Your Child and RSV: Advice from a Pediatrician

Virtually all children get infected with respiratory syncytial virus, or RSV, by the time they turn 2 years old. In adults and older children, RSV symptoms tend to be very mild and mimic the common cold. But in young children and infants, RSV can cause serious illness.

As a pediatric hospitalist at Tallahassee Memorial HealthCare (TMH), I see many little ones, especially under the age of 5, hospitalized with RSV in our Children’s Center each year, particularly in the fall and late spring.

So far this fall, many communities across the U.S. have reported overwhelming spikes in RSV cases. Luckily, that’s not the case here at TMH – yet. We’re seeing what we would expect to this time of year. But it’s crucial that we remain vigilant.

Although it rarely causes death, RSV can sometimes result in severe symptoms that require a visit to the doctor, urgent care or even the emergency room (ER). Therefore, it’s important for parents to familiarize themselves with this common illness. To help you, I’m unpacking what RSV is, how to prevent it and when to seek professional help.

What is RSV?

As its name indicates, RSV – short for respiratory syncytial virus – is a respiratory virus transmitted through coughing, sneezing and touching contaminated surfaces. Droplets containing the virus enter through the eyes, nose or mouth before infecting the lungs. It can take anywhere from a few days to a week for symptoms to show up.

The most common symptoms of RSV include:

• Sneezing
• Coughing
• Runny nose

One in 3 children will also develop these more severe symptoms:

• Fast breathing

• Shortness of breath

• Bouts of wet cough

Newborns can sometimes develop apnea with this infection, meaning they may stop breathing and turn blue. For some infants, this may be the only manifestation of RSV. If this happens, call 9-1-1 or bring your child to the ER immediately.

Historically, in the United States, RSV has been seasonal, with most outbreaks occurring from the fall to the late spring. In Florida, we tend to have earlier outbreaks and a longer season. However, the COVID-19 pandemic has shifted that pattern, likely due to mask wearing, social distancing and more awareness of hand hygiene. For example, in 2021 we saw outbreaks first starting in the late spring.

Pre-pandemic, our pediatric team typically saw one or two cases of RSV from late spring through summer, but over the past two years, we’ve seen between 30 and 60 cases during the summer months.

Diagnosing and Treating RSV

If you suspect your child has RSV, you should call their pediatrician or visit an urgent care or emergency room, depending on the severity of their symptoms.

TMH has many convenient urgent care and emergency room locations to choose from, including our Emergency Center - Northeast, home to the region’s only Children’s Emergency Center. It’s the only ER in the area with board-certified pediatric emergency medicine physicians available 24/7 in a kid-friendly environment.

They will diagnose RSV with rapid antigen and PCR tests, much like those for COVID-19 or the flu.

A small percentage of children with severe symptoms will require hospitalization – many of them infants younger than 1 year old. Some young patients have a higher risk of developing severe symptoms, including children with any of the conditions below:

• Born premature
• Congenital heart disease
• Cystic fibrosis
• Bronchopulmonary dysplasia
• Any sort of medical condition resulting in immunosuppression

It’s important to know that treatment for RSV is only supportive, even in the hospital. While nebulized treatments (treatments that turn liquid medication into inhalable mist), steroids and antibiotics may be given, these have not been proven to resolve symptoms of RSV more quickly. These supportive treatments are given to help keep the child comfortable until they are able to pass the virus.

Your child may run a fever which could result in fast breathing. Over-the-counter medicines like Tylenol may help. If your child gets congested, they may lose their appetite and desire to drink. To avoid dehydration, offer them lots of fluids. Nasal saline drops or suctioning may help to relieve the stuffy nose.

If your child does need to be hospitalized, you can expect the same supportive care but with special attention to keeping them well oxygenated. Very sick little ones may need breathing treatments in our Pediatric Intensive Care Unit (PICU).

How to Prevent RSV

It’s important for parents to work to prevent RSV infection at home, school and daycare. The virus can survive for several hours on surfaces and up to 30 minutes on the hands.

Take these hygiene steps to help prevent RSV:

• Thoroughly clean dirty surfaces with disinfectants
• Wash hands with soap and water
• Use alcohol-based hand sanitizers

Some children who were born premature or have chronic medical conditions may qualify to get Palivizumab – sold under the brand name Synagis – a monoclonal antibody used to prevent severe disease caused by RSV infections. Palivizumab is administered monthly at the onset of the season for up to five doses and can prevent infection or severe disease. Talk to your pediatrician if you believe your child qualifies for this.

Another important step to preventing RSV is to avoid smoking around children and exposing them to secondhand smoke. Exposure to smoking has been proven to increase the severity of RSV infection in hospitalized children, particularly those who are already at high risk for severe infections.

At-risk children should also be kept away from crowds and areas where exposure to sick people can’t be controlled.

While there is no cure for RSV and re-infections are common in both children and adults, subsequent infections are usually milder, because your child’s previous infection and recovery helped build some level of natural immunity to the virus.

If you suspect your child has RSV, don’t panic, but do take it seriously. Never hesitate to reach out to your child’s pediatrician with questions – that’s why they’re there. Keep a close eye on their symptoms and bring them to an urgent care or ER if symptoms intensify.

Remember, prevention is one of your strongest tools to fighting RSV! Take precautions to limit its spread, especially in immunocompromised kiddos.

For more children’s health resources like this, subscribe to our Sweet Peas Pregnancy & Parenting Club

References

• American Academy of Pediatrics (AAP) Publications Reaffirmed. Pediatrics. 2019;144(2). Pii:e20191767. Doi: 10.1542/peds.2019-1767. (PubMed 31358666)
• Center for Diseases Control (CDC) Respiratory Syncytial Virus. Obtained on 9/29/2022 from cdc.gov
• Kimberlin, D.W. et al (2021) Red Book: 2021-2024 Report of the committee on infectious diseases: Respiratory Syncytial Virus. American Academy of Pediatrics. Pgs 628-636.