I had first heard of RSV when Breezy Mama Kelly gave birth to her first-born at 32 weeks. It was winter, and because her daughter was premature, she was scared to death of her having RSV. That was pre-kid time for me, and I didn’t think much about it after. Since that time, I’ve read the occasional magazine article about RSV, but still didn’t know all the details–until last winter, when my friend Kareen’s newborn, Finn, landed in the hospital because he had it. Kareen shares her story below followed by some explanations and details from Pediatrician’s Dr. Jon Conti about what RSV is, exactly. He also lets the rest of whose kids haven’t had it, know what to do. –Alex
It all started with a runny nose . . . I went to Finn’s pediatrician to have it checked out and she told me that my son had RSV. Of course, I had never heard of it before and she told me to watch him very closely as things could change. . . and quickly! Finn was five weeks old at the time and I was still waking him up every three hours to nurse him, so I was able to keep a pretty close eye on him.
That night Finn didn’t nurse well at all, a couple sucks here and there, coughing a lot, sneezing, wheezing, etc. The next day was a Friday and my husband was going out of town for work which I was fine with because at this stage I wasn’t too worried about Finn. I told him that our son would be fine and was sure that he was going to start eating better soon. What I didn’t know was just how serious RSV was, especially in infants. The day went on and still nothing had changed–for better or worse. Finn wasn’t very hungry and he was very tired. 1:00 PM came and I put my daughter down for a nap. I went to change Finn’s diaper and I noticed that he was retracting (his chest was pulling in). I opened his shirt and I could see he was battling to breath. I immediately called his pediatrician and she told me to come in, right now!! I was very scared. I called a friend to come over as my daughter was sleeping, and left for the doctor’s office.
As soon as we got there they brought us right back and gave Finn a breathing treatment. It didn’t seem to help so the pediatrician told me that we needed to go to the emergency room. She called to let the ER know we were coming, and before I knew it, Finn and I were in the car, speeding to the hospital. I was a mess. I called my husband and I’m sure he couldn’t really make out what I was saying, but he said he would catch the next flight home. In the car, I remember listening very carefully for any sound, any movement, any breath… as I couldn’t see him I was very frightened he was going to stop breathing. After what seemed like an eternity, we got to the emergency room and only had to wait seven minutes before we were seen! It was a crowded Friday afternoon, but luckily our pediatrician called a couple times to make sure we were seen quickly! The ER doctor ran many tests and within two to three hours we were admitted to a hospital room and told we would have to spend the night. I was very happy as I knew we were in the best possible place (we are lucky enough to have a Children’s Hospital within 15 minutes of our house) and I felt safe!
They put Finn on oxygen and every four hours (day and night) the respiratory nurse would come in and suction his nose and lungs to get the nasal secretion out. This helped him to breathe better so he could eat well. After that, he would have a breathing treatment to open up his airways. We had to do everything for him–remember he was only five weeks old–he was just so little and helpless. But, in the big picture, Finn was doing really well, each day he was getting stronger and stronger, nursing well and I knew he was feeling better when he started smiling! Our requirements for discharge were: no oxygen requirement for 24 hours, eating / feeding well and no increased work of breathing. Finn stayed for days on the smallest amount of oxygen, but he just couldn’t breathe on his own without it. The last night, our 6th night, he stayed off oxygen and was breathing well on his own. Hurray! We were discharged and we were going home to be with our family! It felt like we were away for a month. My husband came to the hospital every day but because of H1N1 restrictions, the hospital had a strict no visitor (other than parents) policy and we didn’t get to see our daughter and we missed her so much! I can not describe how happy we were to be together again!!
Advice from Pediatrician Dr. Jon Conti:
You jokingly refer to RSV as “Really Sucky Virus.” What exactly is RSV?
Respiratory syncytial virus (RSV) is the most common cause of severe, lower respiratory tract disease among infants and young children worldwide. Why is it so bad? To help us understand more about how this virus causes illness, first let’s break down its name:
‘Respiratory’–refers to the part of the body that this virus attacks (versus say the kidneys). The respiratory system is what helps you to breathe and is divided into two main parts: the ‘upper’ respiratory tract (URT) is composed of the nose, mouth & throat, whereas the ‘lower’ respiratory tract (LRT) involves the bronchi, bronchioles and lungs. NOTE: RSV commonly sets up shop in the bronchioles, which causes the wheezing associated with RSV, and is called ‘Bronchiolitis’ (not Bronchitis).
