RSV...That Pesky Winter Time Virus

Respiratory Syncytial Virus (RSV)

RSV may cause illness in any age, however, the course of illness and severity of symptoms varies with age. RSV has a seasonal pattern presenting in Maryland anywhere between November and April and peaking in January or February. Almost all children will have an illness caused by RSV by 2 years of age and re-infection is common. In children under the age of one year RSV is the most common cause of bronchiolitis (a viral infection of the lungs causing wheezing, cough or respiratory distress). Those at higher risk or more severe illness include:

• Children under the age of 6 months
• Infants born prior to 35 weeks gestation (prematurity)
• Infants with underlying heart or lung disease
• Infants exposed to second hand smoke

RSV is spread from hand-to-hand contact. Once on your hands, the virus is introduced to the body through your nose or eyes when you touch your face (therefore the key for prevention is regular washing of hands with soap and warm water). RSV may stay on your hands for several hours.

RSV may cause a variety of symptoms depending on age. Older children (>1yo) and adults symptoms will often be limited to congestion, runny nose, cough and fever. However, in infants , we will often see an increased rate of breathing, decreased appetite, wheezing on exam and a cough that can last up to 2-3 weeks. Symptoms will peak usually on day 3-4 of illness.

So, Why do infants have more severe symptoms than older children?. Infants are small (duh Dr. Schneider we all know that) therefore, their lungs are small. When RSV gets into the airway it causes swelling and increased production of mucus. In older children and adults, coughing may move this mucus up and out of the airway. In young infants, they are not able to produce enough force to remove the mucus and over time as the infection progresses this mucus may plug up some of the smaller airways (bronchioles, thus bronchiolitis) making it harder for the child to breath.

Call 9-1-1 for an ambulance if your child:

·         Stops breathing

·         Starts to turn blue or very pale

Or Call our office or the covering physician if your child:

·         Has a very hard time breathing

·         Starts grunting

·         Looks like he or she is getting tired of having to work so hard to breathe

·         The skin and muscles between your child’s ribs or below your child’s ribcage look like they are caving in

·         Your child’s nostrils flare (get bigger) when he or she takes a breath

·         Your infant younger than 3 months has a fever (temperature greater than 100.4ºF or 38ºC)

·         Your child older than 3 months has a fever (temperature greater than 100.4ºF or 38ºC) for more than 3 days

·         Your infant has fewer wet diapers than normal

Diagnosis of RSV is made by your physician and is usually a clinical diagnosis (made on the presenting symptoms, time of year and overall picture of the patient). However, in some cases a nasal swab may be used to diagnosis RSV in the office. Results can be obtained within 30 minutes. However, the swab is not a 100% accurate and may miss some true infections with RSV.

Is there anything I can do on my own to help my child feel better?.

You can:

·         Make sure your child gets enough fluids

·         Use a cool mist humidifier in your child's bedroom

·         Treat your child's fever with acetaminophen (Tylenol) or Ibuprofen (Advil or Motrin as long as over the age of 6 months). Never give aspirin to a child younger than 18 years old.

·         Suction the mucus from your child’s nose with a suction bulb if it is interfering with sucking or breathing.

·         Do not allow anyone to smoke near your child

If your child is older than 12 months:

·         Feed warm, clear liquids to soothe the throat and to help loosen mucus

·         Prop your child's head up on pillows or with the help of a car seat.

Is there any medicine that my child can get prescribed to treat or prevent RSV?  -- Yes and No

Occasionally, we will try a breathing treatment in the office to help patients with significant breathing difficulty. Not all children require these treatments and most children will have little to no benefit from the treatment.

There is a medicine called Synagis that has been shown when used preventatively  to decrease hospital admission and severity of symptoms in a select group of infants. If your child is under the age of 1 and was born significantly premature, has chronic lung disease or congenital heart disease he or she may qualify for this treatment. Please ask our office staff for further information if you think your child meets these criteria.

In general, treatment is time. Since RSV is a virus your child’s body will fight off the infection. Our role as caretakers is to support your child through this process and allow their bodies the best chance to succeed.