As we enter the third year of the COVID-19 pandemic and experience colder weather, you may be asking yourself: Does my child have COVID-19? Or is it a common cold? Knowing the difference between upper and lower respiratory infections and learning the warning signs may make it easier for you to best care for your child.

Watch the video or read the article below as TopLine MD Alliance affiliated Pediatrician, Dr. Juan Carlos Millon, explains what parents need to know about diagnosing and treating respiratory illnesses in children.

What are the most common illnesses that impact children during this time of year?

Around the end of the year, mostly wintertime, early spring, or late fall, we tend to see a lot of viral upper respiratory infections in children. These can be your common cold or croup, a very particular barking cough that kids will get that can sometimes get pretty scary at night. We see a lot of those more common conditions during this time, because people gather a little bit more than usual, because of the weather, or because there’s closer contact compared to the summertime.

How can you tell the difference between a common cold or a croup?

Sometimes you can’t tell the difference between infections. The name “upper respiratory infection” describes where the infection is located (in what part of the anatomy). Upper respiratory infections are more from your head up, so you’ll have more nasal congestion, sore throat, rhinorrhea, runny nose, and other similar symptoms. Then, you have lower tract respiratory infections, which are conditions like bronchiolitis or pneumonia or other illnesses like asthma that can happen at that time as well.

What is Bronchiolitis?

Bronchiolitis normally starts as an upper respiratory infection. So it starts as a cold, with maybe a little bit of fever in the front end. When it seems like it starts to settle, the cough continues and becomes this wet cough. I describe it sometimes to parents as if your child had been smoking cigarettes for the last 50 years. It can sound that bad, but for the most part, your child is going to be okay.

Bronchiolitis occurs most commonly in kids less than two years old. At that age, pediatricians typically see bronchiolitis more commonly. There are viruses that we know cause bronchiolitis, such as RSV and influenza so we want to try to prevent catching those when we can. Again, the primary prevention method is proper hygiene: washing your hands, keeping your distance from people who you know are sick, etc.

With regards to what to look for when your baby has bronchiolitis, and it’s not going in the right direction, is if the baby is having trouble feeding because they’re having such a hard time breathing. If the baby is coughing so much that they’re throwing up and they haven’t been able to keep anything down, you should let your pediatrician know. These escalated symptoms are the things that parents should be on the lookout for when dealing with respiratory distress and bronchiolitis in small babies.

When should a parent take their child to the doctor to make sure this isn’t one of those more serious illnesses?

A lot of treating illnesses in children depends on their age. If you have a 10-year-old who’s got sniffles and a cough, you may be able to handle most of that on your own. Most illnesses in older kids (kids above two or three) usually peak around the third day. So you should get a little bit of progression and worsening symptoms for the first two or three days, and then you see them turn around and improve, usually lasting between five to seven days.

For younger children, sometimes that lasts a little bit longer because they don’t know how to handle the secretions in their noses. They don’t know how to blow their nose themselves, so it depends on how the parents suction their noses or if you try to do saline washes to keep their noses clean. That’s some of the difference that we see in the age groups.

So when do you take them to the doctor or seek emergency services? The answer is if symptoms start coming out of the normal progression as described above. If your child is coughing excessively, having so much difficulty breathing that they can’t keep anything down, throwing up after coughing, or you can visually see that they’re struggling to breathe, you need to seek medical attention quickly, and hopefully see your pediatrician within 24 hours. If the respiratory is stressed to the point where the child is struggling, where you see their nose flaring or they’re retracting under their ribs, then you may need medical attention at that moment.

Now that we’ve thrown COVID-19 into the mix, do you advise parents to get their children tested if they have cold symptoms? Or should they just keep them home for those few days?

For the most part, in children, you’re not going to clinically differentiate if a cold or COVID-19 is the cause of the upper respiratory infection. A lot of this depends on considering what is your risk or what is that child’s risk of passing that infection to somebody who may be more vulnerable, such as a grandparent. If that’s a big fear or if they’re going to school, then yes, it’s prudent to get tested and properly diagnosed. If the child is positive for COVID-19, you’re going to treat them with the same methods you were doing before you even knew it was COVID-19.

In terms of treatment for these other illnesses like bronchiolitis and other respiratory illnesses, what type of treatment should parents expect if their child does get one of them?

For a common upper respiratory infection, we expect, for the most part, to treat secretions, so saline and suctioning. In the older kids (above the age of six), there are over-the-counter medications that suppress the cough or help dry out the secretions and make them more comfortable. Mostly, we are treating the symptoms, not necessarily the virus itself. They do not need antibiotics for the majority of these infections.

For the younger children who can’t blow their noses, most of the treatment will be suctioning the secretion saline and making them more comfortable. Some people have used eucalyptus oils or other types of smell to make the airways feel more comfortable with humidifiers, etc. We tend to avoid medications in the younger kids because they tend not to work very well, and they are more likely to have side effects.

