Nolan Alexander (Host): Breathing symptoms like wheezing, coughing, and shortness of breath are common in children, but do you know when to seek help? Welcome to the Live Greater Podcast Series, information for a healthier you from the University of Maryland Medical System. This is an episode in a series of podcasts answering frequently asked questions about what is normal in childhood development and when parents may need to seek a specialist.

I'm Nolan Alexander. And let's learn more with Dr. Anna Lasso, who is the Division Head for Pediatric Pulmonary, Allergy, and Sleep Medicine at the University of Maryland Medical Center and Associate Professor of pediatrics at the University of Maryland School of Medicine. Dr. Lasso, how are you today?

Anayansi Lasso-Pirot, MD: Doing very good. Thank you for the invitation.

Host: It's certainly our pleasure. So as we know, a lot of kids like my own, they get coughs, they get colds, and they get noisy breathing sometimes. So, what tends to be normal and what deserves a closer look?

Anayansi Lasso-Pirot, MD: So, I think the easiest way to think of that is, you know, all children get colds, right? Like typical colds, you know them, you've seen them, little kids running around with a runny nose. If you think that your child is developing longer colds than other kids, if you feel like their cough never goes away, if with that mini cold they now develop chest congestion, you feel like things are more worrisome than what you're normally used to seeing, I would ask your pediatrician.

Host: So, I'm going back to when I was a first-time parent, and sometimes it can be really difficult to determine, well, what is kind of that timeframe and what isn't when a kid should be getting over a cold. So, is it possible to try to ballpark when you think it may be this cold is lingering a little too long?

Anayansi Lasso-Pirot, MD: Yeah, that's actually a very good question. I would use seven days or so as a typical cold. Five to seven days, you'd think may still have a little bit of a runny nose, but most of the symptoms should be getting better by the end of that first week.

Host: Five to seven days. Thank you so much, Dr. Lasso. That's really helpful. And I know for me, I heard the word wheezing the first time, and I think asthma immediately right away. Is that always the case?

Anayansi Lasso-Pirot, MD: No, it's not. All children can wheeze with certain viruses, particularly when they're very young. Babies, you know, first time they catch a virus, a respiratory virus, can definitely develop wheezing. What is not normal is if it starts to be a recurring issue.

Host: So, how can a parent tell the difference between a child who's just uncomfortable and a child who is truly having trouble breathing?

Anayansi Lasso-Pirot, MD: My suggestion is to look at the child's ability to answer your questions. If it's a kid who can already speak, can they speak in full sentences? Are they able to drink? Are they able to eat? Even if they eat less than usual, can they still have a more normal intake? If they're not able to do any of those things, I would worry about how severe their breathing work is at that point.

Host: That's tremendously helpful. So for a child that can speak, can they answer you? Can they answer you in as complete of sentences that they can speak on? And for those that are younger, does their intake change? Are they struggling with it? Is that a good basis that said?

Anayansi Lasso-Pirot, MD: No. That's the best way to think of it.

Host: And with that, things can start to blend together for what young children are experiencing. So, why can asthma, allergies, and viral illnesses look so similar in young children?

Anayansi Lasso-Pirot, MD: Well, they're all common, right? Viral illnesses, respiratory illnesses, colds are very much the most common infections that kids will have in the first few years of life. And asthma is common. Particularly for young children, asthma-like symptoms are very common, and allergies, of course, also. The best differentiation is what I was saying earlier about the length of the symptoms. Are they getting better quickly, or are they lingering or becoming worse over time? Or do you see a pattern where every time this child is exposed to a particular trigger, say going to a home with pets, do they get the same symptoms every time?

Host: So, you've given us a good understanding about being mindful of the lingering symptoms, but are there symptoms during play, during sleep or illness that would make a parent want to get a child checked sooner?

Anayansi Lasso-Pirot, MD: Yeah, actually that is a very good question. Typically, we tell parents that a persistent cough during sleep is not normal. And again, going back to colds, everybody, including children, will cough some during colds. But that pattern of persistent nighttime coughing is not normal, particularly in children that do not have a respiratory infection.

The other thing that you brought up is exercise tolerance, and so activity tolerance. So, children with conditions like asthma tend to get triggered by exercise. So, they'll start coughing when they run around, when they're very active, when they laugh, when they cry. So, those should be red flags for a parent that perhaps this isn't just a cold.

Host: You've done a great job, Dr. Lasso, giving us specific things to look for at times where it can be so difficult for a parent just the way that things blend together, and especially for young children, they can't communicate the way that you'd want them to. So, what would be the most important thing that you want parents to know when they're deciding whether they should wait, whether they should make a call or go get urgent help?

Anayansi Lasso-Pirot, MD: So, I think the answer to that depends on the age group. So, babies, you're going to go faster. You're going to take your kid to seek help a lot sooner, because they cannot communicate with you. So if the baby has a respiratory illness and is not able to feed normally, I would take that child to their pediatrician to make sure that they are listened to, that they're checked.

Kids that are starting to talk a little bit or are more mobile toddlers, you can start assessing a little bit. Can they answer your questions? Can they at least drink? And those would be reasons to say, "Let's give it a little bit of time and see if we get better by the morning."

Other things to think about are high fevers. But again, all of that can overlap, and you can have a child with a high fever who just has a cold really, and they will be better the next day. So, a lot of this has to do with their ability to perform other activities, like I said, drinking, eating, being able to answer your questions.

And one more thing is look at their work of breathing. So, are they pulling to breathe? Are they showing signs of increased work of breathing? When they breathe, are they pulling their muscles at the neck? Are they pulling below the ribs? Those would be signs that they're really working hard to breathe, and then it's important to seek attention.

Host: Dr. Lasso, you've instilled so much confidence in me as a parent for the next time my child may experience something like this. So, thank you so much for giving us specifics to keep in mind and to look out for. Just to wrap it up, is there anything else that you view as a key takeaway or anything you want to leave our listeners with?

Anayansi Lasso-Pirot, MD: My main message is think of your child in the context of a group of children. Are they always that kid that when they go around trick-or-treating, for example, or they're at the pool with little friends, are those that are really coughing all the time, short of breath, or wheezing? Those are kids that need medical attention. If they just have a runny nose, if they seem very comfortable eating, laughing, playing normally, those are probably kids with colds that don't need more than a few days to get better.

Host: Dr. Lasso, thank you so much for joining us today. We truly appreciate your time and insight.

Anayansi Lasso-Pirot, MD: Thank you for having me

Host: That was Dr. Anna Lasso. Listen to more at umms.org/podcast, YouTube, or your favorite podcast platform. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. And don't forget to check out the other topics on A Parent's Guide to What is Normal. We look forward to you joining us again, and please share this on your social media.