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Tag: rsv in kids

  • What Parents Should Know About RSV

    What Parents Should Know About RSV

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    Nov. 11, 2022 – A sick child from Northern California had to go to Portland, OR, to find an ICU bed. A child in Oregon was flown to Nevada last week due to a shortage of hospital beds. The culprit? Respiratory syncytial virus, or RSV. 

    “These stories are not unique and are happening across the country,” says Wendy Hasson, MD, a spokesperson for the American Academy of Pediatrics and medical director of the pediatric ICU at Randall Children’s Hospital in Portland. “This has been an unprecedented respiratory viral season, both in the timing and the number of children affected.” 

    Most children get RSV before their second birthday. Those with the highly contagious respiratory tract infection usually have the same symptoms as a cold, but can develop complications that can turn life-threatening – particularly for infants, those with weakened immune systems, and older adults.    

    Hasson says the formerly predictable illness, which usually peaks in January, has moved up its timeline. She’s now seeing an “overwhelming spike” 2 months early. About 80% of the patients in her ICU have RSV. In previous years, the average age for children admitted to the hospital with the virus was under 2. Now, Hasson says she routinely sees 3- to 5-year-olds on the ward. 

    The recent surge in RSV cases prompted the CDC on Nov. 4 to issue a health advisory alerting the public to the spiking illness. 

    Pediatrician offices are booked, and right now, many parents can’t get in for a sick child visit. If you can’t go the outpatient route, it’s important to know when it’s OK to watch and wait at home, or when it’s time to head to urgent care or the emergency room.  Read on for what parents should know as they navigate the recent RSV surge.

    Educate Yourself About Concerning Symptoms

    Hasson says parents should monitor three things in their children to decide whether it’s safe to keep them at home, or if they need to see a doctor: Breathing, hydration level, and alertness.

    It’s important to seek medical care if:

    • A child is breathing faster or harder than normal
    • The child is pulling around their neck or ribcage, or using their belly to breathe, which you can observe by taking off their clothes and watching
    • Babies are grunting or making a little sound at the end of each breath 
    • Babies aren’t drinking enough and are having fewer than three to four wet diapers per day
    • If a child is blue or purple, call 911

    These symptoms of RSV are often worse on days 4 to 6 of the infection.

    How to Help Your Child at Home 

    Coughs, fevers for up to 5 days, runny noses, decreased appetite, and chills are among many normal and overlapping symptoms of multiple viruses, including RSV, according to Samira Armin, MD, a pediatrician in the Houston area. But fever alone is not a reason to seek immediate medical care. 

    “Viruses need to run their course, and antibiotics and prescriptions don’t tend to work on viruses, so doctors often recommend home care,” Armin says. 

    She warns against using cough suppressants for children, and instead recommends helping them hydrate and rest, and not sending them back to school or day care too early. 

    Parents also can prepare for treating mild RSV at home, says Anita Patel, MD, a pediatric critical care doctor at Children’s National Medical Center in Washington, DC. 

    She suggests caregivers stock up on acetaminophen and ibuprofen (for children over 6 months old) for pain and fever. They should also have on hand a nasal suctioning bulb with saline drops, a reliable thermometer, a humidifier, as well as phone numbers of their pediatrician, an after-hours line, and nearby urgent care centers. 

    Practice Prevention Techniques 

    The COVID-19 pandemic made most of us experts at illness prevention, so put those skills to work to prevent children from getting RSV or other illnesses  during this surge. 

    Although no vaccine for RSV has been approved in this country yet, doctors recommend staying up to date with other vaccines, including those for flu and COVID-19, to prevent the spread and severity of these viruses. Encourage your children to wash their hands frequently, to cover their mouth or nose while sneezing or coughing, and to mask up when in public. 

    “Masks work very well against flu and RSV,” Patel says. “A simple surgical mask has saved me from catching both while taking care of thousands of kids.”

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  • What the RSV Surge Means for Doctors and Patients

    What the RSV Surge Means for Doctors and Patients

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    Oct. 25, 2022 — In early October, respiratory syncytial virus, or RSV, tore through Victoria Thiele’s Indiana home. Her three older children had manageable symptoms. But her 8-week-old newborn ended up developing a severe case.

    Thiele, whose family lives in Fort Wayne, said the baby experienced chest retractions while breathing and was taken to the emergency room at a local hospital, where she was diagnosed with RSV and bacterial pneumonia.

    An Unprecedented Surge in RSV 

    Thiel’s experience mirrors what’s happening across the country. On Oct. 21,  the CDC director tweeted that respiratory viruses, including the flu and RSV, are surging. Data from the CDC shows the percentage of those testing positive for RSV has more than doubled over the past month – straining the capacity of children’s’ hospitals as they try to care for the sickest patients. 

