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Winter illness update

Pediatrician and “Today” contributor Mark Widome helps with a winter-time vocabulary lesson for parents.
/ Source: TODAY

Young kids typically get 6 to 8 illnesses each year. Most are colds, but many are not. For parents about to send their kids off to day-care, preschool or school for the first time, here’s a quick review of common wintertime illnesses. For those not sure of the difference between bronchitis, bronchiolitis, croup, and the flu, pediatrician and “Today” contributor Mark Widome helps with a winter-time vocabulary lesson for parents.


While the common cold is the most common upper respiratory tract infection, affecting the nose, throat, and upper airway, bronchiolitis is the most common lower respiratory tract infection in young children, affecting the bronchioles, the smallest airways in the lungs. Like the common cold, bronchiolitis starts out with a runny nose, mild fever, and a wet cough. But then, after 2 or 3 days, the cough worsens, the child begins breathing fast and the child’s breathing becomes labored. Infants and children with bronchiolitis can be heard to wheeze with the stethoscope, and oftentimes parents can here the wheezing just by standing close.

Like the common cold, a virus causes bronchiolitis, most often the “RSV” or respiratory syncytial virus. Other viruses can also cause the illness as well. Most of the cases occur between three months and two years of age. Rapid and labored breathing is what causes some of these kids to need hospitalization, to get some oxygen and IV fluids until the illness runs its course in 5 to 7 days. Kids with underlying health problems: heart disease, prematurity, and chronic lung disease are at highest risk of getting very sick or dying from bronchiolitis. Some kids in these high-risk categories benefit from monthly antibody injections during the winter months that can protect these vulnerable infants from severe illness.

When to call the doctor

Call if your child is wheezing for the first time. Let the doctor know if you note rapid or labored breathing, retraction of the skin between the ribs with each breath, flaring of the nostrils with each breath, or other respiratory difficulty. If your infant is lethargic, irritable or not drinking or nursing well, that merits a call; so does high fever, or any fever in an infant less than three months old.


Bronchitis is understandably confused with bronchiolitis, but they are very different. The name, bronchitis, means inflammation of the bronchi, the largest airways in the lungs. In infants and children, bronchitis can best be thought of as the final stages of the common cold. The typical five-to-seven-day cold starts with inflammation of the nose, spreads to the throat, moves to the windpipe, and ends its course in the large branching airways of the upper chest. That helps explain why colds start out with runny nose and sneezing, then cause a mild sore throat and hoarseness, and why the cough is the last thing to get better. The large airways of the lungs are lined with lots of “cough receptors.” When these airways get inflamed and irritated, they trigger the cough. As the airways are healing, the cough continues, sometimes for days after all the other symptoms have disappeared.

Rely on your pediatrician’s advice about treating your child’s cough. Usually, no medicine is warranted. Some humidity in the air and offering warm beverages can be helpful. Bronchitis usually caused by the same virus that caused the cold. (It is really all one illness.) Therefore, antibiotics are of no benefit. Unfortunately, cough syrups have not been shown to be of benefit either in the treatment of these coughs in young children.

When to call the doctor

Typically, in colds, most of the fever is in the first three days of the illness. And, once the fever goes away, it does not return. If the fever returns after the child has been fever-free for a full day, that is called a secondary fever, and it usually means that something else is going on. Let your doctor know. Also, if significant cough persists more than ten days after all the other cold symptoms have gone away, your doctor will want to know. That is sometimes an early sign of asthma.


We’ve talked about inflammation of the large and small airways-bronchitis and bronchiolitis. Pneumonia is infection and fluid accumulation in the air sacs or “alveoli.” This is the part of the lung where gases are exchanged, where our bodies trade carbon dioxide for oxygen. Not surprisingly, children with pneumonia look and feel sick. Otherwise healthy kids typically get pneumonia as a complication of a viral respiratory infection. For example, the inflamed and vulnerable bronchi of the common cold get infected with bacteria that spread down into the lungs.

When to call the doctor

The hallmarks of pneumonia are fever, rapid breathing, and feeling uncommonly sick. If your child has had a cold and seems to be getting better, but then suddenly takes a turn for the worse, pneumonia is a good bet, and you should call her doctor. Think of possible pneumonia if there is a secondary fever, a change in the character of the cough, a sicker appearing child (less playing, less eating, more sleeping), and/or rapid breathing.


