Story by: Mark A. Brockman Jr., M.D. on October 17, 2019
You’re in line for day care pickup and discover that your child’s classmate has respiratory syncytial virus (RSV) bronchiolitis. What does this mean for your child? With RSV season about underway, it’s a good time to understand RSV, as knowledge and preparedness are key to keeping children healthy.
RSV is a common virus seen in day care centers and schools every fall and winter. Severity of symptoms vary with age and other existing medical conditions. The illness usually lasts five to seven days. It is spread through coughing and sneezing, as well as through saliva and nasal drainage.
In older children and adults, RSV causes a simple cold. In infants and younger children, RSV can cause a condition called bronchiolitis. Bronchiolitis is inflammation of the small airways combined with significant mucus production. This combination makes it hard for the child to breathe. Symptoms of bronchiolitis include nasal drainage/congestion, wheeze and increased work of breathing. Fever may be present. Dehydration is common, due to increased effort in breathing, along with feeding difficulties. Also, a child may still cough one to two weeks after the initial infection has cleared.
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It’s important for parents to know when to seek medical attention for a child who may have RSV. Signs of increased work of breathing warrant immediate medical attention. These include rapid breathing and what is also called belly breathing, or using accessory muscles for breathing. Retractions, or “sucking in,” can be seen between and under the ribs. In more serious cases, a child will “tire out,” and rapid breathing progresses to slow, shallow breathing, a sign the child is seriously ill. The most dreaded complication of RSV bronchiolitis is respiratory failure, which requires hospitalization with supplemental breathing assistance.
Treatment of bronchiolitis is supportive. Suctioning is an important part of treatment. It may be as simple as using a handheld bulb to suction. More severe cases require deeper suctioning in the hospital. Suctioning before and after feeding, along with before and after sleeping, helps tremendously. Hydration is also vital. Pedialyte is beneficial, as formula and milk are thicker and harder for children to tolerate. Cough medications should be avoided.
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Testing for RSV is not necessary for diagnosis or exposed patients, as it does not change the clinical course or treatment. It may be done, however, if the diagnosis is unclear or if the patient has other, underlying medical conditions.
You’re now ready to tackle this upcoming RSV season: You know the signs and symptoms of RSV bronchiolitis, and you have suctioning tools and Pedialyte handy. Have discussions with your pediatrician now so you are more comfortable when RSV makes its way around.
Mark A. Brockman Jr., M.D., is a pediatrician with Norton Children’s Medical Group – Iroquois.