Health Matters: Know When to Seek Medical Care for Respiratory Symptoms in Children


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By Alicia Brennan, MD

Pediatricians across the United States are reporting an unusual uptick in respiratory viruses among children and advising parents to be on the lookout for troublesome symptoms and know when to seek medical care.

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Many illnesses are connected to respiratory syncytial virus (RSV) and enteroviruses, two common viruses that, while often mild, can be serious, especially in young children and children with asthma.

If you have little ones at home, here’s what you need to know about these viruses and how to reduce the risk of your child getting sick.

Q. What is RSV?

A. Respiratory syncytial virus — RSV for short — is a common virus that usually causes mild, cold-like symptoms. It can affect people of any age but can be especially dangerous for some infants and young children.

In fact, according to the Centers for Disease Control and Prevention (CDC), in the United States, RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia in children under one year of age.

Young infants and children with a chronic health condition that affects the lungs, heart or immune system, such as asthma, are at greater risk for developing bronchiolitis or pneumonia.

Symptoms of RSV include:

• Runny nose.
• Decrease in appetite.
• Cough, which may progress to wheezing.
• Thick nasal discharge.
• Dehydration.
• Trouble breathing.

Fever may or may not be present, and infants younger than six months may show signs of irritability and fatigue.

Incidences of RSV typically peak in November and December. However, this year doctors are already reporting an increase in cases.

Q. What are enteroviruses?

A. Enteroviruses are a group of viruses that can cause a variety of illnesses, most resulting in only mild symptoms.

However, some children can develop acute respiratory illness from the enterovirus, including a troublesome strain known as EV-D68 that is seemingly more prevalent this year compared to previous years, according to the CDC.

Symptoms of EV-D68 include:

• Cough.
• Shortness of breath.
• Wheezing.
• Sneezing.
• Body and muscle aches.

As with RSV, fever may or may not be present.

Infants, children with asthma and those with weakened immune systems are at greatest risk for serious illness and hospitalization.

In rare instances, EV-D68 has been associated with a condition called acute flaccid myelitis, a complication that can cause severe weakness in the arms and legs.

Q. What should you do if your child gets sick?

A. You know your child best, and if you are concerned about their symptoms, call your pediatrician.

In the early stages of a respiratory virus like RSV, the American Academy of Pediatrics recommends gentle suctioning of the nose to clear nostrils. The Academy recommends against cough and cold medications as they may cause side effects and are not effective in young children.

If your child has trouble breathing or sudden symptoms of limb weakness, contact your health care provider right away. Moreover, if your child has asthma, be sure that their asthma action plan is up to date.

Other signs that your child may need immediate attention include:

• Difficulty talking, such as not being able to speak in full sentences.
• Flaring of the nostrils.
• Noticeable contracting of the chest, ribs, or belly when breathing.
• Unusual anxiety or restlessness.
• Change in skin color.
• Increased pulse.
• Decreased level of alertness.
• Not drinking.
• Not making wet diapers.
• If the child uses albuterol or another medicine for wheezing, needing the medicine more than every four hours or wheezing that is not relieved after a few treatments.

Viruses typically last between three to five days. Symptoms such as a cough can linger for as long as one to two weeks.

Q. What if your child has a fever?

A. Fevers are an indication that the body is fighting an infection or other illness, and while they can be scary for parents, they don’t always require a trip to the doctor, especially if other symptoms are mild.

As the American Academy of Pediatrics notes, the most important things you can do if your child has a fever is to improve their comfort and make sure they are drinking plenty of fluids, because fevers can be dehydrating.

Acetaminophen and ibuprofen can help reduce a fever and keep your child comfortable. However, it is essential that parents give the correct dose, and it is important to note that these medicines may not always bring a temperature back to normal.

When a child’s temperature rises, it can cause parents concern to alarm especially when the temperature runs high. If possible, give a dose of acetaminophen or ibuprofen and speak to your child’s pediatrician before heading to the emergency room. When the fever occurs with other serious symptoms such as dehydration, trouble breathing, or seizures visit your local emergency room or call 9-1-1.

If you are concerned about your child’s fever, contact your pediatrician.

Q. How can RSV and enteroviruses be prevented?

RSV and enteroviruses are easily spread from person to person through respiratory droplets from sneezing and coughing, and through contaminated surfaces where viruses can live for days.

The CDC recommends the following steps to help protect against getting and spreading respiratory viruses like RSV and EV-D68:

• Wash your hands often with soap and water for 20 seconds.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid close contact, such as kissing, hugging, and sharing cups or eating utensils with people who are sick, and when you are sick.
• Cover coughs and sneezes with a tissue or your upper shirt sleeve, not your hands.
• Clean and disinfect frequently touched surfaces, such as toys and doorknobs.
• Stay home when sick.
• Consider wearing a mask around other people if you have symptoms.
• Stay up to date with all recommended vaccines.

At Penn Medicine Princeton Medical Center (PMC) pediatricians from Children’s Hospital of Philadelphia (CHOP) are always on-site to consult on emergency cases involving infants, children, and adolescents. If a child needs to be admitted, he or she is cared for in PMC’s inpatient pediatric unit, where a CHOP pediatrician is on-site 24 hours a day, seven days a week.

Alicia Brennan, MD, is board certified in pediatrics and pediatric hospital medicine. She is the medical director of Children’s Hospital of Philadelphia Pediatric Care at Penn Medicine Princeton Medical Center.


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