‘Syncytial’–during infection, RSV causes the infected respiratory tract cell to fuse & merge with its neighbors, creating little tiny bridges (syncytia) between cells. Then RSV can spread from cell to cell along the syncytia like wildfire, rapidly infecting the entire URT & LRT, thus disrupting the functioning of the cells lining the respiratory tract. As you now can imagine, this creates lots of mess, literally overnight–just as in Finn’s case.
‘Virus’ –ultramicroscopic, infectious agents that can replicate only within cells of living hosts. In the case of RSV, humans are the only source of infection. Lucky us.
In summary: RSV is a virus that attacks & rapidly disrupts the breathing system, severely so in infants, babies and children. The classic RSV patient has copious amounts of nasal goo, a wet sounding cough, and in some, an audible wheeze.
How then is RSV then different from the common cold?
RSV is different from a common cold in that it:
- May begin with URT symptoms, but RAPIDLY progress over 1-2 days to involve diffuse small airway-LRT disease–characterized by cough, nasal congestion, wheezing and chest rumbling, fever, and decreased interest in drinking or eating.
- Produces HUGE amounts of mucus, and wheezing.
- The duration of RSV is longer than the common cold: generally 7 to 10-days, but can last longer.
- RSV is EXTREMELY CONTAGIOUS. An infant or child can be infected by direct or indirect contact with VERY SMALL AMOUNT OF VIRUS. Direct contact with the virus can occur, for example, by receiving a kiss on the face from a loving brother or sister infected with RSV, OR it can be transmitted by droplets (like from a sneeze, a cough, or a drippy nose). Indirect contact can occur if the virus gets on an environmental surface (such as a crib guardrail, doorknob, a swing, monkey bars etc.) that is then touched by other people. RSV can live many hours on contact surfaces. To complete transmission, people then rub their eyes or pick their nose.
Once an infant or child becomes exposed, the illness usually begins 4 to 6 days afterwards with a runny nose and a decrease in appetite. Coughing, sneezing, wheezing and fever typically develop 1 to 3 days later. In very young infants, irritability, decreased activity & appetite, and breathing difficulties may be the only symptoms of infection.
Most otherwise healthy infants infected with RSV do not require hospitalization. Although 4-5 million children younger than 4 years acquire an RSV infection per year, only about 0.5 to 2 % will need to go to the hospital for care. Like Kareen’s child Finn, most children hospitalized for RSV infection are under 6 months of age. And like with Finn, most cases, including among those who need to be hospitalized, will fully recover in about 1 to 2 weeks. After infection, your child will continue to be contagious for at least 8 days.
SO as you can see, Respiratory Syncytial Virus (RSV) can be a Really Sucky Virus.
Does RSV strike a certain age group? Can we worry less about it as our children grow older?
RSV strikes children & adults of all ages. By 2 years old, almost all children have been infected at least once and hence have some immunity against it. Although re-infection throughout our lives is common, we are better able to tolerate the virus as we age. Older children & adults usually get upper respiratory tract illness, but the elderly & others with chronic medical conditions (e.g., asthma, cancer, immuno-compromised conditions, etc.) may have more serious lower respiratory tract complications.
Do more cases of RSV show up in your office at certain times a year (for example, during the winter?)
Yes, RSV tends to be seasonal AND regional. As you can see in the graph below, different parts of the United States encounter RSV at different times of the year.
Obviously, RSV is serious business. Is a vaccine being developed to help stop it?
Yes researchers are presently developing a vaccine; however, one is not ready yet. Until then, prevention is key during the RSV season.
You may ask, “But Dr. Conti, I thought I heard about a vaccine that was given to my friend’s super small infant?” It is not a vaccine, but a drug made of antibodies, synthesized in the laboratory, against RSV. The injection is called Palivizumab (say “pah-lih-VIH-zu-mahb”), or Synagis. Short-term, it helps the body protect itself against RSV infection and can help prevent development of serious RSV disease. However Synagis cannot prevent all infections, cure a RSV infection once an infant/child has it, nor can it alleviate children already suffering from serious RSV disease. Synagis has to administered before & during the RSV season.
