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

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

So, will we get lucky again this year?

I doubt it.

And here’s 3 reasons why:

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

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

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

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

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

Will and Anna Esler, Ayla's parents, answered a few questions for us to help us learn more about Ayla and what the family has experienced over the past year.

How did you find out Ayla was deaf?

Ayla failed her newborn screening at the hospital, and after we took her back and she failed it again, we were referred to a great audiologist here in Amarillo who helped us begin to discern the depth of her loss. From there we started working with Early Childhood Intervention, who helped us learn what life is like for kids with hearing loss and introduced us to an amazing community of parents and kids with hearing loss. We also started working with Ayla’s speech therapist, has become a dear friend and has done so much for our whole family—she even came with us to Fort  Worth for Ayla’s surgery and her activation—and she’s helped us learn what Ayla’s loss and now her newfound hearing means for the whole family. After a few months in, we were connected to the amazing team at Cook Children’s, who have gone above and beyond to help our daughter hear. The care that we’ve received from them has been extraordinary, and we’re so grateful for them.

What was going through your mind when Ayla’s implants were activated?

Anna: Every child responds differently when their cochlear implants (CIs) are activated, and so we didn’t know what kind of reaction she would have. And even though I knew it would work, there was still some doubt in my mind, so when I saw her responding to sound I was overwhelmed by thankfulness to God and to everyone else who has been a part of this journey.

Will: Ayla has had a lot of family and friends praying for her, and we saw God answer those prayers when her devices were activated. Like Anna, I was excited and scared and nervous and hopeful all at the same time. I thought she would probably cry and scream when her CIs were activated—and she did do that later when it became overwhelming—but to see her hearing sound and enjoying it was just incredible.

What was it like getting to this point?

Being deaf isn’t bad, it’s just different, and so we had spent a lot of time preparing ourselves for what life would be like without Ayla hearing. We had to let go of some things, like her knowing the sound of our voices, the sound of music, the sound of laughter. We had to prepare ourselves to see her enjoy those things in a different way, through the vibration of them, to “hear” with her eyes. When we found out that cochlear implants were an option for her, sound became a reality for her again, and we are so grateful for that. 

How is Ayla responding now, what kinds of changes have you seen?

She still has challenges ahead of her—we have a year’s worth of catch up to play, and whereas most kids learn to hear naturally we will actually have to teach her to hear, to teach her that sound has meaning. But she’s already responding positively—sometimes she turns to sounds (which she had never done before), she dances to music, she’s starting to calm down when we sing to her if she’s upset. We really couldn’t be more thankful for the new opportunities our little girl has thanks to everyone in her life.

Ear, Nose and Throat Program at Cook Children's

We know it's about more than medical expertise and advanced technology. It's about working together to tackle even the most complex ear, nose and throat conditions. At Cook Children's, our expert pediatric specialists diagnose and treat many ear, nose and throat conditions. The Ear, Nose and Throat (ENT) staff also collaborates with other specialties within Cook Children's system to treat and rehabilitate children with speech and hearing disorders. Meet our team by clicking here. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 682-885-6850 or click here.

Watch Doc Smitty talk about the causes, treatments and concerns of your child's sore throat.

Watch all of our My Kid Minute videos here.

Along with this goal of each child’s attendance, we have to balance the goal of keeping others safe from infectious diseases. Our contagious students need to stay home when they are sick to keep the rest of their classmates safe. (This is why I don’t really care for perfect attendance bike raffles. I prefer responsible attendance.)

Balancing these tensions is often hard for the parent, the school and the pediatrician because we often don’t know exactly when a child is no longer contagious. This is why I got so geeky excited last week to see a new study released in the Pediatric Infectious Disease Journal about the contagiousness of strep throat.

The study looked at 111 children with strep throat over two days.

Day 1: Children who tested positive for strep were given their first dose of amoxicillin before 5 p.m. (They also had cultures taken which allow to see if bacteria will grow from a swab of their throats.)

Day 2: Children were retested and cultured for strep in the morning to determine if they still carried the bacteria in their throats.

