There’s been a rise in RSV (respiratory syncytial virus) cases in kids in parts of the country, filling hospital beds in many states. The good news: Most children recover from RSV. The bad news: Symptoms can look like a cold or COVID-19 (we know, why can’t anything be easy)?
RSV is not new, but the timing of RSV infections has changed (cases usually rise in the winter, but infections started surging this summer and continue to increase).
“There’s no seasonality to these viral surges now. I think the way we dealt with COVID — the isolation, the masking and everything, it just shifted how we see these viruses coming out. In the last several weeks… the hospitals have been full of children with RSV either being evaluated, boarding, and also being admitted to the hospital,” said Dr. Stephanie Duggins Davis, a pediatric pulmonologist and chair of pediatrics at the UNC School of Medicine.
We’ll break down what parents need to know about RSV symptoms, treatment, and when to take a sick child to the hospital.
What is RSV?
RSV is a common virus. In fact, almost all kids get an RSV infection by their second birthday (yep, you probably didn’t even know it was RSV).
Most RSV cases are mild, and infections go away on their own in a week or two. Deaths are rare in healthy babies and kids, but they can happen. The CDC says around 58,000 kids younger than 5 are hospitalized yearly due to RSV and there are about 100 to 300 deaths a year in that age group. (Note: There are about 20 million kids in the US 6 months through 5 years old).
What makes children at higher risk?
Everyone can get RSV, but those with higher risks are:
Children under 2 with heart or chronic lung disease
Young children with weakened immune systems (due to a medical condition or from immunosuppressive treatments)
Children with neuromuscular disorders (think: muscular dystrophy or ALS)
About 1% - 2% of babies younger than 6 months with RSV may need to be hospitalized. RSV could lead to severe illnesses like bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs).
“Infants’ airways are smaller, and they have more problems when there's inflammation in those smaller airways. It's harder for them to clear out that infection,” said Dr. Davis. “The younger you are, the more at risk you are. So even if you're a healthy baby, if you're less than six months, or if you're three months, or two months… because your airways are smaller, you may get sick enough to end up in the intensive care unit. It is rare, but it can happen.”
Important: Premature babies can get monthly shots of a medicine called palivizumab to help prevent RSV. Talk to your pediatrician if you think your child is at risk for severe RSV infection. PS: Researchers are working on a vaccine for RSV.
What do RSV symptoms look like?
Symptoms for RSV look like the symptoms from a normal cold, the flu, or COVID-19 (of course they do). Kids with RSV could have:
a runny nose
coughing, sneezing, fever, or wheezing
(FYI: In very young infants, the only RSV symptoms may be irritability, decreased activity, and breathing difficulties).
“Their [breathing] rate might go up. When you listen to them, they may have lung sounds like crackles or wheezing,” said Dr. Davis. “In younger infants, they can have something called apnea where you have short pauses in your breathing.”
How do I know if my kid has RSV, COVID-19, or the flu?
You really can’t know unless they get tested at their pediatrician’s office, an urgent care, or a hospital. The doc will have to swab your kid’s nose to see what virus it is. And, fun fact: You can have two viruses at the same time.
PSA: There is no at-home test for RSV like there is for COVID-19.
When should I take my baby with RSV to the hospital?
Look for signs that they’re having trouble breathing (aka: their respiratory rate is going up, they’re bringing in their chest to breathe more deeply, or there’s a whistling sound when they breathe). If an infant has apnea (pauses in breathing), parents should get them help immediately.
Dehydration is another reason to take them to a doctor. That could happen if your kid isn’t eating or drinking enough. Signs of dehydration include:
Diarrhea or vomiting in infants 2 months or younger
Baby seems less active or more irritable than normal
Fewer tears when crying or not making tears at all
Sunken soft spot on the head of an infant or toddler
Pro tip: Dr. Davis recommends you take your child to a pediatric urgent care since emergency rooms are so full right now dealing with the increase in respiratory illnesses in kids. Your first call could be to your pediatrician, but not all pediatricians have the tools to test for RSV or treat serious cases.
What treatments are available for RSV?
There is no specific drug for RSV infection, but there are things you can do at home to relieve symptoms:
Manage fever and pain with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen. (Talk to your pediatrician if your baby is younger than 6 months old before giving them any drug).
Make sure they’re drinking enough fluids to prevent dehydration (whether that’s baby formula, breastmilk, cow’s milk for kids over 1, or water).
Use a cool mist humidifier (can help with breathing by decreasing congestion in nasal passages).
Remember: Talk to your pediatrician before giving your child cold medicines or if you have questions about doses.
For (rare) severe cases of RSV that require hospitalization, children could get supportive treatments:
Oxygen through a breathing tube or ventilator
IV with fluids
It makes sense to feel stressed when you see headlines about the rise in RSV cases. But know this: Most kids will experience RSV like any regular cold, and they’ll recover just fine. Still, experts say there are ways to prevent the virus from spreading: wash your hands, stay away from sick people, and keep surfaces clean (sound familiar?). And remember, if your child is having trouble breathing or seems dehydrated, it’s time to get them to a hospital or clinic.
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