Part 4 of our respiratory season series. So far: telling the illnesses apart, this year’s vaccines, and urgent care versus the ER. This one is for the households doing all of it with kids in the house.
Right About Now Is the Worst of It
If it feels like your kid has been sick since the second week of school, that’s not bad luck and it isn’t your imagination.
There’s a pattern in the data that pediatricians have tracked for two decades. Childhood asthma hospitalizations spike every single September in North America, and the peak lands an average of about seventeen days after Labor Day. Labor Day was September 7th this year. Do the arithmetic and you land right about here — the third and fourth weeks of the month.
Roughly a quarter of all pediatric asthma admissions for the entire year happen in September. One month, a quarter of the total.
Thirty Kids, One Classroom, a Lot of Rhinovirus
The mechanism isn’t mysterious. Kids come back from summer, get packed into rooms together, and start trading viruses — rhinovirus mostly, the ordinary common cold virus, which happens to peak in September. In a child with asthma, an ordinary cold isn’t ordinary. Viral infections set off more than eight out of ten asthma flares in children.
The part parents find vindicating: researchers can actually watch the wave move outward from schools. School-age kids peak first. Preschoolers follow about two days later. Adults about six days after that. Your five-year-old brings it home, your toddler gets it, and then you do. That’s the documented sequence, not a joke about daycare.
If Your Child Has Asthma, Read This Part Twice
September through November is the stretch where asthma goes from managed to not-managed, and it usually happens the same way: a cold arrives, the controller inhaler has been skipped for a few weeks of summer, and by day three the rescue inhaler is coming out four times a day.
Things worth doing now rather than later:
- Restart the daily controller medication if it lapsed over the summer, and keep it going through the season even on good days
- Check every inhaler in the house for an expiration date, including the one in the backpack and the one at the nurse’s office
- Make sure the school has a current asthma action plan on file
- Count rescue inhaler use — needing it more than twice a week outside of exercise means the plan isn’t holding
- Treat any cold as a reason to watch more closely, not less
If the rescue inhaler is getting used more than it should, that’s worth a visit before it becomes a 3 a.m. problem. Our pediatric team sees this constantly this time of year.
Keep Them Home, or Send Them?
The everyday question, and there’s a clear answer for the main one.
Fever: New York City schools ask that a child stay home until they’ve gone a full 24 hours with no fever without fever-reducing medicine, and with symptoms improving. Medicating at 7 a.m. so a child can get through the day restarts that clock — it doesn’t satisfy it.
Diarrhea: home until it’s stopped.
Beyond those, use how the child is behaving rather than how they sound. A kid with a rattling cough who is eating, playing, and keeping up is usually fine to go. A kid with a mild cough who is flat on the couch and not interested in anything is not. Coughs also outlast the illness by a week or two, and no child should miss two weeks of school over a lingering cough.
Your school nurse can also make a judgment call on a child who needs to be home for other reasons, and that call stands.
Babies Are a Different Situation Entirely
Everything above is about school-age kids. Infants play by different rules, and the difference matters most with RSV.
In a school-age child, RSV is a cold. In a baby under a year, it’s the leading cause of hospitalization — the virus settles in the smallest airways, they swell, and a baby has very little airway to spare.
The most useful thing to watch in a sick infant is feeding. Not temperature, not how the cough sounds. A baby who is working hard to breathe cannot coordinate sucking and swallowing, so they come off the breast or bottle after a few seconds, over and over. A baby who stops feeding well is telling you something before anything else does. That’s the sign to act on.
Also watch for the skin pulling in between or beneath the ribs with each breath, nostrils flaring, grunting on the exhale, or long pauses in breathing. Any of those means an emergency room now.
Protecting babies before RSV season
This is the part most parents don’t know about, and we’d rather you heard it from us in September than in January.
Infants can be protected against severe RSV, and there are two routes. One is an RSV vaccine given to the mother during pregnancy, between weeks 32 and 36, which passes protection to the baby before birth. The other is a protective antibody given to the baby directly — generally recommended for infants under 8 months whose mothers weren’t vaccinated during pregnancy, weren’t vaccinated in time, or whose status isn’t known. Some higher-risk children between 8 and 19 months entering a second RSV season may also be candidates.
Most babies need one route or the other, not both, and which one depends on what happened during pregnancy. We offer both here, along with RSV testing when a child is already sick. The antibody is typically given across RSV season, roughly October through March, which makes right now the time to ask rather than the time to wait.
One correction we find ourselves making a lot: the RSV vaccine adults get is not approved for babies and is not what an infant receives. If someone has told you your baby needs “the RSV shot,” the antibody is what’s meant.
That Barking Cough at 2 A.M.
Croup has a sound parents never forget once they’ve heard it. Like a seal. It comes on at night, out of nowhere, in a child who had an ordinary cold at bedtime, and it frightens everyone in the house.
It’s usually viral, it’s most common in toddlers and preschoolers, and it’s usually more alarming than dangerous. Cool air often helps — some parents find a few minutes by an open window or in front of the freezer settles it. Staying calm genuinely matters too, because crying tightens a swollen airway further.