As you can imagine, Synagis unfortunately is extremely expensive. Thus its use is limited to infants at the highest risk of severe complications from RSV: those infants born very prematurely, as well as those infants with severe lung or heart disease. If your child is at high risk for severe RSV disease, discuss Synagis with your healthcare provider as a preventive measure.
In her story, Kareen said her pediatrician told her “things could change” with Finn–what exactly does that mean–what do we need to watch out for?
Finn’s good pediatrician was giving her a ‘heads up’ as to the signs that he could need additional help. As Kareen mentions in her story, RSV moves quickly, and Finn’s increasing tiredness, fussiness, and lack of interest in feeding are worrisome signs. The following signs of ‘respiratory distress’ obligate a parent to seek emergent care: grunting, nasal flaring and retracting (while the child is breathing hard, seeing the outline of the ribs, like fingers across the chest).
The take away message here (and for other medical conditions) is “never worry at home alone!” If you are concerned about your loved one, you must call your doctor, or seek care at an Emergency room, and let the experts help you.
At home, Kareen noticed that Finn was having a very difficult time breathing–is there anything we should/can do at home to help with this?
The tenets of care for a simple “cold” or respiratory illness can go a long way to also help an infant or child with RSV. They are:
–elevation of the head of the bed with something under the mattress
–a cool mist or ultrasonic (not ultraviolet) humidifier
–repeated, but gentle use of a bulb suctioning after instilling normal saline drops (easily purchased at the pharmacy)
–small, but frequent formula or breast feedings
–no smoking around the baby. Even on the clothes, tobacco smoke will irritate the lungs and make things worse for the infant/child.
–and if there is a fever, use of (age appropriate) cooling measures
But I cannot emphasize this enough: if what you are doing at home isn’t relieving the symptoms, and your infant/child seems to be having trouble breathing or is lethargic, seek out medical care!
Kareen talks about Finn having breathing treatments performed on him–what exactly is done during this treatment?
It is difficult to know. But generally an emergency room team is trying to relieve a patient’s work of breathing. So, for example, they may want to give him oxygen, or open up his air passages with focused, humidified air treatments. Furthermore, when children are having trouble breathing, they concentrate on breathing through the secretions, but less so on drinking. Hence, they often become dehydrated. As a result, RSV patients often receive intravenous hydration to help with this.
Is there a breathing treatment “kit” that we can keep at home?
Beyond cooling measures and a functioning humidifier, not really. However if your child has ‘reactive airway disease,’ or is an asthmatic, RSV can trigger an attack. Keeping your nebulizer in good working order and a non-expired supply of Albuterol/Xopenex on hand is always a good idea.
Anything I’ve missed or that you would like to add?
Sure, what about prevention? It’s very hard to keep from catching RSV, just like it’s hard to keep from catching a cold. But you can lower the chances by practicing good health habits. Whether you are infected with RSV or not, during the RSV season it is imperative to keep your fingers out of your eyes, nose & mouth! Regular hand washing, eating food with utensils and wiping of hard surfaces with soap and water or disinfectant may help stop infection and spread of RSV. Also, persons with RSV illness should not share cups or eating utensils with others.
Ideally, persons with cold-like symptoms should not interact with infants, babies or high-risk children. If this is not possible, these persons should take extra care not to infect others. They should refrain from kissing. They should also cough or sneeze into the bend of their elbows (not their hands). When possible, limiting the time that high-risk children spend in child-care centers or other potentially contagious settings may help prevent infection and spread of the virus during the RSV season.
About Jon Robert Conti, MD FAAP: Dr. Conti earned both a BA in Psychology and a BS in Biological Sciences from the University of California, Irvine. He went to medical school in Michigan, and completed his pediatric residency from the Children’s Hospital of Los Angeles in 2001—consistently ranked by US News-‘Nation’s Best Hospitals’ since the 1990’s. Dr. Conti is Board Certified in Pediatrics & Adolescent Medicine and presently cares for patients & their families at Sea View Pediatrics in Laguna Hills & San Clemente. He can be reached for consultation at Sea View Pediatrics: (949) 951-KIDS (5437)
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