Are there any preventative measures that parents can take during this time of year, especially?

The most important thing is teaching your children proper hygiene: how to cough into their arms and not cough into the open, washing your hands before you have your meals, washing your hands before and after you come home from school, etc. And nowadays, the proper use of the mask, if they’re old enough to use it, is going to help prevent some of these infections. We have seen some reduction in influenza and other viruses since we started using these masks.

One of the most vulnerable populations to bronchiolitis in premature infants and young children, so kids less than three to four months of age. They are at higher risk of developing complications from bronchiolitis, especially if it’s caused by RSV, which is the Respiratory Syncytial Virus. In premature infants, there are vaccinations that they can get to help prevent the baby or the premature infant from getting RSV, but there’s only a high-risk group of people that are given these because the vaccines are very expensive, and they only tend to work in that particular subset. If you have a premature infant, this is something that you should be thinking about, and you can have that discussion with your pediatrician.

Are there any telltale signs for RSV in older children?

RSV is notorious for giving a lot of congestion. It’s going to give children a really bad cold with a lot of nasal congestion. Most of the older kids are not going to end up in a hospital with RSV.  It’s the vulnerable populations that are at high risk, but for the most part, it’s like a regular cold with a lot of congestion.

What about the flu in children? We haven’t seen influenza for a couple of years in those numbers that we saw beforehand.

I think COVID has taken place of influenza at this moment, but there are incidents where we can get co-infections with influenza and COVID, and there are people who are at higher risk, even if they just get influenza alone.  So we want to make sure that we protect everybody whom we can protect from influenza, especially if they’re vulnerable. The most vulnerable groups or subsets are children less than the age of five, any child who has any history of asthma, and adults over the age of 65.

By vaccinating everybody who can be vaccinated, just like we do for COVID, not only are you getting my flu vaccine for yourself, but you’re also getting it for the cousin who’s got asthma. If we encourage everybody to vaccinate against influenza, it circulates less in the community, and those vulnerable populations are less likely to get sick. Remember that when the time that influenza season is around us, usually from October to May, we should make sure that we get ourselves vaccinated.

When can children receive the influenza vaccine?

Influenza vaccines have a license from six months and above. If it’s the first time a baby ever gets an influenza vaccine, we usually do a two-dose series to remind the immune system, like we’ve done with COVID-19 vaccines now. Everybody’s more familiar with that concept now, thanks to COVID. The first time a baby gets the influenza vaccine, especially if they’re younger than eight, they need to get two doses. These are available at Worldwide Pediatrics and most pediatric offices.

When a child does stay home when they’re sick, what should parents be giving them to help them with their symptoms?

If you have a baby that is less than two or three months of age, you should contact your pediatrician immediately if they have a fever, which is more than 100.4 degrees Fahrenheit. If your child is older than that and they’re not in any distress, but they’re not feeling great, are feeling a little bit achy, or have a little bit of a low-grade temperature, you can use medicine like acetaminophen, which is Tylenol. In the older kids (older than six months of age), we can use ibuprofen, which is Motrin and Advil to manage their fever. Again, we’re doing this to make the child more comfortable, not necessarily to treat the virus. It’s not going to make the virus go away any faster.

A common fear that we see is that the parent will give acetaminophen or ibuprofen, the fever will drop a little bit, and then once the medication starts to wear off, the fever will spike back up and the parent is fearful that the medication is no longer working. You’re right. It’s not working anymore because it is running out. The virus is still present in the body. The body is still fighting it off and that’s why we have the fever. If the fever is now lasting longer than 72 hours, then it’s a good time to get checked out. Talk to your TopLine MD Alliance affiliated pediatrician and make sure that the child gets fully examined.

You want to make sure you’re monitoring your child when they have a cold, including 1) making sure they’re drinking enough fluids to stay hydrated, 2) checking that they’re not in any respiratory distress, and 3) noticing if the fevers are lasting beyond 72 hours, which is around three days. If these things happen, you should your medical provider at that time just, so that at least they can get a look at the child and make sure that everything is okay.

Contact a TopLine MD Alliance Affiliated Pediatrician Today

Parents can find more resources on the TopLine MD website. Plus, if you don’t have a pediatrician for your child, all of the affiliated doctor’s information can also be found on that page. The TopLine MD Alliance consists of a group of top-of-the-line medical physicians and care teams who are committed to an exceptional patient experience while helping them to coordinate their care.


Juan-Carlos-MillonDr. Juan Carlos Millon is a proud member of the TopLine MD Alliance practicing Pediatrics in Miami-Dade County.






The TopLine MD Alliance is an association of independent physicians and medical practice groups who are committed to providing a higher standard of healthcare services. The members of the TopLine MD Alliance have no legal or financial relationship with one another. The TopLine MD Alliance brand has no formal corporate, financial or legal ties to any of the affiliated physicians or practice groups.