What to do if your child has a respiratory infection? Our medical analyst explains


A common respiratory virus, respiratory syncytial virus, is emerging in the United States, causing some children’s hospitals to be overwhelmed. The flu virus is also on the rise, along with other viruses – such as adenovirus and rhinovirus – that cause colds.

At the same time, children are back in school and families are resuming many in-person activities, often without the mitigation measures applied during Covid-19, increasing the possibility of viral spread.

There are two main symptoms that should cause concern in respiratory infections - difficulty breathing and dehydration, says Dr. Leana Wen.

What kinds of respiratory infections can be treated at home — and with what treatments? What symptoms should prompt parents to call the doctor or take their children to the hospital? When should children stay out of school? And what precautions can families take to reduce the spread of respiratory viruses?

To help us answer these questions and more, I spoke to Dr. Leana Wen, CNN medical analyst, emergency physician, public health expert, and professor of health policy and management at George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and a mother of two young children.

CNN: Why are respiratory infections on the rise?

Dr AS Leana Wen: They have always been common in children. Before Covid-19, it was the norm, especially during the fall and winter, for schoolchildren to have runny noses and coughs.

Now they may rise in part because mitigating measures taken during the pandemic – such as social distancing, masking and avoiding large gatherings – have led to a decrease in the spread of respiratory viruses over the past two winters. . As a result, many children lack the immunity they normally would.

My own children have already had at least three episodes of respiratory illness each since returning to kindergarten and preschool less than two months ago. Fortunately, they recovered well and did not become seriously ill, but I certainly understand the concern and distress that parents and caregivers feel when our children are sick.

CNN: What respiratory infections can be treated at home?

Magnifying glass: The vast majority of respiratory infections in children can be managed at home with fluids, fever medications, and rest. The cause of the infection is usually not the determining factor in whether a child needs hospital care – it’s how the child is doing.

Respiratory syncytial virus, also known as RSV, is a public health concern as some hospitals are filling up with children who have it. Prior to the Covid-19 pandemic, the US Centers for Disease Control and Prevention estimated that virtually all children will contract RSV before their second birthday – and some 58,000 children will end up in hospital each year. Obviously, RSV is a very serious infection in some children, and parents need to know what to look out for to detect serious illness. But also keep in mind that the vast majority will have mild, cold-like symptoms and won’t need to be hospitalized.

The same goes for other viruses. The flu can cause very serious illnesses, just like Covid-19. However, most cases in children do not result in hospitalization and symptoms can be managed at home. On the other hand, there are viruses that are usually associated with a mild cold, such as the adenovirus, which can make some children very sick.

If you end up going to the ER, your child will likely be tested for Covid-19, influenza, and RSV. Some pediatricians would do it too. If your child is hospitalized, they may undergo additional screening tests. But many medical practices would not provide such care because, again, the virus causing the illness is less important in determining whether your child needs hospitalization than their condition.

The exception is very young infants – usually those under 2 months old – who are usually tested and monitored more.

CNN: What other risk factors should parents watch for serious illness?

Magnifying glass: Newborns are very vulnerable. They have little immunity and not much physiological reserve, which means that once they get sick, they can get very sick very quickly. Premature babies are also at risk. Many of them have underdeveloped lungs. A baby born two months before term has a physiological age two months younger than a baby born full term on the same day.

Parents and caregivers should have a health plan in place in case their children contract a respiratory virus.

There are also other factors to consider, including for young children who have significant heart and lung disease or who are severely immunocompromised. In all of these situations, families should have a low threshold for calling their doctor.

CNN: If a child is generally healthy and develops a fever, cough or runny nose, should parents and caregivers call the doctor? When should we rush to the hospital?

Magnifying glass: There are two major symptoms that should cause concern in respiratory infections. The first concerns breathing difficulties. Look for labored and rapid breathing. For example, if your children are wheezing or grunting; if their nostrils dilate; if they breathe through the belly, that is, the chest sags during breathing and the belly comes out; or if their breathing rate is higher than normal.

The second is difficulty staying hydrated. This is especially a problem in babies. If they have a stuffy nose, it may be difficult for them to drink breast milk and formula, and they could become dehydrated very quickly. If your child seems drowsy and isn’t drinking, or your baby has a decrease in wet diapers, call your doctor as soon as possible.

Persistent issues — for example, a mild fever that’s been going on for a few days — could likely wait until your pediatrician’s office hours.

I would advise you to have a plan before your child gets sick. Many pediatricians have an on-call service where you can reach your doctor or other health care provider within an hour, even at night and on weekends. Know if this possibility exists and have this number readily available to call. If your pediatrician cannot be reached after hours, you need to know which hospital you would take your child to if he or she became seriously ill. Ideally, this is a hospital near you and staffed with specialists in pediatric emergency medicine.

If you can’t easily reach your doctor by phone in an emergency, have a low threshold for bringing your child to the hospital, especially if you have a newborn or young baby. Breathing difficulties and the inability to stay hydrated are good reasons to go to the hospital immediately.

CNN: When should children stay out of school?

Magnifying glass: It depends on the policies of your child’s school. Many schools ask children to stay home while they have a fever. They should also not be present if they vomit. Some schools may also require Covid-19 tests to ensure the cause of symptoms is not coronavirus.

That said, it’s probably not reasonable to ask children to stay home if they have the slightest suspicion of sniffling. This could mean that children miss several weeks of school during the winter months. Parents and caregivers should assume that there are children infected with certain respiratory pathogens in their child’s classroom at all times and take precautions accordingly. Some families may choose to hide. Others may go back to what they did before Covid, which is to stick to good hand hygiene and not be around vulnerable people when sick.

CNN: What kinds of precautions should parents and caregivers take?

Magnifying glass: Hand washing is important. Many of these respiratory pathogens travel through droplets: when someone sneezes or coughs, those droplets land on surfaces someone else touches and then hit their nose or mouth. Encourage your children to wash their hands frequently and if they need to cough or sneeze, they should cough or sneeze into their elbow or a tissue to reduce the spread of droplets.

If someone in your household has a respiratory infection, it can easily spread to other household members. You can reduce this risk by not sharing utensils or drinks with the sick person and by keeping the sick person away from vulnerable household members such as newborns and the elderly. In general, families should also limit the exposure of newborns and premature babies as much as possible.

There is no approved vaccine for RSV, but there is for influenza. Parents should have their children vaccinated against the flu. They should get their children vaccinated against Covid-19 if they haven’t already and assess their own family situation to determine if they should get their children 5 years of age or older vaccinated with the new bivalent booster.

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