As often happens at this time of the year, physicians are busy caring for children with respiratory illnesses that can range from a common cold to something more serious, including COVID-19. What’s different this season is an increase in the number of cases of respiratory syncytial virus, better known as RSV.
In this Q&A, C. Anthoney Lim, MD, the Director of Pediatric Emergency Medicine for the Mount Sinai Health System and the Medical Director of the Pediatric Emergency Department and Pediatric Short Stay Unit at Mount Sinai Beth Israel, explains what symptoms to look out for, how to help your child if they are sick, and when to seek medical care.
As always, Mount Sinai’s Emergency Departments and Urgent Care centers are available to help any time, and they work closely with your pediatrician and primary care provider. And one important reminder: Be sure your child is up to date with their vaccinations, which is one of the best ways to prevent serious illness.
What pediatric respiratory illnesses are circulating now and who is most at risk of getting them?
All of the respiratory viruses are circulating among most school age children and those in preschool. They all look essentially the same to physicians and parents at the onset. These are the most common ones we’re seeing:
- Respiratory syncytial (sin-SISH-uhl) virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. It typically affects younger infants, premature infants, and children with underlying medical conditions.
- Influenza is the seasonal virus that causes the flu. The flu season stated early this year. Like RSV, it especially affects young children and those with chronic illnesses or medical conditions such as asthma.
- Enterovirus D68 causes a mild cold in most cases. But it produces a more severe illness in some children, possibly requiring hospitalization, especially for those with asthma.
- COVID-19 has been circulating throughout the year. Children who require hospitalization are those who have not been vaccinated or have not received all of their vaccinations.
C. Anthoney Lim, MD
What advice do you have for parents whose children may be sick?
In general, it’s less important to try to tell the differences between these respiratory illnesses. It’s more important that you support your child and their illness by keeping your child hydrated, making sure they are breathing comfortably, and taking care of their symptoms, such as fever. It is helpful to prepare by having some Motrin or Tylenol at home. If your child has an underlying medical condition, you should be prepared to treat other symptoms, such as having an inhaler for those with asthma or carefully managing your child’s sugar levels if they have diabetes.
How do I know if my child is becoming dehydrated?
There are some simple things that you can do to make sure your child is properly hydrated. The most important thing is making sure your child is peeing. A well hydrated infant will urinate about four to six times a day. For young children, that means that you should have a wet diaper about every six or eight hours. If it starts getting longer than that, it’s important to start encouraging your child to drink fluids. If your child continues to go without peeing, it’s time to talk to your doctor. Other signs of possible dehydration are that you may see your child will just be less active. They might cry, but not make any tears. Their mouth might start looking dry as well. All of these can be signs that it’s time to see the doctor.
How can I monitor my child’s breathing?
When your child is breathing comfortably, you should almost barely recognize they are taking breaths. As they start having more trouble breathing, you’ll see them start using all of their body muscles that you don’t typically use to breathe, such as their belly moving. You might see their neck moving or their shoulders. You’ll see their nose flaring. All of those can be signs that your child is now using these muscles to breathe that they don’t normally use. If it goes on for a prolonged period of time, it can be dangerous. So once that starts, it is time to see a doctor.
How do I know if I need to call the doctor?
If you begin treating symptoms and don’t see any improvement, it’s often time to reach out to a doctor. For example, if you’ve been giving your child Motrin or Tylenol and your child is still very tired, and they’re not getting up to drink, then it’s probably time for a conversation with your doctor. If you’ve been giving albuterol every four for hours and it looks like the child’s breathing is not improving, definitely call the doctor. You can expect a variety of symptoms, including cough, runny nose, vomiting, diarrhea, fevers, rashes, just more crying. These typically can last three to five days. If after that time, your treatments are not leading to an improvement in your child’s condition, then it is time to have a chat with your pediatrician.
Any tips for managing symptoms?
When your child has a fever, and they’re fussy and don’t want to eat or drink, and they don’t want to sleep because they’re uncomfortable, giving them Motrin or Tylenol can help them feel comfortable enough so that they’ll drink or get some rest. I often tell parents that if your child is sleeping in the middle of the night and you check on them and they feel a little warm but they’re sleeping and breathing comfortably, there’s no need for wake them up to give Motrin or Tylenol. You are only defeating the whole purpose of the medication, which is to allow them to rest and have the body help with their illness. If your child has asthma and you notice coughing or wheezing, it’s a good time to give your controller medications because they can still have some benefits. For children with other underlying illnesses, make sure you’re keeping up with what your action plans are. Talking with your doctor in advance can be helpful in coming up with a plan to help your child.