    “Nobody has enough beds,”  says Renee Higgerson, MD, pediatric intensivist and medical director at Pediatrix Critical Care of Texas and St. David’s Children’s Hospital. “We’re taking care of patients in every possible location we can in the hospital.”

    Yvonne Giunta, MD, director of pediatric emergency medicine at Staten Island University Hospital, part of Northwell Health in New York, said the pediatric emergency department at her facility is seeing a high volume of RSV cases, along with other respiratory infections. 

    “It’s not uncommon for a surge in pediatric volume in the late fall and early winter,” Giunta says. “But this surge seems to have started earlier than in previous years.”

    What’s Behind the Surge? 

    RSV usually has a predictable seasonal pattern, peaking in late December to mid February, according to the CDC. The virus hits young children hardest, causing about 58,000 hospitalizations of kids under the age of 5, and 100 to 300 deaths per year in that age group. But as the CDC noted, RSV was almost nonexistent in 2020, when pandemic prevention methods nearly knocked the virus out of circulation.

    Christopher J. Harrison MD, professor of pediatrics at the University of Missouri-Kansas City, said children get RSV by the time they are 2, and these first exposures make children less susceptible to the virus. 

    But the COVID pandemic means that some children born over the past couple of years were never exposed to RSV. 

    “Since the hiatus where we lost regular viruses, we ended up really shaking up the whole epidemiology thing,” Harrison says. 

    The loosening of pandemic control measures coupled with a much more susceptible younger population is a “perfect storm” for this outbreak, he notes. 

    Hospitals Pitching In 

    Higgerson says she has been heartened by how hospitals in her area have come together, inviting patients to take free hospital beds on the rare occasions they become available. 

    “Everybody is working cooperatively,” she says. 

    But the biggest hurdles are nursing and staffing shortages. 

    “We’re opening some sections of the adult hospital, creating pediatric beds,” she says. “But what’s limiting us is the availability of nurses. We just need more nurses.”

    Giunta says she is already strategizing ways to accommodate staffing needs. 

    “We are encouraging the swing shift, which typically would cover mainly the adult emergency department, to cross-cover the pediatric area in the later afternoon and evening hours,” she says. 

    Educating Parents 

    Michael Chang, MD, a pediatric infectious disease specialist at UT Health Houston and Children’s Memorial Hermann Hospital, whose facility is also operating at or near capacity due to a high volume of RSV, stresses the importance of parent education when it comes to managing this outbreak.

    Many parents have resumed normal pre-pandemic activities and are burned out by pandemic protocols, Chang says.

    “People are so tired of thinking about the pandemic that we have really returned to our prior behavior of shrugging off mild illnesses, runny noses, etc.,” he says. 

    Hospitals and pediatric offices should emphasize the ABCs of disease prevention when it comes to RSV, such as avoiding crowds, staying home when sick, and hand washing, Chang says. Teaching parents to recognize when symptoms can be managed at home, and when to take a child to the ER, could also help decrease the number of patients overwhelming emergency rooms. 

    What Parents Need to Know 

    In most children, RSV causes mild cold symptoms like sore throat, congestion, and coughing. But for children under the age of 2, children with weak immune systems, or those with asthma, RSV can be more serious.

    In vulnerable children, RSV can cause bronchiolitis, an inflammation of the small airways, making it difficult to breathe. It can also cause pneumonia.

    Most cases of RSV can be treated at home with extra fluids, cool-mist humidifiers, and nasal suctioning. But some children may need emergency medical care.

    Theile’s baby was put on high-flow oxygen, but her oxygen levels remained below normal. 

    “At that point, they told me she would need to be put on a ventilator,” Theile says. 

    After 4 days of ventilation, antibiotics, and treatment with steroids, the infant was able to breathe on her own. Thiele says she’s grateful for the compassionate care her daughter received, but that the atmosphere at the hospital was chaotic and frightening.

    “When we went into the ER, they had to take her stats in a hallway because all rooms were full of children with RSV,” Thiele says. “The PICU was filled with the sounds of children coughing and monitors going off due to their stats going down. It was truly heartbreaking.”

    According to the Academy of American Pediatrics, signs your child may need immediate medical attention include:

    • Labored breathing
    • Flared nostrils while breathing
    • Retractions at the belly or ribs
    • Sucking in at the collarbone while breathing
    • Wheezing
    • Gray or blue skin or lips
    • Extreme lethargy
    • Dehydration symptoms, such as decreased wet diapers

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