RSV: When It’s More Than Just a Cold

What is RSV?

RSV (or respiratory syncytial virus) is one of the many viruses that cause respiratory illness―illnesses of the nose, throat, and lungs. This virus occurs in can vary in different parts of the country.

With mask-wearing and physical distancing for COVID-19, there were fewer cases of RSV in 2020. However, once safety measures relaxed with the arrival of COVID-19 vaccines, a rise in RSV cases began in spring 2021.

Typically, RSV causes a cold, which may be followed by bronchiolitis or pneumonia. Symptoms generally last an average of 5-7 days.

Cold: Upper Respiratory Tract InfectionBronchiolitis: Lower Respiratory Tract Infection
Symptoms may include Fever (temperature of 38c or higher), Cough (dry or wet sounding), Congestion, Sneezing, Runny nose, FussinessPoor feeding.Symptoms may include cold symptoms, plus: Fast breathing Flaring of the nostrils had bobbing with breathing rhythmic grunting during breathing Belly breathing, tugging between their ribs, and tugging at the lower neckWheezing
How hard is your baby breathing? Know what to look for.
Chest wall retractions occur when a baby must use muscles between the ribs or in the neck to breathe. It is a sign that the baby has to work harder than usual to breathe. Watch your child’s rib cage as they inhale. They are working too hard if you see it “caving in” and forming an upside-down “V” shape under the neck.

Is your baby or young child at greater risk?

Those infants with a higher risk for severe RSV infection include:

  • 12 weeks old or younger at the start of RSV season
  • Premature or low birth weight infants (especially those born before 29 weeks gestation)
  • Chronic lung disease of prematurity
  • Babies with certain types of heart defects
  • Those with weak immune systems due to illness or treatments
  • Additional risk factors for severe RSV infections include low birth weight, having siblings, a mother’s smoking during pregnancy, exposure to secondhand smoke​ in the home, history of allergies and eczema, not breastfeeding, and being around children in a child care setting or living in crowded living conditions.

When should you call the doctor?

RSV symptoms are typically at their worst on days 3 through 5 of illness. Fortunately, almost all children recover from an RSV infection on their own.

Call your paediatrician right away if your child has any:

  • Symptoms of bronchiolitis (listed above)
  • Symptoms of dehydration (fewer than 1 wet diaper every 8 hours)
  • Pauses or difficulty breathing
  • Gray or blue colour to the tongue, lips, or skin
  • Significantly decreased activity and alertness

Some children with RSV may be at increased risk of developing a bacterial infection, such as an ear infection. Call your doctor if your child has:

  • Symptoms that worsen or do not start to improve after 7 days
  • A fever (with a rectal temperature of 38°c or higher) is younger than 3 months of age (12 weeks).
  • A fever that rises above 38°c repeatedly for a child of any age.
  • Poor sleep or fussiness, chest pain, ear tugging or ear drainage.

How do doctors diagnose RSV?

Paediatricians diagnose children with a cold or bronchiolitis by asking about their symptoms and doing a physical exam. Your paediatrician may do a nasal swab test to determine if your child has RSV or another virus. A chest x-ray and oxygen saturation test may also check for lung congestion. Because most children recover without difficulty and there is no treatment for RSV, these tests are usually unnecessary.

Is RSV contagious?

Yes. RSV spreads just like a common-cold virus―from one person to another. It enters the body through the nose or eyes or, usually, from

  • Direct person-to-person contact with saliva, mucus, or nasal discharge.
  • Unclean hands (RSV can survive 30 minutes on unwashed hands).
  • Unclean objects or surfaces (RSV can survive up to 6 hours on surfaces, toys, keyboards, doorknobs, etc.).

Symptoms can appear 2 to 8 days after contact with RSV. According to the U.S. Centers for Disease Control and Prevention (CDC), people infected with RSV are usually contagious for 3 to 8 days. However, some infants and people with weakened immune systems can be contagious for four weeks―even if they are not showing symptoms.

Keep in mind, children and adults can get RSV multiple times–even during a single season. Often, however, repeat infections are less severe than the first one.

What can you do to help your child feel better?

There is no cure for RSV, and medications, like steroids and antibiotics, do not help with RSV.

To help your child feel more comfortable, begin by doing what you would for any bad cold:

  • Nasal saline with gentle suctioning to allow easier breathing and feeding.
  • Cool-mist humidifier to help break up mucus and allow easier breathing.
  • Fluids and frequent feedings. Make sure your child is staying hydrated. Infants with a common cold may feed more slowly or not feel like eating because they have trouble breathing. Try to suction the baby’s nose before attempting to breastfeed or bottle-feed. Supplementation with water or formula is unnecessary for breastfed babies. If difficult for the baby to feed at the breast, expressing breastmilk into a cup or bottle may be an option.
  • Paracetamol or ibuprofen (if older than 6 months) to help with low-grade fevers. Always avoid aspirin and cough and cold medications.

Only 3% of children with RSV will require a hospital stay​. Those children may need oxygen​ to help with breathing or an (intravenous) IV line for fluids. Most of these children can go home after 2 or 3 days. Rarely, a child may need care in a pediatric intensive care unit (PICU).

How can you protect your children from RSV?

Wash your hands! Just as you would prevent germs at any time, use soap and water and scrub for at least 20 seconds. Remind children to practice good hand hygiene all through the year.

Other things that can help

  • Vaccinate. Keep your children up to date on their immunisations and get the whole family annual flu shots.
  • Getting vaccinated with Tdap―to protect against whooping cough is especially important for adults around infants—new parents, grandparents, babysitters, nannies, etc. Your child should also be immunised against COVID-19 if they are eligible.
  • Limit your baby’s exposure to crowds, other children, and anyone with colds. Keep them home from school or child care when they are sick and teach them to cover their coughs and sneezes.
  • Go germ-free. Disinfect objects and surfaces in your home regularly and avoid exposing your child to smoke from tobacco or other substances.
  • Feed your baby breastmilk. It has unique antibodies to prevent and fight infections.

Injections for high-risk infants

A monoclonal antibody treatment ​may reduce the risk of severe RSV infection in some high-risk infants. Your paediatrician will let you know if your baby is a candidate.

Hope on the horizon

Medicine is constantly advancing! Scientists are currently studying vaccines to prevent and medications to treat RSV. We may have more options in the future. In the meantime, rest assured that most children recover well from RSV and grow to be healthy adults.

This article is from the American Academy of Paediatricians.

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