State officials say three children in Tennessee have died of complications from the flu in the last month.

Two deaths occurred in Middle Tennessee and one was reported in East Tennessee. The latest deaths bring the total number of flu-related child deaths to six, which is higher than normal.

“We are expecting a severe flu season” Department of Health spokeswoman Shelley Walker told the Knoxville News Sentinel. “Every flu season is different, but we typically see 2-3 child deaths a year from the flu.”

Healthcare professionals say they’ve seen a high number of cases so far this year.

Darci Hodge, a registered nurse and director of infection control at East Tennessee Children’s Hospital in Knoxville, said there’s been more flu cases this month than in any December over the last five years.

She said there had been 446 flu cases as of Monday, compared with 398 in December 2012, which had been the high.

Dr. Don Arnold, a pediatric emergency room doctor at Vanderbilt University Medical Center, told WSMV-TV that there have been “hundreds and hundreds of cases of influenza in children this season.”

Doctors recommend taking precautions such as washing hands and not touching eyes, hands and nose after interacting with those who may be sick.