV is so common in infants and particularly dangerous in preterm infants, this level of protection is very significant and dramatic.

What should parents of toddlers and young children know about the RSV vaccine since, if approved, it would only pertain to pregnant women?

RSV is a very low-risk infection for children outside of the first year or two of life and in younger adults. Until vaccine risks are clarified, there likely will be no push for using this vaccine outside of infants (via pregnant mothers) and elderly adults. Should further evaluation (or a new vaccine) emerge to show minimal risk to getting the vaccine, there may be a role in vaccinating older children to prevent the spread within families to high-risk groups. But, for now, the discussion is likely to stay with pregnant women and older adults.

Why is there a need for the vaccine? How will this impact health care systems?

The Centers for Disease Control and Prevention reports that per year, there are between 58,000 and 80,000 hospitalizations for RSV among children under 5. Because so many children get RSV every year, the actual number of children with severe disease is very high. This leads to a massive use of health care resources each year. That’s why there is so much effort into evaluating the vaccine despite some significant safety questions that need answering.

Go here to view more info about RSV from the CDC.

According to the CDC, those at greatest risk for severe illness from RSV include:

• Premature infants
• Infants, especially those 6 months and younger
• Children younger than 2 years old with chronic lung disease or congenital (present from birth) heart disease
• Children with weakened immune systems
• Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

Story by Jean Yaeger. Video by Tom Riehm.

Babies and toddlers treated for viral respiratory infections at certain Cook Children’s locations can get their breathing checked at a special clinic that provides free follow-up visits. 

The clinic serves children ages 2 months to 2 years old who were previously admitted to these Cook Children’s facilities: Medical Center, Emergency Department (ED) or Urgent Care centers. What’s the benefit? For up to a week after these patients go home, their caregivers can bring them to be seen by therapists who specialize in caring for the lungs. 

No appointment is necessary at the Cook Children’s Respiratory Outpatient Clinic. But patients must have a referral from a provider at the Medical Center, ED or Urgent Care centers.   

The clinic is designed to give guidance and reassurance to parents whose little ones are continuing to recover from severe bronchiolitis. If a child has trouble breathing or other complications within seven days of being discharged, the experts at the clinic can do an evaluation. 

Janie Galindo found out about the clinic at the Cook Children’s Urgent Care center where her twins, Dallas and Dionne, tested positive for the respiratory syncytial virus (RSV) in October. Thanks to a referral from their Urgent Care provider, Janie had access to the clinic when her babies got sicker overnight. As soon as the clinic opened the next morning, they were there.   

Just as their mom suspected, Dallas’s and Dionne’s symptoms had gotten worse. A respiratory therapist met them at their vehicle and took them inside for evaluation. In their case, the clinic checkup ended with admission to the hospital.   

Janie is grateful for this resource. And she urges other parents to take advantage of the clinic, which Cook Children’s has offered every year since 2019 during peak season for respiratory illnesses. The clinic saw 119 patients from September through December 2022.

A surge in RSV and flu cases has hit hard in North Texas and nationwide in recent months, contributing to long wait times in health care settings. But the convenience of the Respiratory Outpatient Clinic at Cook Children’s can allow families to avoid returning to the crowded ED or Urgent Care locations where their child was recently treated. 

Families come to the clinic seeking peace of mind. Many children are doing OK and can go back home. Others might need additional treatment as Dallas and Dionne did. 

“It was so helpful,” Janie said. “If your babies aren’t better, just to ease your nerves, just take them in. It doesn’t hurt.” 

The clinic, located at the Medical Center in Fort Worth, is open through March. Hours are from 11 am-7 pm daily. Here’s how it works: 

• Get a referral and instructions when your child is discharged from Cook Children’s Medical Center, ED or Urgent Care with a bronchiolitis/RSV diagnosis.  You can come to the clinic as often as twice a day over the next week. 
• Park in the designated area, call the clinic when you arrive, and wait in your vehicle.
• In the meantime, registration personnel verifies that your referral is on record.     
• A respiratory therapist from the ED walks you to the clinic. The therapist checks your child for labored breathing, low oxygen, dehydration and other concerns. The therapist also determines if your child needs further medical attention.  
• There’s no charge, and insurance isn’t required. 

Cathy Carroll, respiratory director at Cook Children’s, said the clinic is structured to serve children with RSV or bronchiolitis who are otherwise healthy after they leave the Medical Center, ED or Urgent Care. If concerns arise while their children recover at home, parents can bring them to the clinic for a quick outpatient visit. “It’s very helpful, reassuring and a great experience for parents,” she said.

Carroll said the clinic is staffed by respiratory therapists who reinforce the educational tools that were provided when the patients were discharged earlier. The therapists take the opportunity to explain signs of low oxygen -- teaching parents to look for fast or shallow breaths, flared nostrils and bluish lips. It’s a model that aims to prevent unnecessary return trips to the ED or Urgent Care. 

The clinic was there when Dallas and Dionne needed help to fight RSV. This is their story. 

Two Too Sick  

Dionne and Dallas were born 15 weeks early, in August 2021. They each weighed less than 2 pounds, and their lungs weren’t fully developed. Dallas was intubated to help him breathe while in the neonatal intensive care unit (NICU). After several months in the NICU, the preemies were strong enough to join their parents and three older siblings at home in Fort Worth. 

The U.S. Centers for Disease Control and Prevention puts children like Dionne and Dallas in a category for higher risk from RSV, due to their impaired lungs at birth. Other higher-risk groups include infants younger than 6 months old, and children with heart disease or weakened immune systems. 

