RSV (Respiratory Syncytial Virus)

As I sit at work in the ER at 3 am after a night up with my own baby coughing and seeing multiple children with bronchiolitis, RSV sits heavily on my mind.  I sent all of the children that I treated in the ER home tonight with the same advice that I use for my own children, but no “magic” cure. I tell my patients, truthfully, that if I had a cure to the common cold, I would happily give it out (and use it myself).   

RSV is the most well known virus that causes bronchiolitis, which is congestion, runny nose, cough, along with inflammation in the lungs – I liken it to bronchitis in adults. Most people with RSV (babies and adults) get a bad cold, with LOTS of snot! When the snot gets down into the lungs, it causes plugging and inflammation. Some children have fever with their respiratory symptoms. The babies that are most affected have labored breathing and wheezing with their illness. Children most likely to have more severe symptoms are premature infants, young infants (less than 3 months), children with heart disease and children with a predisposition to asthma. Older children with known asthma can have a severe asthma attack with this virus.

Currenlty, the best treatments that we have are symptomatic (meaning there is no cure with a medicine). In infants and toddlers this means nasal saline with frequent suctioning, using a cool mist humidifier, and encouraging fluids (breastmilk, formula, milk, pedialyte or popsicles) – remember that most childhood illnesses come with diarrhea, so be stingy with the juice! Acetaminophen or Ibuprofen for fever and fussiness.

Other treatments that may be used after seeing your pediatrician:
- Deep nasal suctioning (only at the doctor’s office or hospital). Remember the cause of the difficulty breathing and drinking…snot. This treatment is just as it sounds, using a long tube to suck out all the snot from the back of the nose and throat.
– Albuterol breathing treatments. Usually this is attempted for wheezing. It may not work, but it is worth a try.
– Antibiotics. Bronchiolitis is caused by a virus. Antibiotics will not treat the symptoms. However, children may have a bacterial ear infection or pneumonia along with their illness and some phyciains choose to treat these with antibiotics.

Children who need to be seen by a physician have:
– Labored breathing (chest or tummy moving in and out with each breath), fast breathing (>40-60 breaths per minute, depending on the age of your child), grunting or wheezing noises, or pauses in breathing for greater than 10 seconds for young infants
– Decrease in fluid intake. Many children who are sick refuse to eat, but they need to drink enough to have 2-4 wet diapers per day.
– Fever for longer than 3 days, fever that starts after the illness has improved, or fever in any infant younger than 3 months old.

Children sometimes need to be admitted to the hospital, if they are not getting enough oxygen, having difficulty breathing not relieved by nasal suctioning or albuterol, or if they are dehydrated. Most children, however, will stay home with symptomatic care from their loving (and tired) parents. Symptoms usually last 3-5 days, but coughing and wheezing may go one for 2-3 weeks after a severe bought with RSV.

As I write this, I am feeling very thankful that so far, neither of my children have required anything more than some extra love, nose suctioning, and ibuprofen for their wintertime illnesses (and we have had MANY), but we have 2-3 months left of RSV and Influenza season this year and many more years to come…

Heather Joyce, MD