Let caregivers know that if symptoms are mild, they can watch children at home and encourage fluid intake. If having trouble breathing, the child should be seen right away.
Lifelong Learning in Clinical Excellence | November 28, 2022 | 2 min read
By Shannon Scott-Vernaglia, MD, Mass General
A six-month-old sits on her parent’s lap, nose running, smiling, but breathing fast. I listen to her lungs, unsurprised by the crackles and scattered wheezes. As I finish, I pause because telling a parent I think their baby has RSV bronchiolitis. I know this will cause them to worry more than ever before.
Respiratory Syncytial Virus (RSV) is an extremely common respiratory virus that usually peaks seasonally in the fall/winter. RSV causes cold symptoms like runny nose, cough, and fever in people of any age and reinfection is common over time. Most children have their first infection before age two. Young infants, especially those born prematurely or who have lung or cardiac disease, as well as the elderly, are at risk for developing more serious illness. In children, lower respiratory tract inflammation of the smallest airways causes bronchiolitis which is what my patient had.
This year, likely due to the fact that COVID-19 precautions limited our exposure to all respiratory viruses, many more children are experiencing their first infection, contributing to a tremendous spike in pediatric hospitalizations. However, it’s important to remember that the majority of young children who have RSV disease will recover without needing hospitalization.
With RSV, treatment is symptom-based. If needed, we give oxygen and provide respiratory support, as well as IV fluids if children are dehydrated. Testing usually isn’t needed because knowing the virus is RSV doesn’t change how we treat patients. The majority of previously healthy infants and children will recover on their own without intervention.
As with most viruses, children tend to get worse for the first few days, then plateau, and then start to improve. If symptoms are mild, like a typical cold, families can watch children at home, encouraging fluid intake, and observing for respiratory distress. If a baby is starting to have increased work of breathing such as shown in this AAP video, caregivers should call their doctor’s office right away. Primary care practices may have families come to the office for assessment rather than recommending the emergency department depending on the situation. Most important is to not worry alone. Primary care teams are there to help families through this challenging viral season.
For my patient, her oxygen level was in the safe range and she was able to drink just fine, despite her fast breathing. Her parents took her home with the plan to watch respiratory rate and fluid intake, alert for grunting, flaring, or color change as seen in the video above and this handout. We made a clear plan in case she worsened and the family was reassured that the likely outcome was improvement over time without further interventions.
To best prevent respiratory infections, wash your hands and the hands of children frequently, avoid visits or events where others are sick, and keep your children home when they’re sick. Everyone six months and older should have the annual flu vaccine and the most updated COVID-19 vaccine for which they are eligible.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.