November is typically the start of RSV season but it came early this year. Every year, severe RSV disease is the number one reason babies under 12 months old have to be admitted to hospitals in the US. But this season has been a doozy so far. There are so many cases that nationwide some children's hospitals are having trouble finding room for all the sick kids.If you want to track the numbers for your location, click here
This post will review
What is RSV disease?
Respiratory syncytial (sin-SI-shul) virus, or RSV, is NOT new. It is a common, seasonal virus that is often simply referred to as an especially bad cold. Nearly all children will get their first RSV infection by age 2. Like most viruses, it ranges in its severity from case to case. Let me repeat - I am sorry to say, but your child is likely to get this! No need to freak out…Keep reading.
RSV often settles in the bronchioles. These are the little airways in the lungs that lead to the microscopic alveoli, the place where oxygen is pulled into the blood. The virus causes these little airways to get clogged with mucus, making it difficult for air to pass. This is part of why the virus is so much worse for younger kids. Their smaller airway gets clogged more easily. Some studies show that somewhere between 25-40% of young infants with the RSV virus will have bronchiolitis or pneumonia. That is a scary statistic, but to balance it out, here is some reassuring data: in the US, 99.4% of kids under 5, and 98.5% of kids under 6 months will not need to be hospitalized with RSV. By far, the majority of cases can be safely managed at home.
You know the wretched colds that knock you flat? Not only do you have a runny nose, sniffling and sneezing, but you also have a harsh, deep cough and fever. That might well be RSV. I actually can almost diagnose it just by hearing the distinctive cough. It is deep, wet and sounds like it hurts.
RSV can come on slowly, unlike the flu that usually has a sudden ‘hit by a truck’ onset. Generally the first signs are runny nose and decreased appetite. The cough comes along a few days later. It is also common to have mild to moderate fevers that can come and go for several days. The symptoms are usually at their peak at the 3-5 day mark, but often last 8 days total. It is common for the cough to linger for several weeks.
Unfortunately RSV is not one of those viruses that is ‘one and done’. Sadly it takes multiple exposures before you develop immunity. Adults don’t get as seriously ill, but they still get it and are in for a miserable week. Most folks get RSV about 8 times until they finally seem to be not as vulnerable! It spikes again in older folks when the immunity tends to wane. It can sweep through retirement communities, so be cautious for the older adults in your life as well.
So how do you know if you need to worry? Severe RSV disease symptoms usually include some abnormal breathing but there are some specific things to watch out for.
As Dr. Ted says, “Respiratory distress looks like your kid ran a baby marathon. It’s not subtle” We worry when:
See the chart at the bottom of the post for a list of respiratory rates/age.
Check out the Tik Tok that Dr. Ted and I did. Seeing what labored breathing actually looks like is worth 1000 words (if someone had told me a few years ago that I would be doing TikToks, I would not have believed them.)
If you are reading this and your child is actually one of the few kids who is not coughing and doesn’t have a fever, I strongly recommend making note of what their normal breathing looks like before they get sick. Lift their shirt and get a baseline assessment.
Labored breathing is usually pretty obvious, but hydration is another big concern that sometimes gets missed. Warning signs include
A dehydrated kid is almost never playing happily. They usually seem pretty droopy.
It is normal for the appetite to be pretty off. I don’t even worry if kids lose a bit of weight from a week of pathetic eating. They will gain it back when they are recovered. However if they are not drinking adequately, they may need to get checked to see if they need to get an IV for some hydration and nourishment. Having an elevated fever is a symptom that often gets the parents the most worried. In general my attitude is that fevers are part of the package and can usually be managed with fever reducing meds or a tepid bath. If the fever is higher than 103 and not responding to medication or it is lasting longer than 5 days, then I would want to have your kid checked. This could be a sign that the RSV has turned into an ear infection and/or pneumonia. Bottom line - If your child is having trouble breathing, or significant trouble feeding, they may need to be hospitalized for a night or two for fluids, oxygen and observation.
Treatment
For mild cases, time tends to be the great healer. Your medical team can simply suggest the same symptomatic treatment and supportive care that we would do for any bad cold and cough.
If you need some tips and trick getting the medicine in check out this post
If your child is having trouble eating because of all the congestion, try doing some clearing about ten minutes before a feeding.
To clear the nose, squirt some saline, xlear nose spray or breast milk in each nostril. Next step is to suck it back out with either a Nose Frida/ aspirator or the Neil Med Naspira. I think these products are easier to use than the standard bulb aspirators. Some parents swear by the Oogie bear. This is a safe little scoop that can safely get into the nostril and remove the more stubborn boogers.
