An added twist has popped up in the respiratory virus circulating among kids, enterovirus-D68 (EV-D68)—a cousin to the common cold that first appeared in August and causes wheezing.

There have been ten cases of children with paresis or muscle weakness related to EV-D68. The new symptoms include muscle weakness in shoulders, biceps, hips, neck and face, sometimes affecting ability to swallow. Symptoms range from mild weakness in one limb to severe weakness in all limbs, but all of the kids are able to move, which is why doctors are not using the term paralysis.

Six out of nine cases of kids with the muscle weakness tested positive for EV-D68. Doctors aren’t sure whether the virus is directly causing the paresis, though.

“We are not saying this is due to the virus. It’s not known what’s causing it,” says Dr. Sam Dominguez, Children’s Hospital Colorado Microbial Epidemiologist.

The Centers for Disease Control (CDC) first identified EV-D68 in August. The strain has not circulated in several years and therefore people don’t have immunity. Children are particularly susceptible because they have not been exposed to many viruses and have smaller windpipes more prone to wheezing.

The surge of infections has affected Kansas City, Chicago and Denver the worst. It is now spreading coast to coast. The start of school is the perfect storm for spreading the disease, according to Dr. Christine Nyquist, pediatric infectious disease specialist and medical director of infection control at Children’s Colorado.

From August 18 to September 28, more than 4,000 kids have been treated for severe respiratory illnesses at Children’s Hospital Colorado. Ten percent of those children have been hospitalized for severe breathing difficulty.

Children’s Colorado is working closely with the CDC to figure out the connection between the paresis and EV-D68. They haven’t identified any virus in the spinal cord fluid. They also haven’t found any common line among the kids who have the weakness—schools, medications, etc.

The children do have distinct MRI findings, though. The biggest concern is long-term neurological damage, according to Dr. Joyce Oleszek, Children’s Colorado, Pediatric Rehabilitation Medicine. “Only time will tell,” she says.

“I think parents shouldn’t panic. If there is weakness in the legs or arms they should access health care,” Nyquist says.

There is no vaccine to prevent EV-D68. Nyquist suggests common sense health tips to prevent getting the virus: wash your hands; avoid sick people and if you and/or your kids are sick, stay home; keep asthma under control and stay on asthma medications; and get the flu and whooping cough vaccines as soon as they are available.

Parents do not need to have their child tested for EV-D68. The hospital will not be able to identify a specific strain because it requires a specialized test be sent to the CDC. Plus, the test would come back as rhinovirus/enterovirus, related to the common cold, so treatment would be the same regardless. Symptoms should be treated like the common cold. If there is wheezing or muscle weakness related to a cold, call your doctor.