Thankfully, RSV season is coming to a close, but it still may be fresh on your mind.
For those parents who had to spend a night (or more) in the hospital this season, they know how serious a “simple” virus can be. Keep reading to learn why you shouldn’t scoff at such viruses and what you can do to avoid it.
What is RSV?
Respiratory Syncytial Virus, or RSV (I mean really, it’s WAY easier to use the acronym) is one of many viruses that causes illness in the respiratory tract (i.e. the nose, throat, and lungs). In the vast majority of kids, it manifests as simple cold symptoms: fever, profuse runny nose, irritability, congestion, and perhaps a cough. For the unlucky, however, it progresses and can affect the lungs causing “bronchiolitis”, or inflammation of the small airways in the lungs. Basically, a viral pneumonia. Symptoms of bronchiolitis include breathing fast, “belly” breathing, wheezing, head bobbing, or tugging at the neck. It can also include any of the cold symptoms above.
Basically, RSV sucks. It’s responsible for a number of admissions to pediatric wards and even pediatric ICUs around the US. It can be flat out deadly. But RSV isn’t the only virus that can cause bronchiolitis- though it definitely gets the most attention. Other viruses such as metapneumovirus or parainfluenza can cause bronchiolitis and can be just as severe as RSV.
Natural Course of Bronchiolitis
Symptoms of both the cold and bronchiolitis generally peak between 3-5 days and slowly start to improve thereafter. In general, the sicker your child is, the longer recovery will be. For most, however, symptoms start improving within a week and are resolved by 2 weeks, with the cough being the last thing to improve.
Unfortunately, there’s no treatment for RSV other than time. Supportive care is generally the only thing we can offer, mainly consisting of treating fevers with tylenol or ibuprofen and suctioning out the nose (optimally timed before feeds). Speaking of suctioning, one of the best devices on the market, in my opinion, is here (and check out the upcoming article on different devices and which is best).
Oxygen (if your child needs it), respiratory support (CPAP, high flow, intubation), and fluids are other things we can provide to help kids get through the illness. These are provided during a hospital stay. For young infants, sometimes we admit them to the hospital to monitor them out of an abundance of caution.
One of the most common complications of bronchiolitis is dehydration for which you should be on the lookout. In babies, keep an eye on the number of wet diapers. If this number significantly drops off, go see your provider. For toddlers who are potty trained, keep an eye on how much they are drinking and how often they use the bathroom.
Factors that Increase Risk
Almost all kids have been exposed to RSV by the time they are 2, so what factors place your child at increased risk of getting hospitalized?
A big one is age. Infants under 6 months are at high risk, and those under 3 months are at the highest risk of complications from RSV. For many families, birthdays in the latter half of the year mean early exposure to viral season (end of fall to early spring) at young ages. For those of you, I salute you. Lots of hand sanitizer and prayer will hopefully get you through!
Other risk factors are children who are born preterm or have chronic medical conditions such as congenital heart disease, chronic lung disease, asthma, male gender (yes, I know), or kids who have parents that smoke.
For certain populations of kids at high risk such as those with congenital heart disease, chronic lung disease, or preterm infants there is an injection called palivizumab, or Synagis, that can be given to help prevent infection with RSV during viral season. This injection is incredibly expensive which limits its use. Researchers are actively working on a vaccine for RSV, so keep your hopes up!
Tips to Avoid Bronchiolitis
Let’s face it, most kids (>90%) will get RSV at least once by the time they’re 2 years old. The best bet is to try and put off the infection as late as possible, but even this doesn’t prevent infection from being severe.
Hand hygiene is incredibly important for many reasons, one of them being the spreading of illnesses. Having an alcohol based hand sanitizer on hand with you at all times is a great idea, especially with an infant.
Limiting time out in very public places is a hard thing for me to recommend, but if you have an infant under 3 months it’s probably a good thing to practice during viral season. If you have to get out of the house, keeping your child covered and not available to prying, potentially infected hands can help.
Staying out of daycare can prevent or delay infection, but this isn’t practical in the least for the majority of working parents.
Finally, separating sick siblings (in particular older siblings in school) can help prevent infection but this is also not practical.
In summary, RSV and bronchiolitis are common ailments with potentially devastating outcomes. The majority of kids make it through, however, with the help of supportive care. If your child is displaying signs of a cold (runny nose, congestion, fevers) along with signs of distress (breathing fast, “belly” breathing, wheezing, head bobbing, or tugging at the neck) see your pediatrician right away. If you have a child under 3 months of age who has a fever (even if no other symptoms) greater than 100.4 F or 38.6 C, see your pediatrician right away.
If you have any questions about RSV or topics you want me to discuss, share below 👇