February 09, 2016
RSV - three letters that strike fear in parents’ hearts and it’s that time of year again. Also known as respiratory syncytial virus, RSV causes seasonal outbreaks, usually November through April, with a peak in January or February. Almost all children are exposed by the age of 2, and it is highly contagious.
RSV infection usually starts with a fever, nasal congestion, very runny nose, and cough, similar to a cold or the flu. It does tend to be one of the more severe “cold viruses." The runny nose and nasal congestion are often very prominent and the cough is more congested-sounding, and more persistent than with other cold viruses. Children may be more irritable than usual and may not eat or drink as well.
In some children, these symptoms can progress to a severe cough with wheezing and difficulty breathing. If the child is breathing rapidly, using the belly muscles to breathe, sucking in the skin beneath the ribcage or between the ribs, or flaring the nostrils, further evaluation at the doctor’s office or an emergency room is imperative. Small infants can even have periods when they stop breathing and if the infection becomes this severe, babies need to be admitted to the hospital for treatment. Some babies even require a machine to help them breathe until they recover sufficiently to breathe on their own. The illness is a long lasting one: lasting 1-2 weeks, and the cough can linger up to 3-4 weeks. Most children should begin to improve by the beginning of the second week.
Remember, RSV is a virus and treatment focuses on symptom relief. Antibiotics have no effect in treating the illness itself.
There are several risk factors that predispose children to a more severe infection: prematurity, low birth weight, chronic lung disease, congenital heart disease, asthma, immune system deficiency, daycare attendance, and exposure to cigarette smoke. For some high-risk babies, there is a monthly RSV injection called Synagis, which can help prevent severe infection. Be sure to talk to your doctor to see if your baby qualifies.
Remember, RSV is a virus and treatment focuses on symptom relief. Antibiotics may be used to treat secondary infections such as ear infections, but antibiotics have NO benefit in treating the RSV itself. Some things you can do at home to help with the symptoms:
- Encourage fluid intake
- Use nasal saline drops and suction (bulb or NoseFrida) to help clear mucus out of the nose
- Use a cool mist humidifier
- Use Tylenol or Motrin if your child is fussy or running a fever
- Avoid any exposure to cigarette smoke.
- In some cases albuterol “nebs” may be tried. Unfortunately, many studies show that albuterol does not help much with RSV, so the most recent recommendation is to avoid it. However, this recommendation is currently controversial amongst physicians, and some may opt to try it to see if the child will benefit from it.
Prevention is the best way to reduce the risk of contracting RSV. The virus spreads very easily through coughing, sneezing, and touching and it can live for hours on solid surfaces such as countertops, phones, and tissues. Wash hands frequently, cover coughs and sneezes, don’t eat or drink after other people, and clean high contact surfaces frequently. Spring will come and it will get better!