One day in October, Dallas started running a fever, coughing and throwing up. Dionne soon came down with similar symptoms. The 14-month-old siblings were too sleepy to play or eat. Dionne, who is normally feisty, wanted to be held constantly. Dallas, who is normally cuddly, wanted to be left alone. Then he started breathing rapidly. 

“I don’t think this is a cold,” Janie thought at the time. She took both twins to Cook Children’s Urgent Care, where they were tested for flu, COVID-19 and RSV. The RSV tests came back positive, but their vital signs weren’t alarming. 

Urgent Care staff gave Janie a referral to the Respiratory Outpatient Clinic and encouraged her to take the twins for a follow-up visit if their illness changed for the worse anytime in the next week. Back at home, Janie grew concerned when the babies had more trouble keeping food down. And she thought Dallas’s lips began to look gray.  

“They were really groggy. They weren’t crying because they didn’t have energy. They were just blah. Dallas had a really bad cough. Dionne wasn’t doing good at coughing it out.” Janie wanted a medical professional’s opinion. 

So she took the twins to the clinic’s designated parking area when it opened at 11 am. Within the hour, therapists were evaluating their condition. Dallas and Dionne then were admitted to the Medical Center, receiving oxygen and IV fluids for dehydration. A high-flow oxygen device was used on Dallas because his oxygen level kept dropping when he slept, Janie said. 

The twins perked up quickly. They wanted to eat and play with toys in their hospital room. But their airflows still needed monitoring, and they needed rest. Dionne stayed in the hospital for six days; Dallas for nine.  

Janie said she appreciates that because of the referral from Urgent Care, the clinic already had the background on Dionne’s and Dallas’s diagnoses. That made it easier and faster to get checked out by respiratory experts the next day without having to go back to Urgent Care. “It was nice to already know what was going on. We were just following up on that.”   

More info on RSV 

Most of the time, an RSV infection causes a mild illness like a cold. But it can also lead to bronchiolitis or pneumonia in young children. Early symptoms are runny nose, decrease in appetite and cough. Get medical help right away for more serious symptoms:

• Fast, shallow breathing, indicated by the belly moving up and down quickly and the area around the ribs sinking in. 
• Extreme fussiness, can’t be comforted.   
• Sleepiness, won’t wake up for feedings. 
• Poor appetite and fewer wet diapers.  
• Blue color to the lips, tongue or fingernails. 

Help prevent the spread of RSV by washing your hands often, avoiding close contact with sick people, covering your coughs and sneezes, and staying home when you’re sick. 

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)

Cook Children's is currently experiencing a surge in patients diagnosed with RSV, flu and other respiratory illnesses – this is impacting our ability to care for our patients in a timely manner. Other hospitals and children's hospitals around the country are also experiencing high number of RSV and respiratory illnesses.

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, 568 patients went to the Emergency Department, which is equivalent to one check in every 2 minutes. There were 740 patients across our seven Urgent Care Center locations.

This is causing long wait times (8-10 hours) for patients to be transferred to the Pediatric Intensive Care Unit. This is putting unnecessary strain on the health care system.

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)

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 (positivity rate of 14.6%)
• Oct. 30- Nov. 5: 
  • 333 cases (positivity rate of 22.6%)

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

The influx of patients to the Emergency Department is causing long wait times (8-10 hours) to be transferred to the Pediatric Intensive Care Unit. This is putting unnecessary strain on the health care system.

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.

Bring your child to the emergency room if he/she has 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: 

• State of the System: High Census of Patients With RSV & Respiratory Illness (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. According to the Texas Hospital Association, pediatric hospital beds across the state are currently 88% occupied. 

Urgent Care Centers

We had 728 visits across our seven Urgent Care Center locations on Wednesday. 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

We saw 623 patients in the ED yesterday, which is equivalent to one check in every 2 minutes. The influx of patients is causing long wait times (8-10 hours) to be transferred to the Pediatric Intensive Care Unit. This is putting unnecessary strain on the health care system.

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.

Bring your child to the emergency room if he/she has 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.

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
  • o   (23% 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 (positivity rate of 14.6%)

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)

This is resulting in longer wait times. Our emergency department is seeing between 400-500 children each day. Our Urgent Cares are seeing 600-700+ children each day.

A high number of our hospital admissions are RSV cases. RSV can range from mild upper respiratory tract infections to severe lower respiratory tract disease, including bronchiolitis or pneumonia. The increase in RSV and influenza A is happening much earlier this year.

From Oct. 2 to Oct. 8, there were 210 positive RSV cases at Cook Children’s, a positivity rate of 24%.

One week later (from Oct. 9 to Oct. 15), there were 288 positive RSV cases, a positivity rate of 29%. During the same time period, there were 47 positive influenza A cases, a 4.7% rate.

RSV cases normally spike much later in the respiratory season, such as in December or January.

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

Parents should not go to the Urgent Care or Emergency Department for only a flu or a 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.

Laura Romano, D.O., a hospitalist at Cook Children’s, urges parents to keep their children at home when they are sick to prevent the spread of illness, especially to vulnerable populations. Flu, COVID and rhinovirus are also circulating in our community.

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 getting sick.

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.

What are the symptoms of RSV?

In infants younger than six months, RSV infection may result in symptoms of irritability, poor feeding, lethargy, and/or episodes where they stop breathing with or without fever.

In older infants and young children, a runny nose and decreased appetite may appear one to three days before cough, often followed by sneezing, fever, and sometimes wheezing. RSV, COVID, and the flu can all worsen a child’s asthma and lead to an increase in asthma symptoms such as wheezing, waking up at night coughing, and shortness of breath.

Symptoms in adults are typically consistent with upper respiratory tract infections, including runny nose, sore throat, cough, headache, fatigue, and fever. RSV can be a very serious illness for anyone who is immunocompromised. But for most children, it is a minor upper respiratory infection.

