Ellie Rudd will be buried in a light blue and white Princess Elsa costume, made for her as a last gift from her aunt. “Frozen” was one of her favorite movies.
The rambunctious 4-year-old – who loved mud and getting dressed up and having dance parties with her brother and sisters – died January 6, after the flu and a co-infection with an adenovirus turned into pneumonia and sepsis.
“She was probably my healthiest of all my kids,” said her mom, Sarah Rudd.
“She had no medical issues. No eczema, no cavities in her teeth, nothing. She was completely healthy,” she said. “I have no idea why it hit her so hard.”
This season, at least 17 children in the United States have died from the flu, a number that will grow as more states report their numbers to the US Centers for Disease Control and Prevention. The last flu season, which spanned the winter between 2024 and 2025, set a record for the most pediatric deaths in a season, with 289.
This year’s flu season has proved to be even busier than last year’s, with outpatient visits for “flu-like” symptoms reaching their highest level in nearly 30 years, driven by a new virus strain called subclade K. And infectious disease experts fear this year may turn out to be even deadlier than last year.
“There was a strain that emerged after we had a chance to make the predictions for our current flu shots, so it was too late to change any of our vaccines,” said Dr. Buddy Creech, a pediatric infectious disease expert at Vanderbilt University. Although subclade K isn’t included in this year’s shots, studies have shown that many people do generate antibodies against it when given the current flu vaccines.
Still, “we’re seeing what happens when there’s a bit of a mismatch and when enthusiasm over getting vaccinated is low, and again, that one-two punch is leading to a really significant flu year,” Creech said.
The flu arrived at the Rudds’ house in Ogden, Utah, on Christmas Day.
Sarah, a mom of four, was the first to get sick. She had it for about a week, she says. “It was pretty rough, but everybody else seemed to be just fine,” she remembers.
Then the baby, 14-month-old Dani, developed a fever that would come and go, but she seemed to bounce back quickly. After that, dad Michael also began having intermittent fevers. By the time he began feeling better, the three older children – Mary Jane, 6; Ellie; and 3-year-old Kyler – had caught it, too. They began showing symptoms on New Year’s Day.
“Neither Michael nor I have ever had the flu shot before, and so we just don’t think about getting it,” she said.
“Honestly, I don’t even know if it would have helped in this situation, as it seems like it might have been a different strain,” she said. “We don’t know.”
For the most part, Sarah says, people have been kind, but she and her husband have also been hurt by comments from strangers who second-guessed their medical decisions.
“I feel that we made the best choice that we could at the time,” she said.
Initially, Mary Jane seemed to be the worst off of the three older kids. Her fevers spiked to 102 degrees, so Sarah began alternating ibuprofen and Tylenol to keep them under control.
Ellie and Kyler seemed to quickly return to their normal energetic selves after a dose of children’s ibuprofen that first morning, Sarah said, but by the next day, they were also spiking high fevers and needed more than one medicine to stay comfortable.
On January 2, Ellie fell asleep on the couch, so Sarah woke her up and sent her to bed. A few minutes later, Kyler, who shares the bedroom with Ellie, walked out with his sister and said, “Mommy, Ellie needs you.”
Ellie’s cough had turned into a harsh bark, “and I was like ‘crap, what is that?’ ” Sarah said, “I didn’t like the sound of it.”
Sarah bundled Ellie up and drove her to a local hospital, where Ellie tested positive for both the flu and adenovirus, which can also cause respiratory illness.
Sarah learned that Ellie’s cough was called croup and was due to swelling around her vocal cords, which can happen with viral infections. An X-ray didn’t show any signs of pneumonia, but her blood oxygen level was only 85%, so the medical staff gave her some supplemental oxygen and the antiviral Tamiflu and told Sarah they wanted to keep her overnight.
“I thought they’d just give us something and send us home,” Sarah said.
Ellie woke up coughing throughout the night. She would cry a little and go back to sleep. Around 3 or 4 a.m., she began to complain of pain in her lower abdomen.
The next day, the attending doctor examined her and said everything was going well. The hospital was preparing to discharge her when her oxygen level began to drop again, and that afternoon, Ellie started throwing up blood.
She was bleeding internally, but doctors didn’t know where the blood was coming from.
