RSV- Don’t Panic?

This week’s guest columnists are Drs. Brian Allen and Chris Fontenot, Family Practice residents at University Hospital and Clinics here in Lafayette.

Winter- the season of holidays, travel, and people congregating indoors. Friends and family share hugs, gifts, food, and germs.  Just as common as sharing good tidings and Mardi Gras are those three letters that strike fear into parents: RSV.

RSV, or Respiratory Syncytial Virus, is the most common cause of a condition called Bronchiolitis.  Bronchiolitis is an illness in babies and toddlers where the smallest airways in the lungs get inflamed, decreasing oxygen delivery to the bloodstream. Worsening inflammation causes a “whistling” sound as the air squeaks through those narrowed airways, a.k.a. wheezing.

Anyone can get RSV.  For people over age 2 and adults, it’s simply a cold.  Only babies under age 2 get bronchiolitis.  Even then, if your kid has RSV, don’t panic. Most babies have only a cold as well. RSV is rampant from November through April, particularly in January and February.  Also know that kids don’t stay immune to RSV: some unlucky babies get it twice in a season!

The basic symptoms of RSV are runny nose and congestion, cough, fever, and decreased appetite.  Babies with colds can have trouble feeding, because clogged noses make it hard to suck the bottle or breast, and breath.  More concerning signs of RSV, when we call it bronchiolitis, are rapid breathing (breathing 60-80 times per minute), wheezing, and worsening feeding.  Kids may have “retractions,” where the skin over the ribcage sucks in as they tug in breaths. Infants may grunt with every breath. Children with grunting, retractions, fast breathing, or worsening drinking need attention immediately.

RSV is highly contagious.  It travels on water droplets that are coughed, sneezed, or breathed out.  The virus lasts up to two hours after landing on surfaces like furniture and counters, where others can unknowingly touch, pick it up, and infect themselves.

“Your child tested positive for RSV” is a painful phrase for parents.  Parents ask, “Are you sure,” and “Will she have to stay in the hospital?”  The answer to “Are you sure”, weirdly, doesn’t matter!  As we alluded above, RSV isn’t the only virus to cause bronchiolitis, that condition with coughing, fever, wheezing, and  congestion- many others cause it too.  We don’t recommend testing most kids for RSV, since whether the test is positive or negative, what’s important is how your child is handling bronchiolitis, not which virus caused it.

The mainstay of treatment is “supportive care.”  The first support is hydration.  It’s important that children drink plenty, to keep mucus moist, thin, and easy to handle. When an infant or toddler can’t drink because of congestion, they begin to dehydrate.  Their mucus gets dried and sticky and gums up their already inflamed airways.

Breast milk or formula are best, but extra clear fluids can help.  Pedialyte is a good option for infants; its designed to hydrate babies if they can’t handle milk.  Babies tend to vomit with bronchiolitis when they gag on mucus and have upset stomachs from swallowing it, and Pedialyte is easier to absorb than milk. However, Pedialyte tastes a little too salty for older children, so these kids can hydrate with dilute juices and sports drinks.  If a kid just won’t drink, he may need admission for IV fluids.

Breathing also needs support.  Bedside humidifiers and nasal saline may help hydrate and thin mucus.  Elevating the head helps noses and upper airways stay clear too. When babies starts to struggle to breathe like we discussed above, need oxygen and other respiratory support, it’s time for admission.  Unfortunately, nebulizer breathing treatments don’t help.  Breathing treatments are often prescribed with bronchiolitis since the symptoms look like asthma, which treatments do help.  However, multiple studies have shown that nebulizers for bronchiolitis are a waste of time and money.

Finally, keeping your child isolated is important for others to not get RSV- it’s highly contagious, and the cough and “viral shedding” last for weeks.  No daycare until baby is fever free and coughing much less.

So don’t panic if your child has RSV. Like we said above, most kids will just have a nasty cold, only a few need hospitalization.  Fever medicine, fluids, patience, and TLC usually take care of it.

What the heck is Bronchiolitis? Is that like Bronchitis?