If parents begin to see any RSV symptoms in their child, it is important to keep them well hydrated.

Call your pediatrician if:

• You are concerned that your child might have been exposed to either the flu, RSV, or COVID.
• 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.

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.
•  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.

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.
• 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.

They shared how Cook Children’s is currently being impacted by a surge in COVID-19 cases and hospitalizations.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases, Corwin Warmink, M.D., medical director of Emergency Services, Kara Starnes, D.O., medical director of Urgent Care Services, and Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Pediatrics Haslet have all worked tirelessly to ensure our patients and families are receiving the best care throughout the pandemic.

During the news conference, the experts addressed what they are seeing in our urgent care locations, emergency department, and Cook Children’s system as a whole.

“We need compassion from the community and this is an illness affecting our children,” Dr. Starnes said. “We are hitting crisis mode and we can’t do it without your help.”

Cook Children's Urgent Care facilities are being stretched thin. Over the weekend, Cook Children’s was forced to close its Hurst location due to a lack of staff members and high demand for services.

"This is the first time we’ve had to take such measures. We closed in an effort to consolidate staff and safely take care of our patients,” Dr. Starnes explained.

On Monday, the six remaining urgent care locations saw 1,400 children. This is twice the number of patients the urgent care centers typically see.

Dr. Starnes stressed that if you believe your child has been exposed to COVID-19, it is best to find a local testing site in the community or use an at-home testing kit. You can find a list of local COVID-19 testing locations here. 

Cook Children’s Emergency Department (ED) is experiencing patient volumes not seen since the H1N1 pandemic in 2009. On Monday, the ED saw 601 patients with patients arriving every 2.5 minutes.

“We are breaking records we don’t like to break,” Dr. Warmink said. “I have been at Cook Children’s for 18 years and this is the worst it’s ever been.”

We encourage all families to come to the emergency room for emergencies but ask that they do not come for a simple COVID-19 test. This pulls resources away from critically ill and injured patients and takes up already limited bed space. Along with COVID-19, we are still seeing RSV cases but thankfully, they appear to be on a downswing.

“The adults in the room need to step up and do the right thing,” Dr. Warmink said. “If you send your kid to school without a mask, it’s not if they are going to get sick, it’s when.”

Dr. Warmink advises all parents, “Ask yourself if this can wait” before bringing their child into the emergency department.

Most children have mild illness with COVID-19, but that is not the case for everyone. Throughout the course of the pandemic, Cook Children's has hospitalized 1,129 children with COVID-19, with 241 of those admitted to the Intensive Care Unit (ICU). Throughout the pandemic, seven children with COVID-19 have died. Two died this past week. They were a 4 year old and a 15 year old. 

"We are seeing more severe illness than we have seen at any point during the pandemic. The January surge was nothing compared to what we’re seeing now,” Dr. Whitworth said.

As a result, on Monday, Cook Children’s opened up a third COVID-19 unit for the first time since the start of the pandemic. This unit has nine beds – and within the first 24 hours of being open, was completely full.

With Labor Day weekend ahead of us, Dr. Whitworth encourages everyone to be safe, mask up, and socially distance, as we cannot handle another influx at this time.

“Every child that has the virus inside of them has the potential to spread it to someone else, and they don’t mean to,” Dr. Whitworth said. “Much of what we are seeing is 100% preventable, children have to wear a mask.”

Cook Children's also set a record for COVID-19 hospitalizations on Wednesday with 35 patients. This is the highest number of COVID-19 patients hospitalized at the medical center at any point in the pandemic. The COVID-19 ICU was also filled. 

What can the community do to help?

All four experts we heard from on Wednesday have a few simple pleas:

1. Get vaccinated and get your child vaccinated as soon as possible.
2. Please have your children wear a mask to school.
3. Wash your hands frequently.
4. Re-think gatherings – if you gather, wear masks, stay socially distant and gather outdoors if possible.

Across the board, Cook Children's is seeing record numbers of families each day who are wanting rapid COVID-19 tests for their children.

"We understand this is a scary time, but want to remind families not to panic if your child was exposed to COVID-19," Dr. Starnes said. "We understand schools have requirements, but we need you to understand we do not want you to panic or rush in to be seen immediately after an exposure. Rushing to our urgent care locations puts a strain on our resources.”

The best thing you can do if your child was exposed is find a local testing-only site in the community or use an at an at-home testing kit.

Cough, fever, runny nose, sore throat, body aches, headache, vomiting and diarrhea are all common symptoms of COVID.

For children over the age of 3 months, these symptoms can typically be managed at home with symptomatic care. Medications such as acetaminophen or ibuprofen can help with fever and pain. You should encourage your child to drink plenty of fluids and it is ok if they do not have much of an appetite.

Parents should seek care for their child over 3 months of age if they have had 5 days or more of fever, difficulty breathing, inability to keep fluids down or stay hydrated (no tears or no urination for 8 hours or longer) or if their child is having pain or fever that is not helped by an appropriate dose of fever reducer/pain reliever.

Patients under 3 months of age who are sick should be seen in person and evaluated.

Also, if there is at least one known positive case at home and others are sick, it can be assumed that all have COVID and everyone needs to isolate at home for 10 days from the start of symptoms.

“We cannot magically create hospital beds at the drop of a hat,” Dr. Whitworth said. “Wear a mask no matter if you’re vaccinated or not, wearing a mask is not an option.”

The American Academy of Pediatrics is recommending that all children over age 2 wear masks in school this fall. The internet rejoiced, everyone agreed it was a great plan, scientists and politicians shook hands, and no one had anything to say about it.

Ha. Kidding. I promptly picked up some curly fries and wine when I heard about it and laid face-down on my office floor. Not the most sanitary place to do some deep breathing, but whatever.

