How to help your child through cough and cold season - Toronto Star

We've officially entered the season of sore throats and stuffy noses. Cooler weather typically arrives hand in hand with an increase in common respiratory ailments. Assuming COVID-19 has been ruled out as a cause of your child's symptoms, we've turned to Dr. Jeremy Friedman, associate paediatrician-in-chief at The Hospital for Sick Children, to help decipher what might be causing those sniffles and to advise when it's time to check in with your health-care provider.

RSV/BRONCHIOLITIS

I've been hearing a lot about RSV — what is it?

Respiratory Syncytial Virus, or RSV, is one of the respiratory viruses we see predominantly in winter. Its claim to fame, in pediatrics anyway, is that it's the most common cause of bronchiolitis, which occurs exclusively in children under two.

In most cases, RSV presents just like a cold. But in a percentage of children — particularly those under a year — RSV gets into the lungs and causes swelling of small breathing tubes called bronchioles. And it's extremely common among babies under a year old.

A usual case of bronchiolitis, not unlike the common cold, will last about a week, peaking around day two or three of the illness.

Probably 80 per cent of children by the time they are two will have had at least one episode of an RSV infection. Only a small percentage of them will ever land in the emergency department, and an even smaller percentage will be admitted to hospital. The risk of your child being hospitalized is very small, but because it's such a common infection in the first year or two of life, it still does account for the largest number of admissions of children under one.

When is it serious?

Most cases of bronchiolitis settle without the need for tests or medications. However, if your child is having trouble breathing, she needs to be assessed. This includes if your child is breathing very quickly or breathing so hard the skin on her chest or neck is retracting, or her nostrils are flaring.

CROUP

How will I know if my child has croup?

Typically, a child first develops common-cold symptoms — runny nose, congestion. However, parents will quickly notice what separates croup from a cold — the characteristic barking cough — which, unfortunately, often seems to manifest in the middle of the night.

That cough is how you know it's different from a cold. We joke that when you have a child with croup in your office, you can make a diagnosis from outside the room — it's that distinct. Whether you describe it like a seal or a dog — when parents hear it, they know. It's a very different cough from what they might be used to hearing.

The vast majority of cases of croup are pretty mild and will clear up, like most viral illnesses, on their own without the need for any specific treatment. So, parents just need to treat it pretty much like a common cold — by making sure your child is well hydrated, that she's comfortable. It's basically TLC.

When is it serious?

As with RSV/bronchiolitis, if your child's breathing is impacted, you'll want to take her to see a health-care provider. Typically, we would treat bronchiolitis with a steroid medication — either prednisone or dexamethasone. It's usually just one dose — a one-off that's taken by mouth. It decreases the swelling, which occurs around the windpipe area, which, due to the narrowing of the windpipe, is what gives rise to both that barking cough as well as the increased difficulty with breathing.

COLD AND FLU

How will I know the difference if my child has a cold versus the flu?

The flu in medical terms is very specific; it means you've got an infection caused by the influenza virus, which is a group of influenza viruses different from the viruses that cause the common cold.

You'll know if your child has the flu as opposed to a bad cold, as there is usually a sudden onset of a very high fever — as opposed to the common cold, where you may see a low-grade fever or none at all. With influenza, along with cold symptoms such as nasal congestion and perhaps a cough, your child will typically have a headache, plus muscle aches.

The other thing about flu is that it is preventable. Having your child inoculated with the flu vaccine is a really good way to prevent influenza among kids.

When is it serious?

One thing to keep an eye on, especially with very young children, is the risk of dehydration. This is true not just for flu, but for bronchiolitis and croup as well. Pay attention to how much your child is taking in, and how much she is putting out. Are you changing as many diapers as usual?

Also, how does your baby look? Is she lethargic and more sleepy than usual? Are the eyes starting to get a bit sunken, and the tongue a little bit dry? These symptoms might suggest dehydration. If you suspect your child is dehydrated, that would be an important reason to see your health-care provider.

OTC Meds

Over-the-counter (OTC) cough and cold medications are a big no-no for children under the age of six, for two main reasons. Number one, they don't work. And number two, they have the potential for significant side effects. That said, pure fever medications — acetaminophen or ibuprofen — are different. If a child has a fever as part of a viral illness, and is uncomfortable, giving her something to treat the fever is fine.

Healthy Kids poses health questions to experts at SickKids. Always consult your health-care provider with specific concerns. Torstar is in a fundraising and educational partnership with SickKids Foundation to help raise $1.5 billion for new facilities.