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, and when is it something more?

"[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 include stuffy nose, runny nose, sneezing and cough. Dr. Abramson says that in young infants, overmedicating is avoided. "Sometimes just a bulb suctioning of the mucus to help open up the airway, so that (they) can breathe," 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. Sometimes just washing the nose with saline – an over-the-counter saline spray – can be helpful."

Dr. Abramson says RSV is a virus that almost everyone will eventually get, but the concern is for children younger than 2. Premature infants, infants with heart problems, such as congenital heart disease, and anyone with underlying immune deficiencies need special attention to prevent RSV. The symptoms start by mimicking a cold, but then lead to increased coughing, difficulty breathing and lethargy. RSV can also 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," he says.

Croup is another viral infection associated with coughing and difficulty breathing. "One can hear a noise called a '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. "Humidified air is sometimes helpful, certainly if the child is not oxygenating [breathing] well." Difficulty breathing is among the criteria for being admitted to the hospital for more aggressive treatment.

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