I hate to joke about serious things like this, but if I don’t, I may cry. The idea of a uniform and agreed-upon plan for halting the spread of a disease that could prevent the deaths of many seems like a pipe dream at this point.

Let’s walk through this and see if I can help you with your decisions this fall.

What did the American Academy of Pediatrics recommend?

• “Everything possible must be done to keep school in-person.” This is because the rates of academic struggle, obesity, and mental health crisis all rose tremendously this past year. Kids need to be in school. We all agree on that.
• They recommend all eligible kids receive the COVID vaccine (12 and up currently)
• Universal masking for anyone in school over age 2 (all students and all staff)
• Flexibility in policy – COVID is an ever-changing scenario and if something isn’t working well, schools need to recognize it and change it
• Attendance of students should be closely watched, and mental health resources for both students and staff should be available
• There should be ongoing federal, state, and local funding to schools to help them with all this.

Why is the AAP recommending all kids wear masks this Fall?

• The AAP is asking all students to wear masks in order to not only protect those that cannot be vaccinated yet, but also the families of these children, and the community as a whole.
• The AAP advocates for children. ALL children. Not just your kid. The wealthy ones. The poor ones. The sick ones. The healthy ones. The physically and mentally challenged. The kid who is being raised by his elderly grandmother and doesn’t have the means or transportation to get that vaccine yet. The kid who doesn’t have enough food at home but gets 2 good meals at school. The child who doesn’t have access to the fancy laptop or functioning internet. The AAP gives us advice based on what will help our community better support and protect our kids.
• Guess what? Last year, we masked in schools. We washed hands more. We asked sick kids to stay home. And schools were then found to not contribute significantly to the spread of COVID-19. (Click here for more information)
• We also noticed a pleasant, NONEXISTENT flu and RSV season as an added side-bonus.
• What happened this summer? We took our masks off, had playdates, saw friends, had parties. And now have plunged into a winter-sized scourge of viral illness. My office has been booked days in advance. The hospital is full. In July. These school strategies work not only in regards to COVID, but all viral illness– both focused studies and my own practice numbers have proven this.

What is the “Delta variant”?

• The COVID virus is mutating (as we expected), and this is the newest and most common version of it in the U.S. right now
• It is crazy, freaking contagious. More so than the original bad boy.
• Verdict’s out on whether it makes you sicker. I suspect it will put a larger burden on hospitals just given the number of unvaccinated people who may be infected.
• Vaccines seem to be working well against it.
• A recent study from the United Kingdom showed that children and adults under 50 were 2.5 times more likely to become infected with Delta.

Why should my vaccinated kid wear a mask?

• Because keeping track of who is vaccinated and who isn’t is a huge burden on schools. And trust me, they have already suffered enough burden.
• Because many kids cannot have the vaccine yet, or haven’t had access to it.
• Because we don’t yet know how well the vaccines work against the new COVID variants and until we are more comfortable with seeing how effective it will be, this is the most low-risk and safe thing we can do.

Will masking harm my kid? Why are all these people saying these awful things about masks?

• Putting a piece of thin cloth on your child’s face does not harm your child.
• I have written one mask exemption this entire year. One. It was for a child with a very rare lung disease. The child’s lungs are anatomically and physiologically very different than a normal child’s and keeping oxygen levels up even without a mask was a struggle for this kiddo.
• The worst I’ve seen is a mild face rash here and there. Otherwise, don’t believe the hype. Masks are not causing TMJ problems, lost social development, increased CO2 levels, increased illness, etc etc. It’s a lot of weak arguments with no evidence and as a pediatrician who saw and examined thousands of children this past year: the kids are fine.

Does masking protect other people? Or me?

• Both.
• Even if your child is the only child wearing a mask in the class, it will protect him. (Click here for more information)
• This all works better if everyone masks.
• If an unmasked sneeze happens nearby, a mask prevents your child from inhaling AS MUCH virus into his airway – and there is brewing evidence that the MORE virus particles you inhale into your body, the more severe the subsequent illness may be.
• I also think it really keeps kids from touching their face, picking their nose, putting fingers in mouth, etc. Our absolute lack of flu and RSV last winter can attest to this.

What if only some kids are wearing masks? Will my kids get bullied?

• I don’t know. I doubt it. We did a whole year where everyone masked and school-aged and young kids were generally pretty cool and flexible about it. Most don’t seem to care either way. The bullies in this scenario often seem to be the adults.

When are the vaccines for the younger kids going to be ready?

• Pfizer’s clinical trial data for children age 5 to 11 is likely coming in September. If approved, shots for kids this age will be available within 1-2 weeks after that.
• Ages 2 to under 5 coming soon after that, in October.
• 6 months to 2 years soon after that.

What about my child under 2 who can’t wear a mask?

• It’s okay. Send them to daycare. Send them to mother’s day out. Do the swim lesson. Get the speech therapy. You need it to work, thrive, survive. COVID seems to be milder in young kids. And while I can never guarantee anything in life 100%, I think the benefits outweigh the risks for kids in this age group.

What if the daycare doesn’t require their staff to be masked? Vaccinated?

• I’m hopeful that daycare centers will strongly encourage their staffs to vaccinate and mask up, but I know that not all will. I think you should ask the questions and expect answers from childcare centers. You can certainly make that a part of your decision-making process when choosing where to place your child.

Do kids really get severely sick with COVID?

