It is that time of the year when trees are starting to change colors and it looks so beautiful outside! Fall is here, but so are the nasal allergies and respiratory infections in kids! As a pediatrician working in the emergency room, I am bracing myself for the upcoming flu and RSV season. Parents, especially parents of infants, are especially concerned about the possibility of their little ones getting the flu or “the RSV.” Parents tend to be more worried about the RSV because there are so many awareness campaigns about the flu with vaccine recommendations. Also, with the option of treating the flu infection with medications such as Tamiflu, parents may feel a sense of assuming an active role in trying to prevent the flu. But with RSV, there are no universal vaccines to prevent the infection and no specific medications to treat it.
What is RSV?
RSV or Respiratory Syncytial Virus is one of the many viruses that can infect the respiratory tract. It starts out with a runny nose, cough, and low-grade fevers — like a common cold. According to the CDC, more than 57,000 children younger than five years old are hospitalized each year due to RSV, and approximately 177,000 adults older than 65 are hospitalized each year with the condition.
Who’s at risk?
In most healthy kids, RSV can be treated at home with fluids and fever medications. It will run its course as a cold-like illness. RSV is most dangerous, and potentially fatal, in babies who are born prematurely and people with weak immune systems, heart disease or lung disease. Even babies who were born full-term and healthy can sometimes develop severe symptoms.
What are the symptoms?
The RSV infection starts off as a cold and usually resolves in a few days. However, it can sometimes spread from the upper airways to the lower smaller airways and cause a condition called bronchiolitis. These babies can have increased mucus production in their airways. This can lead to symptoms such as cough, wheezing, rapid breathing and potentially lead to respiratory failure and the need for hospital admission to help maintain their oxygen levels and hydration. Very sick babies with RSV can end up in the intensive care unit and even need mechanical ventilation.
What to look for?
If your baby started with cold-like symptoms but then starts to have rapid breathing, chest retractions, grunting, increased fussiness, poor feeding, dehydration, and/or lethargy, then it is time to head to the emergency room. These symptoms usually peak around day four to five of the illness. Doctors will diagnose an RSV infection with a nasal swab. Treatment will include checking the oxygen saturations and your baby’s hydration status. Chest X-ray, IV fluids, and further interventions may be needed based on how sick the baby looks.
RSV can spread from person to person through secretions and contaminated objects. Practice lots of handwashing, good hygiene and avoid exposing your little ones, especially infants, to sick people and crowded areas during the peak season from November to March. You can get RSV multiple times, even during a single season, but repeat infections are mostly less severe than the first one.
A medication called Synagis may reduce the risk of severe RSV infection in some high-risk infants. Premature babies born before 29 weeks of gestation, who are considered a high-risk population, can be given this medication to help prevent contracting RSV. It consists of a series of monthly shots given during the peak season. Your pediatrician will let you know if your baby is a candidate. Also, make sure your baby is up to date on his/her immunizations. RSV, like any other viral infection, can weaken the immune system and make your baby susceptible to other bacterial infections.
There is no specific medication to cure RSV, and medications like steroids and antibiotics do not help with RSV. Nebulizer treatments to help with wheezing are not routinely recommended for bronchiolitis. What helps is fever medicines, nasal saline drops and gentle suctioning to clear the nose to help with feeding, sleeping, and maintaining hydration.