Here is what they found:

• 101 children tested negative for strep on the morning of day 2.
• 7 children had significantly decreased growth of bacteria from their throat cultures.
• 2 children continued to have high loads of bacteria.

The author’s conclusion: “all children treated with amoxicillin for streptococcal pharyngitis (strep throat) by 5 p.m. can, if afebrile (fever free) and improved, may be permitted to return to attend school on day 2.”

I’m pretty sure you’re not as excited as I am, but THIS IS HUGE!

Based on current guidelines, children must be treated for 24 hours before being allowed to return to school. If we treated according to the results of this study, it would allow for the child to be back in school and for the parent to be back at work a whole day earlier.

I feel like there is a lot of work to be done in this area and this type of study, along with other models of health care delivery, are good examples of the work that will be necessary.

Because I value education and our school districts so much, I want to be constantly thinking about ways we can do this better. As a general pediatrician, I can really boil down the goals of my job to these:

1.Keep kids growing and healthy.

2.Keep kids developing and learning.

Early in your baby’s life, this looks like frequent checkups for preventing illness, monitoring growth (and talking about diet) and teaching ways that parents can help their child with development. (Read: Everyone should homeschool.)

As your child gets older and starts school, my role changes a little bit. I don’t ask my elementary age patients about fractions or my high school students about “The Great Gatsby.” Instead, I might ask, “How is school going?” “Any problems I need to know about?” “Any way I can help?”

On a practical level, this means offering school aged children after school appointments when possible. It means getting sick kids in the same day so that we can start treatment and get them back in their desks as soon as possible.

In the future, this may mean totally different modes of delivering health care and working with the school and school nurses in order to decrease missed class time.

But I’m getting ahead of my geeky self again. I’ll save that discussion for later.

“He snores just like his daddy.”

Are these things that you have said about your child? If so, you may want to ask your doctor if your child might have sleep apnea. Because pediatricians often forget to ask about snoring during checkups, it is not uncommon for the diagnosis of sleep apnea to be significantly delayed or even missed altogether.

It is probably more common than you think. I spoke with Natalie Roberge, M.D., an ENT (ear, nose and throat) doctor with Cook Children’s, who estimates that obstructive sleep apnea occurs in 1-5 percent of children.

Snoring alone does not make the diagnosis of sleep apnea. Here are some of the other symptoms that could be present:

1. Pauses in breathing. (If your child snores, it might be worth listening to them occasionally to see if you hear these).

2. Bed-wetting.

3. Mouth breathing (at night or during the day).

4. Daytime sleepiness.

After discussing symptoms and examining your child, the doctor may recommend a sleep study. During a sleep study, a child will be observed for many different characteristics of their sleep including: apnea, excessive movement and level of oxygen in the blood during sleep.

There are many causes of sleep apnea but according to Dr. Roberge, “The most common cause in children is large tonsils and adenoids. The next most common, potentially treatable cause is obesity. Other causes include craniofacial, genetic and neurologic disorders.” If your child has any of these risk factors, it is important to pay closer attention to his or her snoring and quality of sleep.

Sleep apnea is treated differently depending on the cause of the apnea. If large tonsils are the problem, the pediatrician and ENT might recommend having them removed. If the child is obese, addressing healthy lifestyle and decreasing excess weight may help to improve the apnea.

It is important to address apnea for many reasons. You can find many different conditions associated with sleep apnea such as bed-wetting, ADHD and other behavioral problems, as well as hypertension and other cardiovascular problems. The consequences of untreated sleep apnea can be missed because they are common in many children.

Despite the fact that it might be fun to tease your child about his or her snoring, it is important that we consider the serious consequences of snoring and sleep apnea. If you have questions, please discuss them with your pediatrician and they can recommend a referral to an ENT if it is necessary.

About our sleep lab

The staff in our Ear, Nose and Throat Center collaborates with other specialties within Cook Children's system to treat and rehabilitate children with speech and hearing disorders. At Cook Children's, we can diagnose and treat many ear, nose and throat conditions. Our expert pediatric specialists have access to many services within Cook Children's system to provide your child with the best care.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joined Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.