Respiratory Syncytial Virus (RSV) is a respiratory virus that usually causes symptoms of a mild cold, and is currently (as of fall 2022) experiencing a surge. Here’s Dr. Jim with a video describing why we’re seeing this surge in RSV, symptoms, prevention tips, at-home treatments, and advice for when to seek medical treatment. For those of you who prefer, the transcribed text from the video appears below.
Hey everybody, this is Dr. Sears from AskDrSears.com, and today we’re talking about RSV, Respiratory Syncytial Virus. It’s one of the many cold viruses out there that’s circulating, but this one is just a little more aggressive, and it tends to make little babies quite ill, and often lands them in the hospital.
There’s a big surge going on right now. As a matter of fact, a lot of the children’s hospitals are just full of babies with RSV, mainly because these are the babies that didn’t get it last year or the year before because of all the lockdowns and the masks and the handwashing. We’ve been really careful not to spread germs, but this is kind of one of the side effects, now there’s all these babies that haven’t gotten it before and they’re getting it now. And the hospitals are getting a little bit overrun.
Now, many babies, most babies actually, before they’re age 2 will get RSV at some point. Many babies get it twice or more. And only about 1-2% of those babies will be sick enough to land in the hospital. So most babies will just get mild cold symptoms: fever, cough, congestion, runny nose, sneezing, fussiness, poor feeding, that kind of stuff, we all know it. As a matter of fact, I’ve been so busy in my office with babies with RSV, I’ve been actually trying to get this video out for a couple of days, but I have just been swamped. And I’m actually starting to get that tickly, itchy feeling in my throat. So, maybe I’m coming down with it, I don’t know. But that’s the cold version of it, the upper respiratory infection part of it, the throat, the nose, the sinuses, that sort of thing. That usually is not that big of a deal.
But some babies, and older kids, will get a lower respiratory tract infection, in the lungs. They can get pneumonia, which is an infection in the lungs. Or they can get something that’s called bronchiolitis, that’s where the small airways get inflamed because of the virus, and it squeezes down, it makes them have a hard time breathing. Signs of that would be rapid breathing, nasal flaring, if you see the nostrils flaring out with each breath that’s a sign that the baby’s not getting enough oxygen. Sometimes head bobbing with each breath, or belly breathing, or if you see tugging in of the skin between each rib with each breath, or tugging of the lower neck just above the sternum with each breath, that’s a sign that the baby’s having to work hard to breath. Or you might even hear audible wheezing. If you hear those signs, that’s usually a reason to call the doctor or head to the ER.
What babies are at increased risk for getting bronchiolitis? Any baby that was a premie, premature babies, or any baby that’s under 6 months old. Babies that are 2 and under but have chronic lung problems, or maybe a congenital heart problem, that can make RSV a lot worse too. Or maybe if a baby has a weakened immune system, they may not be able to fight it off as well. Or a child that has a neuromuscular problem that makes it difficult to either swallow or cough or clear out mucus.
Now any parents with kids with any of these risk factors should just take certain precautions. Lots of handwashing, keep your hands away from your face, be careful of surfaces that might be infected: doorknobs, things like that. Basically avoid other sick people, especially kids. Most kids during the winter are either currently sick, just sick, or they’re about to be sick. So if you have a younger baby, I usually recommend for parents to just stay away from other kids. Just stay home for a while.
Now how is RSV spread? It’s spread by saliva, coughing, mucus, it can be on the hands, surface (doorknobs), things like that. So just be super careful.
Now if you get a cold, whether it’s RSV or not, there are some things you can do to help a little bit. Nasal saline sprays, squirt saline drops up into the nose. If they can’t blow their nose then suction it out. Staying hydrated is super important. Now if the baby can’t feed because of all the nasal congestion, maybe pump your milk and put it in a syringe so that they can feed it a little easier. A cool mist humidifier can be very helpful as well. And then if there’s a fever, treat it so that they feel better, and if a baby’s feeling better they’re more likely to eat and stay hydrated, and that’s super, super important.
When to call the doctor if your child has a cold? Certainly all those signs that we talked about before, and we’re going to go over them again. Rapid breathing, flaring of the nostrils, head bobbing with each breath, tugging between the ribs, if you see the skin tugging in, or tugging at the lower neck, or belly breathing. Other signs too: if you think your child’s dehydrated, and that generally for a baby would be less than 1 diaper every 8 hours. If they look like they’re having a hard time breathing, or if there’s a color change, like your baby’s turning gray, or blue in the tongue, lips, or the skin, that would be a sign that the baby is not getting enough oxygen and you should call the doctor or go to the ER. Or even just significantly decreased appetite or activity or alertness. If the baby’s acting really really lethargic, it’s time to call the doctor.
How long is RSV contagious? A lot of parents want to know. RSV generally is contagious for 3 to 8 days, about a week or so. However, some babies will be contagious for up to 4 weeks. So I always say as long as you have symptoms (coughing, mucus, that kind of stuff), consider yourself contagious and just stay home.
All right. That’s a lot about RSV. Hopefully it helps. And we will talk to you guys later. I’m Dr. Sears for AskDrSears.com.
UPDATE for ’23-’24 RSV season:
Based on what we’ve seen so far in our office, this winter will be another nasty RSV season. All the recommendations in my video still hold true, but there are a few new options for parents to consider. Talk with your doctor to see if any of these treatments are right for you and your family:
- There is an RSV vaccine that can be given to pregnant mothers between 32-36 weeks. This has been shown to reduce the risk of RSV hospitalization by 57%. In the clinical trials, there was a small increase in preterm labor. This is why they are having moms wait until 32 weeks while additional studies are being conducted.
- There are two antibody injections that can be given to babies that are at high risk for severe RSV. These are a little different than a traditional vaccine, in that the protection is immediate. The clinical trials showed a reduction of RSV hospitalizations by 80%. Unfortunately, these are quite new and are in very short supply. In fact, I just received a letter from the major children’s NICU in our area explaining that they are reserving their limited supply to the infants at highest risk. It seems that for this winter (’23-’24), the only babies that will be eligible for these antibody injections will have spent a good amount of time in the NICU. I would anticipate that NEXT winter, more babies will be able to receive this protection.
Learn about more childhood illnesses here.