• COVID in children is mostly mild. No one debates that. But kids (especially the older kids) contribute to the spread in the community.
• Let’s not forget the times it’s not mild. I’ve seen kids with post-COVID chronic fatigue, long-term smell and taste change or loss, multisystem inflammatory problems, psychosis, and cardiac issues that have kept them out of sports for the year.
• We are still learning about the long-term consequences of COVID infection. There is thought that up to 30% of people who have had COVID will develop long-term medical problems.
• I talked to one of the Cook Children’s Pediatric ICU doctors the other day, Dr. Linda Thompson. I wanted her input about kids with more severe illness as she has seen much more of it than I. She said she’s seen more severe illness in older children compared to the younger ages. She also mentioned “please let everyone know I vaccinated my 14-year-old as soon as I could.”

What do you recommend, Dr. Diane? What will you be doing with your kids?

My kids (6 and 7 years old) will be going to school in-person this fall. They will be wearing masks regardless of what the other children are doing. They can take them off when outside. We will talk about it a lot before it happens, and expectations will be clear.

We will practice wearing them while we watch our screen time to get used to them again on our faces. We will pick the favorite fabrics. If our community numbers drop and my children are able to safely get vaccinated this winter, I can’t wait to tell them to take ‘em off.

But until enough of us get vaccinated, COVID is not going away. And it will likely surge again this winter.

As long as the numbers keep climbing in the community, we have to protect not only the kids, but all of us. Remember those hospital numbers in January? Remember the goal of not over-straining our medical resources? Remember Uncle Pete who had a heart attack and there wasn’t a single hospital bed available for him last winter?

I’ve said it before and I’ll say it again: we are building this boat as we float in it. We don’t know what the future holds for us and we are making the best decisions we can in a situation that no one has yet conquered. Having patience as we gather the data and learn from our successes and mistakes is the beautiful and necessary process of science.

"He would have coughing bouts where he was choking," Crowell said.

Bridger is among the children battling a rare summer outbreak of a virus that attacks the lungs. Parents around the country are being warned about Respiratory Syncytial Virus, or RSV, a disease that infects the lungs and breathing passages and usually occurs in the winter. 

Healthy people typically experience mild, cold-like symptoms, including cough, congestion and fever. But the virus can be serious among infants and the elderly, leading to as many as 14,500 deaths a year. The virus is responsible for more than two million outpatient visits a year for kids under five.

"This is more RSV so far than we had three or four years ago in a typical winter season, and the numbers here are still climbing," said Dr. Suzanne Whitworth, the medical director of infectious diseases at Cook Children's Medical Center.

The U.S. is in the midst of an unusual summer surge, especially among southern states. Those seeing a surge include Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee and Texas, according to the Centers for Disease Control and Prevention. 

"For the last 15 months, no one in the United States has been exposed to RSV. So we've got a lot of susceptible hosts," Dr. Whitworth said. "The other thing is, the masks are off, we're moving back closer together, more indoor activities, more moving life towards normal."

Bridger is getting better, but it could be days before he can leave the hospital.

"If your child starts experiencing any kind of cold symptoms, take it seriously," Crowell said.

Read the full story here.

Speaking with Yahoo! News this week, Jason Terk, M.D., called the summer surge 'unprecedented.'

“If you look at typical RSV, it’s a type of illness that we see usually starting in late fall into the wintertime and then goes away usually by late winter, early spring," he told the online publication. 

Dr. Terk, a pediatrician at Cook Children's Pediatrics in Keller, says serious cases of RSV can occur but are rare.

“Most of the time RSV causes an illness that is entirely manageable at home with use of the usual things that we recommend for viral respiratory infections — nasal saline, suctioning and humidification,” he says. “If there’s a worsening of the respiratory status or they have a hard time breathing, then they need to be seen by their physician.”

Read the full story here.

“When will this cough ever go away?”

These and similar questions have been the topic of the last month at my practice.

And while I know parents are annoyed and I’m annoyed and the kids are annoyed - everyone’s annoyed - most of the time we don’t need to be concerned.

Here’s why I think kids have been sick A LOT for the last few months:

1. Cold and upper respiratory virus season were delayed due to masks and social distancing-which are starting to go away.
2. A season of terrible weather changes from hot to cool, dry to wet and everything in between and back again.
3. A wicked allergy season which tons of mountain cedar, pollen, grass, mold, etc. (Thanks to all the rain.)
4. The beginning of summer illness season with lots of fevers and rashes and insect bites and swimmer’s ear.

We see all four of these things every year, but we usually see them spread out over six months instead of crammed into two.

So what do we do?

Try to keep calm. Several mild illnesses don’t necessarily mean something bad is happening-it’s usually just bad luck.

Talk with your doctor. If you’re worried something else is going on, ask your doctor.

Consider testing if in addition to several mild illnesses, you have some severe illness or mild illness that doesn’t respond to typical treatments.

“You don’t typically have two viral epidemics at the same time,” Dr. Whitworth said. “We’ve never had an RSV outbreak in June.”

Dr. Whitworth says the medical center began to see RSV patients in early May. Over the last few weeks, there has been an increase in RSV patients and the number is rising each week.

“The numbers reflect inpatient and outpatient testing done at the medical center,” Dr. Whitworth explained. “It looks like we could have an RSV season ahead of us at an unexpected time of year.”

According to Dr. Whitworth, RSV is a very common respiratory virus that we all get every one or two years throughout our lifetimes. The first time you get it, you might be sicker and some children require hospitalization, but most do not. In infants younger than six months, RSV infection may result in symptoms of irritability, poor feeding, lethargy, and/or episodes where they stop breathing with or without fever. In older infants and young children, a runny nose and decreased appetite may appear one to three days before cough, often followed by sneezing, fever, and sometimes wheezing. Symptoms in adults are typically consistent with upper respiratory tract infections, including runny nose, sore throat, cough, headache, fatigue, and fever. RSV can be a very serious illness for anyone who is immunocompromised. But for most children, it is a minor upper respiratory infection.

