As Enterovirus D68 infections continue to spread across the United States, the American Lung Association offers tips on how to protect your child from infection and what to do if your child is struck by the virus.

The severe respiratory illness, which has been reported in 43 states and the District of Columbia, has landed some children in the hospital. With a total of 514 confirmed cases and four deaths that may or may not have been connected to the virus, experts are urging parents to take every precaution.

Health officials are also trying to determine if the virus is associated with cases of muscle weakness or paralysis that have struck 10 children in the Denver area. Similar cases have been reported in Massachusetts, Michigan and Missouri.

“Children with pre-existing lung conditions, such as asthma, appear to be at the greatest risk for severe symptoms from this virus. Most EV-D68 infected children recover without serious illness,” Dr. Albert Rizzo, senior medical advisor at the American Lung Association, said in a news release.

“However, it is important for parents to understand that children with this infection who have asthma or a history of wheezing episodes are at higher risk for increased symptoms of shortness of breath and wheezing and are more likely to need specific treatment to address this problem. This means quick contact with their pediatrician or family doctor and even a trip to the emergency room, or a call to 911 is appropriate if respiratory distress is present,” Rizzo advised.