http://www.kidsdr.com

What's that hissing sound? Plenty of wheezing and coughing have ushered in the cold and flu season, and with all that noise, I'm on the lookout for respiratory distress. As I see more and more sick kids, my office is filled with a cacophony of coughing. While many of the coughs sound horrible, fortunately most patients don't have serious problems. Those who do need help fast.

I'll spend a lot of time this season talking to parents about the symptoms of respiratory distress. As with many aspects of effective parenting, observation is key. Watching your child's breathing when they're coughing or wheezing is the most important thing you can do. Recognizing genuine respiratory "distress" or "shortness of breath" means you need to know what to watch for.

A little girl, my first patient of the morning, had a history of wheezing episodes, and did have a nebulizer and medications at home. She'd been well all summer and her mother hadn't thought about wheezing, but noted that her daughter had started to cough over the previous weekend. Her condition then worsened and the child coughed all night, prompting an early appointment the next morning.

When I walked into the room, I knew immediately that the girl was in respiratory distress. Not only was she coughing (which every other patient seemed to be doing), but she was also retracting or "pulling"; while still happy and playing, you could tell she was "working" to breathe. Her tummy was moving in and out, and her ribs were doing the same. Gladly, she was still well-oxygenated and pink.

The mother had not looked at her daughter's chest and had forgotten about the nebulizer (out of sight out of mind), since she hadn't used it for 6 months and wasn't "clued" in yet to the new cough and cold season.

After a quick review, she remembered what we'd discussed the previous winter and realized she should have pulled out the nebulizer at the first sign of trouble. Repetition helps you remember the "home wheezing action plan."

Any time your child is coughing -- whether the youngster is 2 days or 20 years old -- observe their skin color (pink, not blue) and look at their chest. Check to see if they're using their ribs or tummy to breathe. The sound of the cough is not as important as LOOKING at the chest. Whether it's daytime or the middle of the night, take off their shirts and look.

Any sign that the child is struggling to breathe should direct you to call and visit your pediatrician or a hospital emergency room. Coughs are usually OK, but never respiratory distress.

(Dr. Sue Hubbard is a nationally known pediatrician and co-host of "The Kid's Doctor" radio show. Submit questions at http://www.kidsdr.com.)