While parents frequently refer to their child’s bothersome cough as a “croupy cough,” real croup has a cough all it’s own. The word “croup” is borrowed from the Scottish word for “croak,” which only begins to describe the distinctive hoarse, shrill sound of the croup.

This viral illness occurs most frequently in two-year-olds, and most frequently in the late Fall and early Winter. It is caused by a virus that infects the larynx (voice box) and the trachea (windpipe). The illness can start as a cold, or come on suddenly in the middle of the night with the very distinctive cough. If there is sufficient swelling of trachea, there is also stridor, which is the turbulent sound of air struggling to get through a very swollen and narrow upper airway. Kids with croup can be struggling to breath, even if they do not appear very sick and are not even breathing very fast.

Home treatments of croup include taking the child into a steamy bathroom to soothe the swollen air passages or out into the cold night air to relieve some of the airway swelling. But any child who has either stridor or trouble breathing should be seen by the doctor to see if they need either inhaled medication or a steroid to help open the air passages and restore comfortable breathing.

When to call the doctor: If a child with croup is having any stridor or trouble breathing, or if they have high fever or appear sick and are not drinking, then the physician should be consulted promptly.


The influenza virus causes flu. It occurs in some years in epidemics that sweep through communities. Flu differs from the common cold in that it has a sudden onset, there is more headache and body ache, fevers tend to be higher, and people with flu are often so exhausted that they usually go right to bed.

When illnesses include vomiting and diarrhea, people often use the term “stomach flu.” Flu, however doesn’t really cause many intestinal symptoms, so if vomiting and diarrhea are present, it probably isn’t the flu! There is no such thing as “stomach flu.”

The other point about flu, unlike the common cold, is that it is preventable by getting an annual flu vaccine. Almost anyone can get the flu vaccine, but children and adults with underlying medical conditions should have the highest priority, as they are the ones that will be hit the hardest if there is an outbreak.

When to call the doctor

Whenever your child seems particularly ill, when things hurt or when the fever is high, a call to the doctor is in order. In young infants it is often difficult to tell the difference between flu and more serious infections. Pediatricians often want to take a look. Also, call your doctor now to determine whether it would be a good idea for your child-and your family-to get flu vaccine for protection this winter.


It is hard to tell the difference between a viral sore throat (a sore throat caused by a virus) and a strep throat (a sore throat caused by the streptococcus bacteria). Yet, the difference is important, because a strep throat should be treated with an antibiotic to prevent complications, and an antibiotic does nothing for a similar-appearing viral sore throat.

Your child’s physician will do a throat culture to determine whether the sore throat is due to a virus or bacteria. The results of the test will determine whether an antibiotic is needed. Depending on the kind of test, the results may be available in the office while you wait, or available the next day by telephone call.

When to call the doctor

Whenever a child over the age of three has a sore throat and fever without cough or cold symptoms, a strep throat should be suspected. There may or may not be pus on the tonsils, swollen lymph nodes in the neck, headache, stomachache, vomiting, or body rash. (When a rash is present with a strep throat, the illness is called “scarlet fever.) If the culture reveals strep throat, it is important to take the full course of the prescribed antibiotic both to prevent spread of the infection and the development of rheumatic fever-which is an occasional, but serious, late complication of strep throat.


This is a winter viral illness, but it affects the digestive tract instead of the respiratory track. It occurs most dramatically in infants and toddlers, with sudden onset of vomiting, followed by diarrhea. Rotavirus sweeps across the United States from west to east with the earliest cases in late November and latest cases in March and April. Although the illness tends to last only a few days, kids get so sick so fast that they can quickly become dehydrated. This is particularly true for infants who are vomiting. Parents should have some oral electrolyte solution on hand to feed their infant according the doctor’s instructions to prevent dehydration during the illness.

When to call the doctor

Call if there are any signs of dehydration, such as lethargy or decreased urine output. Call if there is severe belly pain or if your child is persistently irritable. Fevers above 102 degrees, or any blood in the diarrhea merits a call as well. As in all the other conditions we have discussed, call your child’s doctor if you are concerned either by your child’s symptoms or by the way your child is acting.

As always, this information is intended to complement, not replace, the individualized advice from you child’s physician. Dr. Widome is a general pediatrician and professor of pediatrics at Penn State’s Children’s Hospital in Hershey. Dr. Widome writes frequently on topics of interest to parents. He is a regular contributor to the TODAY show.