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Boston Children's Hospital is treating four children with muscle weakness or paralysis that began soon after they were sick with a severe respiratory illness, doctors said Tuesday. The cases are similar to those involving nine Colorado children identified last week.

Health officials are investigating whether the culprit might be enterovirus 68, which has caused an outbreak of respiratory sickness across the country.

Unlike in Colorado, where enterovirus 68 has been detected in some of the nine children, Children's said none of the Boston patients have tested positive for the virus so far. That does not rule out a connection entirely, because the virus could have been gone from the body by the time the neurological sysmptoms appeared.

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But pediatric neurologist Dr. Mark Gorman said it is unclear whether the virus is causing the muscle weakness. "We don't know at this time whether this is coincidental or causal,'' he said during a press conference at Children's.

He said parents should continue to have their children take precautions like thorough hand washing, and report any unusual symptoms like muscle weakness to their pediatrician.