“The virus is spread by respiratory droplets and can be spread from person to person very easily,” Dr. Whitworth said.

If parents begin to see any RSV symptoms in their child, Dr. Whitworth says it is important to keep them well hydrated.

“They can use Tylenol if they have a fever,” she said. “Cough and cold medicines are not routinely recommended for children two years old or younger because of the side effects.”

She says if parents are worried that their child is having difficulty breathing, or if they are concerned that their child is lethargic, not eating or drinking enough, or irritable, they should call their primary care physician.

Dr. Whitworth says the most important thing to stress is, “RSV is common, and most children don’t require any treatment at all.”

This trend at Cook Children’s is a part of a larger RSV outbreak across the South. Late last week, the Centers for Disease Control and Prevention (CDC) issued a Health Advisory Network warning to health care providers to be on alert for the virus.

Important to note:

Cook Children Urgent Care facilities do NOT test for RSV. Please discuss any questions with your child’s medical team.

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.

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.

More than 1.5 million people visited checkupnewsroom.com. We thought we would take a look back at our most popular stories written in 2018. Let's start the countdown:

10. Couple Fights To Give Child Abuse Victim, Foster Chlid Forever Home: We begin our countdown with one of the most heartwarming stories of the year. Read about a wonderful family, their fight to make baby Jett their own and the help Cook Children's provided them.

9. Let's Learn Something About Hand, Foot and Mouth Disease!: Leave it to Dr. Diane to make "Hand, Foot and Mouth Disease" interesting.  All of her "Let's Learn" About posts do well and this was no exception.

8. 5 Children Treated for Bath Drownings at Cook Children's in One Month: Sadly, we once again had to talk a lot about drownings in 2018. But we didn't just warn about the dangers of pools or lakes. In May of this year, we got an important message out: "Don't leave your child alone in the bathtub."

7. Father who nearly lost son to a Tide Pod reacts to ‘Tide Pod Challenge’: Remember the Tide Pod Challenge fad of 2018? One family did not think it was amusing. Chris and Heidi Slaydon know all too well the dangers of a child swallowing a laundry detergent pod.

6. What Is Guillain-Barré syndrome?: When we learned that Dallas Cowboys center Travis Frederick  had been diagnosed with this rare neurological disorder, it gave us a chance to talk about GBS. Cook Children's neurologists see between 6 to 10 cases per year.

5. 'Is it RSV?': By the end of November, 178 kids had tested positive for RSV. Here's a quick look at what respiratory syncytial virus is. 

4. Is That Blue Vein Across Your Child's Nose a Sugar Bug?/Here's What You Need to Know About Kanmushi and Sugar Bugs: Have you ever noticed a prominent blue vein across your child's nose? Our Doc Smitty wrote two posts about Sugar Bugs and they both made our Top 10.

3. Can Elderberry and Other 'Alternative' Medications Treat Colds and Flu?: We may have only scratched the surface in talking about Elderberry (look for more articles in 2019), but here's the first post we published on the topic. 

2. Is It Strep Throat or The Flu?: We published this helpful overview to distinguish whether it's strep or flu in January of 2018 and it stayed in our top 10 throughout the year on its way to the No. 2 spot. 

1. Juul, Other E-Cigarettes Called an 'Epidemic' by FDA Chief: With more than 75,000 views, this was our most read story we published this year. We reported on this topic a few times during the course of the year because new information came out about the dangers of e-cigarettes and kids. We talked to Don Wilson, M.D., an endocrinologist at Cook Children's, to learn more about this topic. 

That wraps up another great year. Thank you for reading. We will be back with much more in 2019 and drop us a line in the comments below for any articles you would like to see our experts discuss.

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). 

While flu always receives a lot of attention, I thought this would be a great time to talk about RSV. Of the 273 kids tested last week at Cook Children's, 78 tested positive for RSV at Cook Children's, while only two tested positive for Influenza A. 

Each year, thousands of kids flood the Cook Children’s Emergency Department with bronchiolitis, and countless more are seen by their pediatrician. Children with bronchiolitis may have a stuffy nose, cough, wheezing, fever, or fast and hard breathing.

So what is bronchiolitis, you ask? It is an infection of the small airway tubes in the lungs caused by a virus. It mostly affects children under 2 years old. The small airway tubes in these young children become swollen and fill with mucus.

The viruses that cause bronchiolitis live on surfaces. Your child may touch a surface contaminated with the virus at daycare, at the park, or even at the grocery store. The best way to prevent the spread of the virus is to wash your hands. We also know that children around cigarette smoke may become sicker from the virus because their airways are already irritated, so it is best to not smoke around your child.

Bronchiolitis is a frustrating illness for parents and doctors too. Children with bronchiolitis don’t sleep well due to stuffy nose and cough causing frequent nighttime wake ups. Your child’s snot can feel like a constant faucet. Unfortunately, there isn’t much we can do as parents or doctors to make it better.

The virus has been around for many years, which has given doctors lots of time to try out different medicines to try to make it better. In the past, doctors have tried breathing treatments like albuterol, steroid medicine, cough and cold medicine, and even sometimes antibiotics. We now know that these things don’t help and can make things worse.

Antibiotics treat bacterial infections, not viruses like bronchiolitis. Giving your child antibiotics when they aren’t needed may cause diarrhea, and over time can cause bacteria to become resistant to antibiotics. Breathing treatments are good for asthma, but the wheezing caused by bronchiolitis is different than the wheezing caused by asthma. Unnecessary breathing treatments can make children feel jittery and can make their heart beat too fast. Cough and cold medicines do not work either, and have dangerous side effects in children. The American Association of Pediatrics advises that children under 4 do not get these medicines.

