Pediatric COVID-19 cases have risen in Allegheny County since August, with more than 500 cases reported from Sept. 30 through Oct. 6. At the same time, children could face one of the harshest flu seasons in recent history.

“All of the community viruses, particularly community respiratory viruses, that seemed to disappear and hide during those first 12 months of the pandemic have come out to play and cause mischief,” said Dr. Michael Green, medical director for infection prevention at UPMC Children’s Hospital.

As pandemic hospitalizations raise concerns about lengthy wait times, how can parents best seek care for children experiencing either COVID-19 or unrelated health issues? We asked local pediatric experts key questions on navigating the cold and flu season amid the pandemic.

Besides COVID-19, what are the major health issues we’re seeing among children right now?

Pediatric flu cases are expected to increase this year. Because there were fewer cases last year due to remote learning, children didn’t develop as much immunity, putting them at a greater risk for severe symptoms this year, said Dr. Jennifer Romero, a primary care pediatrician for Allegheny Health Network’s Fox Chapel division.

Dr. Debra Bogen, director of the Allegheny County Health Department, expressed similar concerns during an Oct. 6 briefing.

“We worry about flu every fall and winter,” Bogen said. “We had a very quiet flu season last year, but this year we are concerned it will be quite high.”

Illnesses like croup, ear infections, strep throat and common colds are beginning to appear, with a notable uptick in cases of respiratory syncytial virus [RSV] since the summer, Romero said. RSV commonly causes mild, cold-like symptoms, and almost all children contract it before the age 2. However, it can lead to severe breathing illnesses and pneumonia for infants, especially those younger than six months old.

As respiratory illnesses spread, Dr. Maya Ragavan, an assistant professor of pediatrics at UPMC Children’s Hospital of Pittsburgh, advises parents to look out for general breathing difficulties in their child, including breathing that’s faster than normal.

What type of care should I seek if my child is experiencing a health issue?

It’s important for parents to consider the level of care needed. Increased COVID-19 hospitalizations have overburdened providers in parts of the country and led to lengthy local wait times. Parents who are unsure of the appropriate level of care should call their child’s pediatrician first for guidance.

“A lot of what we do day-to-day, even before COVID, was trying to decide who sounds so sick that they need to go right to the emergency room versus who could come into our office,” Romero said. “A majority of things could be seen in our office first, and then hopefully even prevent a family from needing to go into an urgent or emergency room.”

What symptoms are appropriate for a visit to the doctor’s office? Romero said symptoms like most coughing among school-aged children should be brought to a child’s pediatrician first, either through an appointment or a call to the office’s triage team. Parents should seek emergency care directly if their child is experiencing respiratory distress.

Other incidents that warrant immediate emergency care include seizures, major cuts, potential broken bones, symptoms of severe dehydration, loss of consciousness after head injuries or fevers in children less than two months old, according to Johns Hopkins Medicine.

Parents should avoid going right to urgent or emergency care if it’s not needed. Children have been seeking emergency care at a historic rate, which led UPMC Children’s Hospital to set up an outdoor care tent in September to accommodate overflow.

“The goal here is to try to not fill up the emergency department with those kids who were never going to get admitted to the hospital,” Green said.

Johns Hopkins Medicine advises parents to take their child to urgent care if they can’t schedule a pediatric appointment in a couple days for symptoms that could be the flu, strep throat or conjunctivitis (pink eye).

If in doubt, parents should trust their instincts when they believe their child is experiencing symptoms that require emergency care.

“Parents know their children best, and I never want to provide a one-size-fits-all solution because children can become sick very quickly,” Ragavan said.

Should I continue bringing my child in for regular checkups?

“It’s been so hard for parents during the pandemic, thinking ‘Should I bring my child into the doctor?’” Ragavan said. “I strongly recommend, as long as your child is feeling well, to bring them in for their routine visits. We, pediatrician offices, are making sure that children and families are staying safe during those visits.”

Parents who feel concerned about bringing their child to an in-person appointment with their pediatrician should schedule a telemedicine appointment, Green said.

How can I protect my child from COVID-19?

Doctors and public health officials strongly recommend children wear masks to protect themselves and others during the pandemic.

In September, the Pennsylvania Department of Health began requiring all children over age 2 to wear masks in schools and daycare facilities to reduce the spread of COVID-19.

Parents can encourage young children to wear masks by having them choose masks with fun designs and using positive reinforcement techniques, like a sticker chart rewarding mask-wearing, Ragavan said.

Parents should also wear masks in front of their children to be positive role models.

“Kids hear what their parents say, and they may learn that ‘Maybe I don't want to wear a mask either,’” Green said. “On the other hand, if they see their parents modeling wearing the mask, and you know, saying, ‘It's a good thing, keeps us safe,’ kids will learn that.”

Children should stay home from school and daycare if they are experiencing symptoms like fever, coughing and congestion, Ragavan said. If they do have symptoms, inform your pediatrician and arrange for a COVID-19 test.

“It's really impossible to separate the clinical symptoms that you see with SARS-CoV-2 from the clinical symptoms that you could see from the other viruses in the community that typically we're used to for causing respiratory illness,” Green said.

Children 12 and older should receive a COVID-19 vaccine. Younger children aren’t yet eligible, but children older than six months old should also get their flu vaccine and practice public health measures, like washing their hands frequently and staying distant from others, Ragavan said.

Amelia Winger is a Rtvsrece editorial intern. She can be reached at

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Amelia Winger is a health reporter for Rtvsrece, with a focus on mental health. She is telling solutions-oriented stories that combine human experiences with broader context about data and policies....