Enterovirus D68 in Children
Content reviewed against published CDC, CDC, AAP, NIH guidelines
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Enterovirus D68 (EV-D68) is a non-polio enterovirus that causes respiratory illness ranging from mild cold-like symptoms to severe wheezing and respiratory distress. Unlike most enteroviruses, which primarily cause gastrointestinal illness, EV-D68 primarily affects the respiratory tract. It gained national attention in 2014 during a large outbreak that hospitalized hundreds of children across the United States. EV-D68 has been linked to acute flaccid myelitis (AFM), a rare but serious neurological condition causing sudden weakness or paralysis in the limbs, similar to polio. Children with asthma or a history of wheezing are at highest risk for severe respiratory illness.
Key takeaways
- Enterovirus D68 (EV-D68) is a non-polio enterovirus that causes respiratory illness ranging from mild cold-like symptoms to severe wheezing and respiratory distress.
- Duration: Mild cold-like symptoms resolve in 7-10 days. Wheezing and respiratory symptoms may last 1-2 weeks. Cough may linger for 2-3 weeks. AFM symptoms, if they develop, typically appear 1-4 weeks after the initial respiratory illness and may result in prolonged recovery requiring rehabilitation.
- Go to ER if: Severe difficulty breathing — chest retractions, nasal flaring, grunting, or belly breathing
- No vaccine currently available
Symptoms
How It Presents by Age
0-6 months
Relatively uncommon in very young infants. When it occurs, may present with rhinorrhea, cough, and wheezing. Severe respiratory illness is possible but less frequently reported than in older children. Monitor closely for breathing difficulties.
Risk level: Moderate
6 months-2 years
May present with cold-like symptoms progressing to wheezing. Children with prior bronchiolitis or a history of recurrent wheezing are at higher risk for severe respiratory symptoms. Can trigger significant bronchospasm.
Risk level: Moderate
2-5 years
Can cause significant wheezing and respiratory distress, especially in children with asthma or reactive airway disease. Fever may be minimal or absent, which can be misleading. This age group has seen notable AFM cases during outbreak years.
Risk level: Moderate — higher with asthma
5-12 years
School-age children are commonly affected during outbreaks. Children with asthma are at highest risk for severe wheezing requiring hospitalization. AFM, though rare, has most commonly been reported in children ages 3-10. Limb weakness developing days after respiratory illness should prompt immediate evaluation.
Risk level: Low to moderate — highest AFM risk age group
Treatment
Bronchodilator therapy
Albuterol (via nebulizer or MDI with spacer) is the first-line treatment for wheezing and bronchospasm. Children with asthma should follow their asthma action plan and may need increased rescue inhaler frequency. Some children may not respond well to bronchodilators.
Supportive respiratory care
Supplemental oxygen for children with decreased oxygen saturation. High-flow nasal cannula or CPAP may be needed for moderate-to-severe respiratory distress. Close monitoring of oxygen levels and work of breathing is essential.
Systemic corticosteroids
Oral or IV corticosteroids (dexamethasone, prednisolone) for significant wheezing and airway inflammation, particularly in children with known asthma. Helps reduce airway inflammation and bronchospasm during acute episodes.
Asthma action plan intensification
Children with known asthma should step up their controller medications during EV-D68 illness. Daily inhaled corticosteroids should be continued or increased. Close follow-up with their asthma provider is recommended.
AFM management
Children with suspected AFM (sudden limb weakness after respiratory illness) require urgent neurological evaluation and hospitalization. Treatment may include IVIG, corticosteroids, plasmapheresis, and physical rehabilitation. Early intervention improves outcomes.
Home Care
- Use rescue inhaler (albuterol) as prescribed at the first sign of wheezing
- Monitor breathing rate and work of breathing closely
- Run a cool-mist humidifier to ease cough and congestion
- Keep the child well-hydrated with frequent sips of fluids
- Use saline nasal drops and gentle suctioning for congestion
- Ensure children with asthma continue daily controller medications
When to Worry
Go to the ER if:
- Severe difficulty breathing — chest retractions, nasal flaring, grunting, or belly breathing
- Blue or gray color around lips, face, or fingernails
- Rescue inhaler not working after 3 treatments given 20 minutes apart
- Sudden weakness or paralysis in one or more limbs
- Difficulty swallowing, slurred speech, or facial droop
- Child appears extremely distressed, lethargic, or unable to breathe comfortably
- Oxygen saturation below 92% on home pulse oximeter (if available)
Call your doctor if:
- Wheezing that is not relieved by 2-3 albuterol treatments
- Child with asthma whose symptoms are worsening despite rescue inhaler use
- Breathing difficulties developing in a child with a cold-like illness
- Fever with significant respiratory symptoms during late summer/fall
- Any new weakness in arms or legs, even if mild
- Child not drinking adequate fluids due to respiratory symptoms
- Need for albuterol more frequently than every 4 hours
Keep an eye on:
- Wheezing that does not improve with albuterol treatments
- Breathing becoming increasingly fast or labored over hours
- Child is working hard to breathe — using belly muscles or neck muscles
- Any new limb weakness, difficulty walking, or clumsiness 1-4 weeks after respiratory illness
- Sudden difficulty swallowing, drooping eyelids, or facial weakness
- Child with asthma having their worst flare despite following their action plan
Prevention
- Frequent handwashing with soap and water for at least 20 seconds
- Avoid touching eyes, nose, and mouth with unwashed hands
- Keep children home from school when sick with respiratory symptoms
- Clean and disinfect frequently touched surfaces (doorknobs, toys, tablets)
- Ensure children with asthma are taking daily controller medications consistently
- Have an updated asthma action plan before the late summer/fall season
- Avoid close contact with people who are sick
Contagion & Incubation
Incubation
3-6 days (estimated based on enterovirus family)
Contagious for
Most contagious during the first 1-3 days of symptoms when respiratory secretions contain the highest viral load. Virus may be shed from the respiratory tract for 1-3 weeks. Children can transmit the virus before they develop significant symptoms.
Duration
Mild cold-like symptoms resolve in 7-10 days. Wheezing and respiratory symptoms may last 1-2 weeks. Cough may linger for 2-3 weeks. AFM symptoms, if they develop, typically appear 1-4 weeks after the initial respiratory illness and may result in prolonged recovery requiring rehabilitation.
Frequently asked questions
How long does enterovirus d68 in children last?
How does enterovirus d68 (ev-d68) spread?
When should I take my baby to the ER?
Can enterovirus d68 (ev-d68) be prevented?
When can my child return to daycare?
Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Illnesses
Bottom line
Enterovirus D68 in Children is a viral illness that typically resolves on its own. Seek emergency care if severe difficulty breathing — chest retractions, nasal flaring, grunting, or belly breathing.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.