Your doctor can listen to your child with a stethoscope and tell if they have bronchiolitis. A chest X ray is not needed, and doctors try to make sure that we never expose children to radiation from X rays when it is not needed. There are some tests that can tell if your child has a virus like RSV. These tests involve putting a swab in your child’s nose. Unfortunately, proving a child has a virus does not help us treat them better or change the way we manage their illness. For this reason, doctors will probably choose not to put your child through this uncomfortable test when it won’t make a difference.

The best way to treat bronchiolitis is to support your child and let their immune system do the work. This means making sure they have plenty of fluids and sleep. You also can help them clear out the mucus by using a cool mist humidifier and loosening up the mucus with saline drops in the nose. Do not use water.

Children under 2 have a hard time blowing their nose. You can help suck out the mucus in a couple of ways. One is the bulb suction that you likely received when your child was first born. There are also several new suction devices in stores that are easy and work well. One is called Nose Frieda. You should try to suck out the nose if your child is sounding very congested and before they eat.

You should call your doctor if your child is breathing very fast, using extra muscles between the ribs to breathe, is difficult to wake up to eat, will not calm down and is very irritable, or if you are worried about their fever. Tylenol can be used for fever, and ibuprofen can be used if your child is older than 6 months. If your child is younger than 2 months old and has a fever, you probably need to see a doctor right away.

You should head straight to the doctor’s office or emergency room if your child is blue around the lips or face, is struggling for each breath, or is limp and floppy. These are signs of serious illness. Thankfully, most of the time bronchiolitis is much more mild. Even mild symptoms can be scary for parents. Always talk to your doctor if you are worried or have a question that is specific to your child’s illness.

What is a Hospitalist?

Dr. VanVliet is a hospitalist at Cook Cook Children's. Cook Children's Hospitalist Group is a team of board eligible and certified pediatricians who specialize in caring for patients while they are admitted to Cook Children's Medical Center. One of the hospitalists will see your child daily and is available 24 hours a day to manage any urgent medical needs of hospitalized children. Click to learn more about them and how they care for your child.

If you want proof, read this diverse list of our most popular stories of 2016. We hope you enjoy our look back:

10. 7 Ear Infection Myths Every Parent Should Know. Parents flocked to this blog from Doc Smitty. Can your child go swimming with an ear infection? Do all ear infections need antibiotics? If your child gets ear tubes, will the infections stop?  All this and more was answered in this blog.

9. 7 Online Challenges This ER Doctor Warns Could Be Deadly Oh the Internet. Where kids do all kinds of things to get noticed and maybe go to hospital in the process. We asked our medical director of the Emergency Department to look at seven really silly, really dangerous dares that kids (or grownups for that matter) shouldn't try at home. 

8. Almond Milk: A Nutty Fad or Healthy Alternative. Almond milk sales have gone through the roof over the past decade. But is it the right drink for your child? Doc Smitty gave the answer in this informative piece. 

7. The Death of Ethan: A Life of Chronic Pain Ends in Tragedy. This is the most recent entrant in our list of top 10 stories. Only the fact that it was published in December kept this story out of the top five. We were so honored that Ethan's parents shared their son's story of a life filled with chronic pain. They want you to read it to learn about their son and hopefully help other children who may be suffering as well.

6. New Hope In Fight Against Deadly Brain-Eating Amoeba. The Lewis family holds a special place in the hearts of everyone involed in the Checkup Newsroom. Following the tragic death of their son Kyle to a brain infection caused by a water-born amoeba, Jeremy and Julie Lewis created Kyle Cares. Read their inspiring story as they fought to bring a drug to Cook Children's and other hospitals around the nation that may save children's lives.

5. 11 Tips That Could Save Your Daughter's Life.  In Janaury 2016, Rylie Whitten made national headlines after suffering one of the worst cases of toxic shock syndrome (TSS)  that her doctors had ever seen. Rylie's story moved us to run this informative piece on TSS that we hope every parent of a daughter reads.

4. A Sign From Heaven: Family Travels Across U.S. For Care at Cook Children's. A family's desperate search for answers on Google led them to Cook Children's. Read the fascinating story of what led this family to travel from Detroit, Mich. to Fort Worth, Texas, to be treated for a rare condition called hyperinsulinism.

3. The Most Common Rash You Never Knew About. Ever heard of molluscum contagiosum? We hadn't when Dr. Diane Arnaout wrote this blog for the newsroom. Dr. Diane's informative blog "that will save you and your child pain, money, time and anxiety" went viral quickly and became our third most read story of the year.

2. RSV On The Rise: 6 Things Every Parent Should Know. Here we are at the beginning of 2017 and we have been lucky in that we haven't seen much flu yet at Cook Children's. But we have seen plenty of RSV (respiratory syncytial virus), which explains the popularity of this great blog from Dr. Lizy Varughese.

1. Let's Learn Something: Bouncers, Jumpers and Walkers. Dr. Diane Arnaout's "Let's Learn Something" series was a big hit this year and none were bigger than this tale of caution. Dr. Diane's blog on how baby bumpers, bouncers and activity centers could play a role in your baby's motor delays is our most read new story of 2017. You've probably read this blog. But if you aren't one of the more than 117,000 readers who took a look, now's the time. And if you have read it, feel free to click again.

Well, that's it for 2016. Thank you all for reading. We'll be back with plenty more stories to tell in 2017.

Cases of RSV (respiratory syncytial virus) infections in North Texas commonly increase in the winter. But this year, it's arrived earlier than usual. During the week of Nov. 20, 2016, 47 Cook Children’s patients tested positive for RSV. During this same time frame in 2015, only 9 kids had tested postive and the number was 18 in 2014.