No one ever accused modern medicine of being good at naming things.  There are so many jokes out there that whole web sites are devoted to making fun of medical terminology (Example: Definition of Barium: What doctors do after their patients die).  Even Boudreaux and Thibideaux are in on the joke (Doctor: Boudreaux, you’re not sick, you’re just lazy.  Boudreaux: Doc, I coulda tol’ you dat.  But ah need you to give it a big medical name that I can go home and tell Marie!). 

It really gets confusing when we name important and common things alike.  Bronchiolitis is a very common and serious illness in infants, and we see it a lot in the winter.  This winter has been particularly busy.  Bronchiolitis starts out as a regular cold, with cough and runny nose.  Then the baby starts having fevers and wheezing and trouble breathing that looks and sounds like asthma.  Sometimes babies have to be in the hospital for oxygen and IV fluids, because they are too busy breathing hard to be able to drink their milk. 

Bronchiolitis IS NOT bronchitis.  When adult doctors use the term bronchitis, they are talking about an infection in the airways that is often treated with antibiotics.  Kids don’t get bronchitis- rarely do they need an antibiotic for coughs and colds.  Bronchiolitis is caused by viruses, and antibiotics don’t cure those.  One of the more common viruses to cause bronchiolitis is the RSV virus, and often doctors and families use RSV and Bronchiolitis to mean the same thing.  However, many viruses can cause bronchiolitis, not just RSV. 

Unfortunately, there is not a lot of things that make bronchiolitis better.  As above, antibiotics are useless.  The breathing treatments we use for asthmatics do not help most babies with bronchiolitis.  Steroids don’t help either.  Doctors sometimes prescribe treatments or steroids for lack of anything better to do.  The only thing really that can be done is “supportive care”.  This means fluids and oxygen and monitoring in the hospital when needed.

How do you keep your baby from getting bronchiolitis?  As usual, keep them clean.  Wash your hands to make sure your cold virus does not get on baby and baby’s stuff.  Visitors and family need to wash their hands too before picking up baby.  People with colds need to keep their distance.  Day Care and Mother’s Day Out workers need to be extra careful about this.

So when you hear your baby’s doctor talk about bronchiolitis, listen up.  If the doctor talks about bronchitis, they must be making a joke.  Paging Dr. Boudreaux.

 

‘Tis The Season For RSV Wheezin’

We can tell by the paramedic’s voice on the radio if a child is truly sick.  This time his voice has that urgency that says “be ready.”

Moments later they come trundling in, oxygen cylinders hissing, monitors beeping, and the little baby in the big stretcher struggling to breathe, chest heaving.  Into the trauma room, baby is lifted onto the ED bed, trailing monitor wires.  Nurses and techs move in, changing oxygen tubes, starting IVs, hooking up monitors, putting on stethoscopes. 

After a brief talk with the parents and a quick exam of the baby, I see that the baby has Bronchiolitis.  The breathing treatments we give have little effect- baby still struggles to breathe.  Baby is admitted to the Pediatric Intensive Care Unit for IV fluids, oxygen, and monitoring.  She will get better eventually, but it will take time and care.

Bronchiolitis is a common winter ailment for infants and toddlers.  Many people recognize this ailment when it is called RSV, but the RSV virus is only one of the many viruses that can cause it.  Bronchiolitis starts as a cold, with runny nose and cough.  In some little kids it progresses to fever, wheezing (a whistling sound from low in the lungs), and trouble breathing.

Bronchiolitis is one of those frustrating illnesses where modern medicine offers little to stop its progression or ease its distress.  Plenty of fluids help, maybe a vaporizer at the bedside, and Tylenol for fever and comfort.  Sometimes nebulizer treatments help, but like in our case above often they don’t.

The good news is that most babies with Bronchiolitis just have a bad cold.  The treatment for that is described in the “Colds in Babies” category, which you can access from the Categories column on the right side of this page.  A few babies wheeze like an asthmatic and need more attention.  Very few babies need to be in the PICU and it is rare for one to die.

So if your baby has a cough and runny nose but is breathing and drinking comfortably, all is well.  Start the vaporizer and Tylenol, maybe have your baby sleep sitting up in a car seat or swing  (no propping on pillows!).  If you think baby is wheezing or tugging for breath, or is having trouble sucking a bottle for its work of breathing, come right in and see us.