What parents should watch for with respiratory illness and when it’s time to go to the ER

Respiratory viruses including flu and RSV are circulating across the United States at high levels, overwhelming children’s hospitals and prompting concern among parents of young children. Most kids who get sick this season will recover quickly with home care, but some will need medical attention. What should parents watch for, and how might they know it’s time to call their pediatrician or go to the ER?

A medical worker collects a swab sample from a resident for a COVID-19 test in Los Angeles, California, the United States, on August 5, 2022.

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CNN spoke with Dr. Edith Bracho-Sanchez, director of pediatric telemedicine at Columbia University Irving Medical Center, about warning signs of serious illness and the steps parents and children can take to help protect themselves from germs. The following is an edited version of that conversation.

CNN: How quickly can a baby or a small child go from being totally fine to needing urgent medical care?

Dr. Edith Bracho-Sanchez: Every child is different in terms of when they’re going to show signs that it’s time to go into the emergency room or to the pediatrician’s office. I worry the most about the very small babies, the babies under 6 months of age, because their airways are so small. For kids of different ages, they might get worse at different points in any illness.

Kids who are less than 6 months of age can really turn the corner really quickly and get worse at home, really out of nowhere, so it’s so important that parents learn the signs and know when to look for help. Older kids tend to get sick more gradually. It is important in that case as well to know when to look for help.

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CNN: As a pediatrician, what warning signs do you look for when it comes to these respiratory viruses that mean it might be time for someone to go to the hospital?

Bracho-Sanchez: Any time a child is starting to have trouble breathing – by that I mean they’re getting tired, they look like it’s effort that they have to put in with breathing, it’s time to come into the emergency room. Any time a child is getting dehydrated or any time a fever is not coming down at home or has been there for more than three days, it’s time to come in and see us.

CNN: We hear people talk about signs of “respiratory distress,” but what does that look like?

Bracho-Sanchez: Signs of trouble include starting to use muscles that they don’t usually use to breathe – by that I mean using the muscles of the nostrils and then using muscles in between their ribs. Any time you’re noticing that a child is starting to use those additional muscles to breathe or is starting to breathe fast, that means they’re really having a hard time breathing, and it’s time to go to the emergency room.

CNN: Is there any point in trying to treat these things at home? Or is it already time to get in the car?

Bracho-Sanchez: If you’re starting to see signs of respiratory distress at home, call your pediatrician. If you know that it’s going to take several hours or a couple of days to reach your pediatrician, go to the emergency room. Your child needs to be seen more and more urgently at that point.

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CNN: Once you start to notice that something is wrong, how do you make the decision on where to go for help?

Bracho-Sanchez: First and foremost, when you’re deciding where to take your child, I think it’s important to listen to your own gut and intuition as a parent. If you feel that your child needs medical attention right now, go to the emergency room, no questions asked. We’re always so glad to help you.

If you think your child has been getting worse gradually or your child is not improving, you may be able to call the pediatrician first.

If your child gets sick on weekends or at a time when you cannot reach your pediatrician, that might be a good place to go to urgent care instead of going to the emergency room first.

CNN: Many children’s hospitals across the country are operating at capacity. If I look online and see that the hospital wait times are just outrageous, what is my best bet as a parent?

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Bracho-Sanchez: If your child is showing signs of respiratory distress and you feel that it’s time to go to the emergency room, go to the emergency room.

I think it’s important for parents to know that when you come in to see us, we do what’s called triaging. Kids who need urgent, immediate medical attention are seen first. So that is slightly unfortunate for parents who might be there for a broken bone or because their kids might have fallen. I think those parents are unfortunately going to have a longer wait. But if your child is having respiratory distress, we are not going to make you wait. We’re going to help your child right away.

CNN: A lot of children get sick. Not all of them need this kind of care. How many kids are going to be able to be treated at home?

Bracho-Sanchez: It’s important to note that almost all kids are going to catch a cold or some sort of respiratory illness this season. Most kids are going to recover at home and are going to be totally, totally fine with a little bit of rest and extra fluids and a parent who’s watching them at home. It is a very small minority of children who are going to get enough complications or respiratory distress that it is going to need medical attention.

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CNN: In addition to a thermometer, are there any devices that might be helpful for parents to have at home, such as a pulse oximeter?

Bracho-Sanchez: The best device you can have at home as a parent is your own educated intuition. Any time that you are noticing signs of respiratory distress, I don’t think you should waste time trying to get a blood oxygen measurement or trying to do an additional maneuvers at home. When you are spotting those signs, it is time to come in and see us – at least, at a minimum, give us a call if you know that you’re going to be able to get a hold of us right away. But please don’t delay getting your child’s medical attention.

CNN: There are vaccines for flu and Covid-19 but not for RSV. How can you protect yourself from all of these things?

Bracho-Sanchez: During respiratory season, there are so many things that we as parents cannot control, but there are some ways to protect our kids from severe respiratory illnesses and the complications of those severe respiratory illnesses. That includes getting a flu shot and getting the Covid vaccine, including all of the boosters they’re eligible for.

Kids adapt and learn so many things as long as we adults set the example for them. So this respiratory season, it’s so important that we teach them to wash their hands frequently, to cough into their elbows, to cover their coughs and sneezes with tissues when appropriate and to stay home if they’re not feeling well.