A follow-up X-ray revealed that Ellie had developed pneumonia in one of her lungs overnight. She had also developed sepsis, overwhelming inflammation in the body in response to an infection. It can trigger a dangerous condition that causes both uncontrolled bleeding and clotting at the same time.
Paramedics airlifted Ellie to Primary Children’s Hospital in Salt Lake City, but they struggled to keep her blood oxygen up. At the hospital, Ellie was put on extracorporeal membrane oxygenation, or ECMO, a machine that takes over the work of the heart and lungs to give the body time to recover.
On January 5, the doctors explained that Ellie had developed blood clots in her heart, but she was too fragile for surgery to remove them. They discussed trying a blood thinning medication, but that was risky because she had already had internal bleeding.
As the Rudds were talking to doctors about Ellie’s dire situation, Sarah’s phone rang. It was her mother, who was watching the two older children, Kyler and Mary Jane, who were both still sick. Mary Jane had also developed pneumonia, along with bronchitis.
“It was just an absolute … you know … shitshow, I want to say, but it’s too crass of a way to say it,” Sarah said. “There’s no other way to really say it.
“It was devastating,” she said. “It was absolute chaos and terrible.
“Just with Ellie, everything was getting from bad to worse, and there was just never any good spot that we were in,” Sarah said. “I couldn’t stop crying for a while, and I felt like I’d lost all hope at that point. I tried to hold on to some hope, but there wasn’t much left.
“It hit her so fast and so hard.”
The blood thinners didn’t help. Twelve hours later, Ellie had a massive stroke.
“The left side of her brain had no brain activity,” Sarah said. “It was just time to let her go at that point.”
Creech, of Vanderbilt, said the details of Ellie’s story are tragic but familiar. He has seen some children with flu that gets worse very quickly.
“We talk about this a lot in pediatrics. They don’t mean to, but young children often lie to us. They look like they are doing OK until they really aren’t,” he said. “The younger the child is, the more quickly things can change.”
When he evaluates kids, he looks at three types of physical signs: How are they breathing? Are there neurologic symptoms? Are they hydrated?
First, parents should keep an eye on how fast a child is breathing and how hard they’re working to breathe.
“Do they have tough or labored breathing, where they’re really having to tug at it to do it?” Creech said. “Are they having to use extra muscles around their neck or their ribs to breathe? That would be a red flag.”
For neurologic symptoms, he says, it’s important to check to see if a child is lethargic, even if they don’t have a fever. Have they lost interest in eating or drinking or interacting with you?
“I think that’s a really important feature, that they’re shunting all of their energy away from watching a show or interacting with you as a parent, to just trying to breathe and trying to stay in an OK spot,” Creech said.
Finally, he says, a child who is breathing too fast can quickly become dehydrated.
“And when kids get dehydrated, unfortunately, that makes them not want to drink even more. It makes them vomit, and so sometimes they get even further behind,” he said.
Another good test is whether kids feel better after medication. If Tylenol or ibuprofen brings their fever down, do they perk up?
“What most of us will do is give some Tylenol or give some Motrin and then, after about an hour, reassess. And if the child looks great, is drinking, is watching a show, OK, that makes us feel better,” he said. “But if they are now still feeling poorly, even when the fever comes down, that’s another one of those red flags for needing a little bit more evaluation.”
The Rudd family said their goodbyes to Ellie in the hospital on January 6.
Family and friends have rallied around them as they struggle to get through each day without their daughter. Family members have started a GoFundMe page to defray medical and funeral expenses.
Sarah says the other kids are doing their best to cope.
“The other day, we were dropping off a dress for Ellie to be buried in, and Kyler was asking if Ellie had her wings now and she was an angel up in heaven. And I said, ‘yes,’ because we are religious, and so I think he understands some, but I just don’t know how much,” Sarah said.
Mary Jane is older and has been more subdued. She’s recovering well from her own illness, and “she’s finally started to kind of come back to herself.”
Asked whether she had a message for other parents, Sarah said Ellie’s death had prompted the family to rethink the importance of flu shots.
“Honestly, just get your flu shots,” she said. “Even if it doesn’t work this year, maybe it could have helped her a little bit. We don’t really know.
“Probably next season, we’ll look into getting the flu shot for our kids and us,” Sarah said. “So just extra peace of mind.”
She said it would be the first time anyone in their family had been vaccinated against the flu.
“I’ve never been afraid of sickness before, but now I’m a little terrified.”
