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RSV – When a Cold Isn’t Just a Cold

One of the infections pediatricians dread every winter is RSV, or Respiratory Syncytial Virus. RSV is an extremely common, extremely contagious upper respiratory viral infection that can cause severe symptoms in infants. The season generally extends from October to April, although it can be diagnosed any time of the year and most children will have been infected with it by the age of 2 years. While it just looks like a bad cold in older children, in infants less than2 years or in children with problems such as prematurity or heart disease, it can lead to:

• Bronchiolitis (an infection in the small airways of the lungs)
• Pneumonia
• Low oxygen levels
• Poor feeding
• Ear infection

What are the symptoms of RSV?

Most children with RSV will just look like they have a bad cold. While older children with RSV rarely get significantly ill, they can spread the infection to younger infants who will generally:

• Begin with a copious clear runny nose and cough; there may or may not be fever
• Within 2-3 days, the cough may worsen considerably and the baby may begin to wheeze
• Infants will often begin to breathe more rapidly and with more effort
• Babies will generally have difficulty eating because of their clogged up noses and the extra effort they have to put into breathing
• Symptoms will generally begin to improve after 5-6 days and will usually resolve by 7-10 days

What should I do for my baby?

In the early stages, you should treat your baby as you would for any cold by:

• Suctioning the nose as needed
• Running a cool mist humidifier
• Encouraging lots of fluids

When should I call the office?

Call during regular office hours:

• Your baby is under 6 months, was a premie, or has a chronic lung, heart, or immune system problem and has started to cough, wheeze, or run fever. Our phone assistants can help you decide if your baby needs to be seen.
• Your baby is any age and has a severe cough, is wheezing, or is not eating well and showing signs of dehydration.

Call right away:

• Your baby is under 2 months and has a rectal temperature of 100.5 or greater
• Your baby is having significant breathing troubles such as moderate to severe wheezing, rapid breathing, retractions (the sinking in of skin between the ribs, under the rib cage, or at the neck), or a bluish tinge to the skin

What will happen in the office?
The provider will assess your child and determine the degree of respiratory distress. Depending on your child’s symptoms, exam, and past history, they may order a nose swab to test for the RSV virus. Other tests may include a CBC (complete blood count), a measurement of their oxygen level, and possibly a chest X-ray. They may order a nebulizer treatment with a medication called albuterol to see if it improves the baby’s wheezing.

What’s the treatment for RSV?
Unfortunately, because RSV is a viral infection, there is very little treatment available. Antibiotics have no efficacy against RSV and will only be prescribed if your baby also has an ear infection or pneumonia. Even though oral steroids help resolve the wheezing due to asthma, they have not been shown to help RSV and are only used if the baby has a history of asthma or, occasionally, if there is a very strong family history of asthma. Some babies show improvement with albuterol nebulizer treatments and we may order home treatments if they seem to help your child. It is important to realize that the albuterol is only treating the wheezing and not the infection itself. Some children with RSV will require hospitalization for oxygen if they cannot breathe effectively or IV fluids if they are unable to drink enough. Fortunately, RSV is a self-limited illness and the symptoms will resolve on their own in 7-10 days.

How can I keep my baby from getting RSV?
Unfortunately, there is no vaccine for RSV – hopefully someday! Until that time, common sense and good hand washing are your only weapons. Take care not to expose infants under 2 months of age, premature babies, and infants with heart, lung, or immune system disease to people with colds during the winter months (yes, this is difficult!).  If you have older children, have them change their clothes and wash their hands when they get home from school before they play with the baby. Babies with chronic diseases or who were born at less than 34 weeks gestation will often receive a preventative shot once a month called Synagis (which is not indicated for healthy term babies). However, almost all children will contract RSV at least once by the time they are two years old, so it’s really inevitable; we would just like them to be as old as possible!