By Dr. Bonnie Carter, Board Certified in Family Medicine
As seen in OA Medical Matters:
RSV … three simple letters that strike fear into the hearts of parents everywhere. Probably everyone knows someone whose child has been hospitalized due to the respiratory syncytial virus (RSV). We’ve all heard the horror stories and, if diseases had a Most Wanted List, RSV would definitely be on it. According to the CDC, RSV accounts for approximately 2.1 million office visits, 57,000 hospitalizations in children under five, 177,000 hospitalizations for adults over 65 and 14,000 deaths in adults over 65.
The peak season for RSV is late fall to early spring, with January and February seeing the highest numbers. It is estimated that by the age of two, 90 percent of children will have had RSV at least once. RSV is the leading cause of bronchiolitis and pneumonia in children under the age of one. There are multiple strains of the virus, which means you can get it more than once. At this time, there is no vaccine available.
The symptoms of RSV are similar to the common cold: fever, cough, congestion and runny nose. What distinguishes RSV from other upper respiratory infections is the diffuse wheezing and difficulty breathing. For most healthy children over the age of two and healthy adults, RSV is just a bad cold. While uncomfortable, it does not present a danger to most in this age group. However, for children under the age of two, and especially those under six months, RSV can be a ticket to the hospital.
So why is RSV so bad for babies? One of the main reasons babies have so much trouble with RSV is that they don’t know how to breathe out of their mouth until they are older. When a baby’s nose is congested, they can’t breathe. This is why it’s important to use the bulb syringe and suck out any of those nasty nose goblins and boogies that get in there. And there are a lot of nose goblins with RSV! It creates an excessive amount of nasal drainage and secretions. It also causes inflammation of the air tubes, or bronchioles, causing bronchiolitis.
Signs that are concerning for respiratory distress in an infant or small child are tachypnea (rapid breathing), nasal flaring, retractions (caving in between the ribs with inspirations), use of accessory muscles (arm muscles and abdominal muscles) to breathe and perioral cyanosis (turning blue around the mouth).
One question I’m often asked is, “How do I know whether to take my baby to the doctor’s office or the emergency room?” Obviously, our goal is to keep you out of the ER as much as possible. They are busy and don’t need to be bogged down with non-emergent visits. But if your child is having respiratory distress with any of the signs listed above, that is where they need to be. If your kiddo has a runny nose, cough, fever, sore throat or earache, then call your physician and bring them into the office.
Treatment of RSV is symptomatic and it requires the tincture of time to resolve. RSV is a virus and therefore does not respond to antibiotics. Likewise, antibiotics do not prevent the illness from worsening. Like the commercial says, “That’s not how this works…that’s not how any of this works!” Parents often pressure physicians to prescribe antibiotics, especially when the child appears moderately ill. When we tell you antibiotics are not necessary, it’s not that we don’t believe your child is sick, or that we want your child to suffer longer. Trust me, if I had the magic wand to wave and make it all better, I would do it in an instant. Unfortunately, I never got my letter to Hogwarts, so I went to medical school instead. Also, we do not recommend cold medication such as cough medicine, decongestants and antihistamines for small children because studies have not shown an improvement of symptoms with their use and they often cause adverse side effects. The one therapy that has shown any consistent improvement is bronchodilator therapy (nebulized breathing treatments). I do recommend frequent nasal suctioning to help keep their nose clear and Tylenol to help fever. On average, an infection with RSV lasts about a week, with the worst symptoms being in the first three to four days.
As the old saying goes, “An ounce of prevention is equal to a pound of cure.” Preventing RSV infection is always the best plan, but sometimes the best laid plans go astray. Do not take your baby out to stores, church or anywhere there is a group of people who could be sick. If you do have to take your baby out, keep their carrier covered with a blanket to protect them from respiratory droplets. I know that everyone wants to see and hold the new baby, but it is safer to keep away from Grandpa Bill and his germs if he is sick. If someone in the house gets sick, try to keep them isolated in a separate room, especially at night. Cover your mouth and nose when you cough or sneeze and wash your hands. You can use Lysol to spray surfaces such as countertops, door knobs, or toys that might be contaminated with respiratory droplets. As tempting as it is, don’t Lysol the baby (or the dog, or your sibling, or your husband …)!