The Respiratory Syncytial Virus (RSV) is something that a lot of parents had never heard of prior to the fall of 2022. Then it started being reported in the news virtually daily! Why was this, and what do parents need to know about it?
RSV is actually a very common cause of respiratory infections in children and in adults. Studies show that virtually all children have been infected at least once by age two to three and reinfection occurs multiple times in one’s lifetime. Most infections are relatively mild and easily managed at home. However, some RSV infections, especially the first episode in very young children, can be very severe and life-threatening.
RSV was in the news a lot because in the fall our pediatric emergency departments and hospital wards started to become overwhelmed with an unusually high number of kids sick with respiratory illnesses. The three main viruses responsible for the most severe infections were RSV, COVID-19 and influenza, a “tripledemic”.
There are several reasons why this happened, one of which was likely greater exposure to infections with the relaxation of the public health measures that had been used to control the spread of COVID-19. In addition, the new COVID-19 variant was spreading more easily than previous versions and the influenza virus started to circulate earlier in the season than usual.
RSV, like other respiratory viruses, is spread by having virus-containing droplets from an infected person’s mouth or nose get exhaled into the air when they cough, sneeze, talk and breathe. Infection can also be spread by contact with the virus on surfaces such as hands and toys where it can stay alive for several hours. In either case, if the virus particles find their way into a child’s mouth, nose or eyes they can cause an infection. Everything we have learned during COVID regarding good hand hygiene, cleaning surfaces and staying home when ill are very important measures to limit the spread of RSV. Vaccines for the prevention of RSV are currently being developed but are not yet available.
The initial symptoms of an RSV infection will sound familiar – nasal congestion, drippy nose, mild cough, mild irritability, reduced appetite and possibly a fever. Sometimes the eyes will become red (conjunctivitis). If the infection stays in the head and neck, an upper respiratory tract infection then the illness will progress like a common cold. Management includes keeping the child home from daycare or school, ensuring adequate fluid intake and treating fever if the child is uncomfortable and not staying hydrated. Saline nose drops (or bulb suctioning for infants) can be used to help clear the nose congestion. Parents should not hesitate to consult their family doctor, pediatrician or call 8-1-1 if they are at all uncertain about how to manage their child’s illness or if the illness seems to be lasting longer than usual.
If the infection goes down into the chest, the lower respiratory tract, it can be more serious, especially in children under the age of two and especially if it is their first or second episode. The virus infects the small branching tubes (bronchioles) which carry air in and out of the lungs. The bronchioles narrow, making it hard to breathe. This infection is called bronchiolitis. Bronchiolitis can start at the onset of the RSV infection or after a few days. Symptoms include more persistent fever, faster breathing than usual, wheezing (a whistling sound when breathing out), severe cough, more trouble with eating and drinking, grunting and pauses between breaths. Signs of severe bronchiolitis can also include nasal flaring (when the nostrils widen when breathing in), retractions (when the skin between the ribs and at the base of the neck look like it is being sucked inwards when breathing in) and cyanosis (blue-tinged lips, nails or skin from lack of oxygen).
Children, especially with their first episodes of bronchiolitis, need to be assessed in an emergency department or an urgent care center. Caregivers need to call 9-1-1 if the child is getting worse rapidly, has blue-tinged lips, nails or skin, has persistent rapid breathing or appears to be struggling with breathing, is excessively drowsy or agitated or stops breathing. Children with milder cases can be driven to the emergency department by their caregiver.
In the emergency department if the child is found to have low oxygen levels or dehydration, they may need to be admitted to hospital for observation and treatment. A small number of children will require care in the ICU. Antibiotics are not used as they are not effective for viral infections.
What parents need to know about RSV is that most infections are mild and can be managed at home like the common cold. Being aware though of the signs of a more serious RSV infection such as bronchiolitis is important so that they know what to monitor and when to seek medical care.
Dr. Cathryn Kuzyk has been a family physician for 41 years and is a mother of four and grandmother of three.
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