Childhood Respiratory Illnesses

When Baby Sneezes and Wheezes

by Donna Smith

Year round, hospital emergency rooms are filled with children suffering from respiratory tract infections. Many of these illnesses can be treated successfully at home, but it's important for parents to know when to seek more aggressive treatments. When is a cold just a cold – or something more?

The Common Cold

Millions of people each year are affected by the common cold. Children seem to be more prone to getting "the sniffles" because of school and daycare settings, where germs get passed around as often as notes and toys.

"[The common cold] is caused by a variety of viruses in the rhinovirus family," says Dr. Stuart Abramson, assistant professor of pediatric immunology at Baylor College of Medicine and staff physician at Texas Children's Hospital in Houston, Texas. The symptoms, which can be one or all, include stuffy nose, runny nose, sneezing and cough.

Dr. Abramson says that in young infants, overmedicating should be avoided. "Sometimes just a bulb suctioning of the mucus to help open up the airway, so that [they] can breathe" is effective, he says. For older children, decongestants are often prescribed, such as Sudafed or topical sprays like Neosynephrine. "Those are short-term treatments for just a few days," says Dr. Abramson. "Sometimes just washing the nose with saline – an over-the-counter saline spray – can be helpful."

Respiratory Syncytial Virus (RSV)

RSV is a virus that Dr. Abramson says almost everyone will eventually get, but the concern is for children under 2. Premature infants, infants with heart problems, such as congenital heart disease, and anyone with underlying immune deficiencies all need special attention to prevent RSV.

"The recommendation is that these patients should get an antibody injection that prevents RSV," he says. Synagis (palivizumab) is the medication that has been approved for preventing serious complications from RSV in high-risk infants.

The symptoms of RSV start by mimicking a cold, but then lead to increased coughing, difficulty breathing and lethargy. RSV can lead to pneumonia and cause other complications requiring hospitalization. "If the symptoms are severe and they have poor oxygenation from the pneumonia, that can be a complication," says Dr. Abramson.

The Croup

While there is treatment for RSV, there is no home treatment for croup (laryngotracheobronchitis), another viral infection associated with coughing and difficulty breathing. "One can hear a noise called 'strider,' which is a noise that's noisy breathing when one takes in a deep breath or exhales, because the trachea is swollen," says Dr. Abramson.

Croup requires supportive care. "Humidified air is sometimes helpful, certainly if the child is not oxygenating (breathing) well," says Dr. Abramson.

Difficulty breathing is criteria for being admitted to the hospital for more aggressive treatment. Breathing treatments are given to help reduce the inflammation and to facilitate breathing. But Dr. Abramson says hospitalization is usually not necessary unless the child is tiring out from coughing or dehydrated. "These are all potential complications," he says. "But an older child who has just a little bit of a croupy cough generally will get over it in a few days."

Influenza (Flu)

With the increased number of cases and deaths attributed to it, influenza has found itself in the news lately. Influenza, another virus, can cause severe symptoms such as high fever, muscle aches and chills and can lead to pneumonia, which can be life threatening. "We have a particularly bad strain here in the early season," says Dr. Abramson of the 2003-2004 flu season.

Dr. Abramson says it's very important for everyone over the age of 6 months to get a flu shot. The immunization, which is a not a live virus, does not give you the flu, but it can give you some fever and muscle aches. Despite that, it is still the best way to avoid the flu. "And if you haven't done it before, you need two shots, one month apart," he says.

Unlike other viruses, Dr. Abramson says there are some medications that can be given if the flu is detected early. "There are rapid tests for this that can be done at a doctor's office or clinic," he says. "If one has it and it's noted within the first 48 hours, there are some medical treatments, some medicines, that can be given for the flu." The medications are all by prescription only, so a trip to the doctor is required.

Bronchitis

Unlike RSV, influenza, croup and the common cold, bronchitis can be caused by a bacteria or virus. Another deferential is that bronchitis affects the lungs. "Bronchitis is more the lower airway," says Dr. Abramson. "You have the upper airway, which is the nose, and then we have the lower airway, which is the lungs. In younger infants we call it bronchiolitis, because it can involve the smaller airway as well."

Symptoms include breathing problems, coughing, shortness of breath, chest tightness and chest pain, so it can also be a feature of asthma. "If there's wheezing, or what we call reactive airway disease, then the child may benefit from some breathing treatments in the hospital for a while," says Dr. Abramson. If there are no complications, bronchitis can, and usually is, treated at home.

While respiratory tract illnesses can sometimes be serious and require hospitalization, they are also quite common and can routinely be taken care of at home. "If a parent has questions, they should call their primary care physician," says Dr. Abramson. "Certainly infections associated with high fever should seek medical attention. And if they have increasing respiratory difficulties – worsening cough, chest tightness, chest pain – those sorts of things are red flags that one should seek medical attention."