It is also helpful to keep their heads elevated. They may be more comfortable on a bit of an incline. Try to raise the mattress a bit. You can do this by putting a towel underneath or place thin books under two of the legs of the crib. For older kids, add an extra pillow. The American Academy of Pediatrics guidelines specify not to raise the head more than 10% when they are sleeping and you are not keeping an eye on them. If they’re napping but you’re in the room keeping an eye on them, you can raise the bed to 30% for easier breathing.
Let them sit in a steamy bathroom, and use a humidifier at night. Increase fluids during the day.
Warm fluids are great. For kids older than a year, honey is terrific. I especially like the manuka honey. Have a little tea party, invite the teddy bears. Boys can have tea parties, too. This can also be a good way to encourage them to drink.
If your little one is having a rough time your doctor may do a one-time trial of a nebulizer or inhaler to see if it helps. Some children may be prescribed steroids.
According to our local pediatric acupuncturist, Dr. Den, at The Acupuncture Den, the actual symptoms are more important than any official western medicine diagnosis. Whether or not it is RSV, a common cold or even teething, if seen in the office early on, a treatment can help the body to heal itself more easily and will also help with symptom relief (non-needle treatment options are available!)
If you don't manage to stop it in its tracks quickly enough, traditional Chinese medicine can still be very helpful as the infection runs its course. Dr. Den keeps high quality pediatric herbal tinctures stocked in her office, and encourages the families in her practice to keep a bottle or two on hand, as they are most effective when used at the first signs of trouble. While some of the tinctures are highly specific, others can be used more generally (when you know your child is getting sick but you’re not sure yet what’s going on). In terms of the common cold, the flu, and RSV, the two tinctures Dr. Den recommends to keep in your medicine cabinet are CQ Jr (perfect for the first signs of illness) and Lung Qi Jr. (if it starts to move into the chest).
For more information about pediatric acupuncture (or grown-up acupuncture!) and/or herbal medicine, please reach out to Dr. Den. She’d love to hear from you!
How is it spread and what is the exposure period? This is NOT spread the same way as COVID which easily spreads through the air. RSV spreads through heavy droplets.
According to the CDC, people infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks.
Prevention There is no vaccine for RSV yet, although there is a promising one in the works that may be given to pregnant women. It looks like it may give infants several months of protection. It will be exciting to see how that is progressing
What we do have already is a medication called Synagis. Alas this is only approved for very high risk children who are very premature or have significant heart or lung issues. Most doctors are on top of this and would have informed you if you are eligible, but If you think your child might be a candidate, reach out to your doctor.
Since most of our children don’t fit the guidelines to get Synagis, please take precautions to prevent the spread of this nasty virus, especially for babies younger than 6 months.
If your child is unfortunate enough to get a nasty case of RSV, it may take a few weeks for the lungs to calm down. Many of them have an extra tough winter season. Every new cold seems to re-trigger the wheeze.
With any cold or illness, your best bet is to pay attention to the first sign of illness. Here is my blog post with my list of things you can do to boost and protect your immune system.
Testing There is a rapid test (a swab to the nose) that many offices can do to see if it is RSV or not. Usually they will test for flu and covid while they are at it. Believe it or not, some unfortunate kids can have more than one of those at the same time! Unless your child is looking really sick, it might not be worth an actual office visit to get an official diagnosis since it doesn't necessarily change the approach. Since RSV is a virus, the treatments are usually simply those listed above. Antibiotics would not be appropriate unless it progresses to a secondary infection.
Frequently asked questions
When can my little one go back to school? Keeping your child home because they have a mild runny nose or lingering cough is not reasonable. However, kids with fevers and/or copious mucus should stay home.
I am nursing, do I need to stop? Can I still be around the baby? Nursing moms who test positive should still continue to nurse their babies. This includes newborns. Just wear a mask and do thorough and frequent hand washing. (and I am so sorry if you are dealing with this.)
Do I need to keep my kids apart from each other? Sigh, this is SO hard. It is almost impossible to quarantine family members. If there is an infant in the house, I would try hard to keep toddlers who have been exposed at least 6 feet apart (sneezing distance) from the baby. No kissing or hugging. Put them in charge of the ‘magic soap’ otherwise known as hand sanitizer. Tell them to make sure that anyone who is having direct contact with their new baby needs to use the magic soap first. Maybe furnish them with a new baby doll that they can cuddle with instead.
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