Flu Is Spiking Early in East Tennessee, and a Dolly Parton Children’s Hospital Pediatrician Lists What Parents Should Have Ready Before a Sick Day

About 2 percent of all outpatient visits across Tennessee were for flu-related illness in the final week of October, and Dr. Andrea Horbey, a pediatrician at Dolly Parton Children’s Hospital in Knoxville, said that is a sign the season has started early in East Tennessee. She told WVLT that families should have a working thermometer, children’s fever reducers and electrolyte fluids in the house before anyone gets sick.

Her list also includes saved phone numbers for the pediatrician and the after-hours triage line, and a backup plan for child care on sick days.

The Sick-Day Shelf Dr. Horbey Wants Stocked

The checklist is short, and the point is to have it ready before a child wakes up with a fever at midnight. Horbey listed a working thermometer, children’s fever reducers and electrolyte fluids, which guard against dehydration.

She also said to keep the pediatrician’s number and the after-hours triage line’s number handy, and to arrange a child care backup plan. That includes checking an employer’s sick-leave flexibility, since a flu week can pull a parent out of work for days.

The American Academy of Pediatrics’ guide to the flu for parents backs the fever-reducer part with a caution. Acetaminophen or ibuprofen can ease discomfort, using the doses a pediatrician recommends for a child’s age and weight. Ibuprofen is approved for children 6 months and older, but the AAP says to avoid it if a child is dehydrated or vomiting continuously. It also says never to give aspirin during flu, because it is linked to Reye syndrome.

What Early Means in the Numbers

Horbey said the current levels are mild to moderate, but cases usually climb sharply in November and December. This season, she said, has definitely brought an early spike.

She linked the rise to fall weather, children’s play dates, and kids being back in school and daycare. Because the numbers count only people who seek care, she said, the amount of flu actually circulating is likely much higher than the 2 percent figure suggests.

Why the Flu Shot Comes Up Again

Horbey called annual vaccination the single most reliable safeguard against severe illness, and compared the flu shot to wearing a seat belt: it prevents the worst-case scenario, not because anyone expects a crash. She added that vaccinating also protects people who cannot be vaccinated, including infants under 6 months and people with weakened immune systems.

The Centers for Disease Control and Prevention’s page on flu and children says everyone 6 months and older should get a flu vaccine each year. It says September and October are generally good months and that everyone should ideally be vaccinated by the end of October, but that vaccination later in the season can still help while flu is spreading.

Children 6 months through 8 years who are being vaccinated for the first time, have had only one previous dose, or have an unknown history may need two doses, the CDC says. The second dose comes at least 4 weeks after the first, and a health care provider can confirm whether a child needs two. The nasal spray is approved for ages 2 through 49.

The AAP’s flu overview notes that it takes about two weeks after the shot to build immunity, and that the best time is before Halloween but any time during flu season counts.

How Flu Shows Up in a Child

Flu strikes suddenly, Horbey said, unlike a common cold, which develops gradually. She described a child who seems fine and an hour later has a high fever and exhaustion. Other symptoms include general malaise and respiratory symptoms, and frequently nausea and vomiting.

The CDC’s signs and symptoms page lists fever or chills, though not everyone with flu gets a fever, along with cough, sore throat, a runny or stuffy nose, muscle aches, headaches and fatigue. Vomiting and diarrhea are more common in children than in adults. Fever typically lasts three to four days, and most people recover in a few days to less than two weeks.

The AAP says flu in children usually lasts about a week or longer and often brings a fever above 100.4 degrees Fahrenheit with chills. It recommends calling the pediatrician within 24 hours of the first symptom for children with a chronic condition, children under 5 and especially under 2, or those whose symptoms are not improving, because antivirals work best when started within the first one to two days.

To cut spread at home and at school, Horbey recommended frequent hand washing, wiping down surfaces, covering coughs and keeping sick children home from school. She also suggested wiping children down with sanitizing wipes as soon as they get in the car after school.

When a Sick Day Turns Into an Emergency

Most flu cases resolve within about seven days with rest and fluids, Horbey said. She listed the situations that call for immediate medical care: infants under 3 months, children with chronic heart or lung conditions, signs of severe dehydration, or any time a parent feels something is wrong.

The CDC’s emergency warning signs for children include fast or troubled breathing, bluish lips or face, ribs pulling in with each breath, chest pain, and muscle pain so severe a child refuses to walk. It also lists dehydration, meaning no urine for 8 hours, a dry mouth or no tears when crying, and a child who is not alert or not interacting when awake. Seizures, a fever above 104 degrees Fahrenheit that medicine does not control, and a fever or cough that improves and then returns or worsens are on the list as well.

In children younger than 12 weeks, the CDC says, any fever is a warning sign. The agency says the lists are not all-inclusive, and that anyone worried about a severe or concerning symptom should contact a medical provider.

The CDC also notes that children under 5, especially under 2, and children with chronic conditions such as asthma or diabetes are at higher risk, and that in the 2023-2024 season 70 percent of hospitalized children ages 0 to 17 had at least one underlying condition. Prescription antiviral drugs, it says, can be a safe and effective treatment option for children with flu.

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This article was produced with AI assistance and edited for accuracy against the sources linked above.

Image: Shixart1985 – CC BY 2.0/Wikimedia Commons