A simple cold can quickly progress to bronchiolitis caused by the RSV virus, especially in kids under 2 years old. As a parent, here are a few things you need to know about RSV.

1. What is RSV?

RSV is a virus that impacts the respiratory tract, including both the upper and lower airways. It usually starts with cold-like symptoms, such as a stuffy nose and sneezing, but could progress to include a cough, fever or wheezing.

2. How does my child get RSV? Is it contagious?

The virus is spread through droplets caused by coughing and sneezing that linger in the air or land on surfaces. This virus can live on surfaces for about six hours and survive in the air for about 30 minutes.

3. How long does the illness last?

Illness can begin between four and six days after exposure to the virus, and can last for a week or two. Symptoms may continue longer in infants or patients with weakened immune systems.

4. How is it treated?

In most cases, supportive care is all that is necessary. This includes elevating the head of the bed, running a cool mist humidifier and using a nasal bulb for suctioning to clear secretions. Some children develop wheezing, in which case treatment with prescription albuterol through a nebulizer may be helpful. In more severe cases, deep suctioning, supplemental oxygen and hospitalization may be necessary.

5. When should I be concerned?

If your child is having difficult or labored breathing, as evidenced by retractions (tugging of the muscles around the ribs and abdomen), nasal flaring or shallow breaths, they need to be evaluated by your pediatrician.

6. How do I prevent it?

As with any other airborne disease, it is important to cover coughs and sneezes to prevent spread of the virus. Kids should avoid touching faces with unwashed hands, practice good hand-washing techniques and avoid contact with sick individuals. Parents should keep surfaces, like crib railings and toys, sanitized regularly and use disinfectant sprays. There is a vaccine available for certain premature babies or babies with underlying diseases. Talk to your pediatrician to see if your child qualifies for the vaccine.

In the absence of complications, RSV can usually be handled at home with supportive care and kids will feel better fairly quickly. If your child’s symptoms concern you or they show signs of difficulty breathing or dehydration, see your pediatrician right away.

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 vaccine is only in the beginning stages and part of ongoing research, so it will not be available to the public any time soon. But if a vaccine does become available, it has the potential to be a lifesaver for children across the world.

NBC News reports that a team at the National Institutes of Health has genetically engineered a virus that should be safe and effective against RSV, which kills 200 U.S. children a year and hospitalizes 75,000 more. RSV can lead to several types of diseases, ranging from a cold to pneumonia.

So how big would this be? Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s says a vaccine that can prevent RSV will be a difference maker for all of us.

“In terms of preventing hospitalizations, emergency room visits and outpatient clinic visits, it would be huge for infants and toddlers,” Dr. Whitworth said. “Everyone has RSV at least once in the first two years of life. It may just be a minor cold or it could progress to involve the lungs and cause wheezing. We then acquire it regularly throughout our lives as some of our winter colds. In older children and adults, who are generally healthy, it is just a mild respiratory tract infection. But we are all impacted in some way by RSV.”

A new vaccine for RSV is the latest in a line of vaccines that have helped fight against diseases such as the flu and the whooping cough. Dr. Whitworth hopes that this latest medical breakthrough serves as a reminder of the importance of vaccines and why the medical profession seeks them out.

“Scientists all over the world dedicate their lives and careers to developing vaccines because they feel passionate about preventing disease and death,” Dr. Whitworth said.

In the meantime, Dr. Whitworth says families can help prevent the spread of RSV through good handwashing, cough hygiene (covering your mouth with your elbow), using tissues, etc.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

Ailments run the gamut from respiratory and fever issues (RSV and influenza) to gastroenteritis with vomiting, diarrhea and severe dehydration. And while there’s not one illness that stands out, one thing is for sure – children in the ED are sicker than they’ve ever been.

“Our ED is running beyond full capacity and has been since December. But in the last few weeks we’re seeing a larger number of very ill children than even during flu season.” said Corwin Warmink, M.D., assistant medical director of the Emergency Department at Cook Children’s. “The sicker the child, the longer it takes to diagnose, treat and properly care for them.”

In December, 20 to 30 kids were admitted for treatment per day from the Emergency Department, but by February, those numbers jumped to about 40 to 50 children a day.

The Emergency Department is averaging nearly 400 patients per day, and during its busiest times a patient will check in every two minutes.

Overall, children appear to be sicker this year. Compared to this time last year, Cook Children’s has seen a 60 percent increase in the percentage of children who need critical care.

As the number of patients admitted and treated in the ED increases, so does the time physicians spend with each child, which contributes to the much longer waiting times.

Depending on the severity of the illness or injury, it could take 4 to 6 hours to care for a child. But it’s not just one physician treating that child. Nurses and health care providers may be brought in too.

“Many of the children we see are dealing with very serious emergencies and they receive immediate care,” Dr. Warmink said. “We use all necessary resources and manpower to care for those children. Unfortunately, that means longer wait times for the families in the waiting room.

“Families could spend anywhere from 5-10 hours or longer in our waiting room, depending on the day they visit. We are actively bringing in extra doctors, nurses and support staff to try and improve these times.”

Dr. Warmink advises parents that Sundays and Mondays are the busiest days of the week in the ED. Evenings after 5 p.m. seem to be popular too.

Families with sick kids who aren’t experiencing emergencies do have other options. The first line of defense is your child’s pediatrician. Making an appointment with a child’s doctor may help avoid a long wait at the ED. Cook Children’s also has several Urgent Care Clinics for non-emergent needs.

Previous articles on this topic:

• More flu, longer waits in the ED
• Emergency? 6 signs from an ER doc
• Cook Children's to build new South Tower on main campus
• Is it RSV?
• 8 flu myths I wish would go away