What changes the picture: noisy, high-pitched breathing when the child is sitting still and calm. A harsh sound on the way in, not just with coughing. That’s stridor at rest, and it needs to be seen right away. Same for any child who is struggling to breathe, drooling, unable to swallow, or turning blue around the mouth — that’s an ambulance, not a car ride.
Croup that’s settled but keeps returning night after night is worth a daytime visit. A single dose of steroid given in clinic often shortens the whole thing considerably, and it’s a straightforward visit.
Emergency room now — don’t wait for a clinic to open:
- Any fever in a baby under three months old
- Working hard to breathe: ribs pulling in, nostrils flaring, grunting
- Noisy breathing at rest, or pauses in breathing
- Blue or grey lips or face
- A baby who won’t feed, or has had no wet diaper in many hours
- Limp, unusually sleepy, or very hard to wake
- Not responding to a rescue inhaler the way they normally do
- Drooling with a refusal to swallow
- A child who improved and then got suddenly worse
Parents are usually right about their own child. If something seems wrong in a way you can’t name, that counts as a reason.
What We Can Do This Season
We see kids of every age, seven days a week, across Brooklyn and Queens — no appointment required.
- Testing for flu, COVID, RSV and strep, with results the same visit
- Flu shots for children and adults, so the whole family can go once instead of three times
- RSV immunization for infants, and the RSV vaccine for eligible adults in the household
- Asthma flares, croup, ear infections, and the endless sore throats
- On-site X-ray when a cough raises a pneumonia question
- School and sports physicals, including the CH-205, if that’s still outstanding
Walk into any location, or check in online first so you’re not sitting in a waiting room with a miserable toddler longer than you have to.
Frequently Asked Questions
Why does my child get sick every September?
Because school restarts and thirty children start sharing viruses in one room. Rhinovirus, the ordinary cold virus, peaks in September, and it spreads through classrooms quickly. For children with asthma it’s more consequential than a cold sounds — viral infections trigger over 80% of childhood asthma flares, and about a quarter of the year’s pediatric asthma hospitalizations happen in September alone.
When can my child go back to school after a fever?
New York City schools ask that a child be fever-free for a full 24 hours without any fever-reducing medicine, with symptoms improving, before returning. Giving medicine in the morning so they can get through the day restarts that clock rather than satisfying it. Your school nurse may also require a child to stay home for other reasons at their discretion.
How do I know if my baby’s cold is turning into something serious?
Watch feeding more than anything else. A baby working hard to breathe can’t coordinate sucking and swallowing, so they feed for a few seconds and stop, repeatedly. That change often shows up before anything more dramatic. Also watch for the skin pulling in around the ribs, flaring nostrils, grunting, or pauses in breathing — all of which mean emergency care right away. Any fever in an infant under three months is an emergency regardless of how well they seem otherwise.
Do you give the RSV shot for babies?
Yes. Infants can be protected either through RSV vaccination given to the mother during pregnancy at weeks 32 to 36, or through a protective antibody given directly to the baby — typically for infants under 8 months whose mothers weren’t vaccinated in time, plus some higher-risk older infants. We offer both, and we also test for RSV when a child is already ill. Note that the RSV vaccine given to adults is not approved for infants; the antibody is what babies receive.
My child’s cough has lasted three weeks. Should I worry?
A cough commonly outlasts the illness that caused it by a week or two, sometimes longer in children, and by itself a lingering dry cough after a cold is usually not alarming. What warrants a visit is a cough that is worsening rather than fading, one that comes with a returning fever, one that’s disrupting sleep night after night, or any cough in a child with asthma that isn’t responding as usual. When in doubt, have it listened to.
Can my child get a flu shot at the same visit as something else?
Usually, yes, and it saves a trip. Whether it’s appropriate depends on your child’s age, health, and why you’re in — a provider can sort that out during the visit.
What’s croup, and when is it an emergency?
Croup is viral swelling of the upper airway, most common in toddlers and preschoolers, and it produces a distinctive barking cough that almost always shows up at night. Most cases are more frightening than dangerous, and cool air often helps. It becomes an emergency when the child makes a harsh, high-pitched noise breathing in while at rest, is struggling to breathe, is drooling and unable to swallow, or looks blue around the mouth. Repeated nights of croup are worth a daytime visit — a single dose of steroid in clinic often shortens it.
One More to Go
Part 5 closes the series with the adults who need to handle all of this differently — anyone 65 or older, pregnant, or managing asthma, COPD, diabetes or heart disease — and the antiviral window that closes faster than most people realize.
Meanwhile: it’s the peak week for sick kids in this city. If yours is one of them, come see us. Seven days a week, every location, check in online if you’d rather not wait.
Medical Disclaimer: This article is for general informational purposes only and is not medical advice, a diagnosis, or a treatment recommendation for any child. Children’s symptoms can change quickly, and no article can account for an individual child’s medical history, age, or risk factors. Always consult your child’s healthcare provider about their care, and never start, stop, or adjust a child’s medication — including asthma controller or rescue medication — without speaking to a provider. School exclusion guidance reflects current New York City public school policy and may differ for private schools and daycare settings; check with your child’s school. If you believe your child may be facing a medical emergency, call 911 or go to the nearest emergency department immediately.