RSV-What’s in a name? (PedPathforParents)

6 Feb

Do you think it’s RSV?  This time of year, I hear this question often in my office.

My answer might surprise you: “I don’t care.”

Let me explain why.

RSV is a virus.  It’s short for respiratory syncytial virus (but you don’t and shouldn’t care).  It causes a disease in young children (especially those less than 2 years) called bronchiolitis.

Bronchiolitis is a disease of the lower respiratory tract which causes children to wheeze.  They are wheezy because their small airways have swelling and junk (mucous and cells from the lining of the airway) in them.

The smaller airways are similar to the area where a child with asthma has issues (which is why they wheeze).  The difference is that children with asthma have a squeezing down of the walls of the airway (which is what a breathing treatment reverses).  This is why breathing treatments in children with bronchiolitis usually don’t work.

Bronchiolitis is not just caused by RSV.  There is a long list of viruses that can cause the same symptoms:

  • RSV
  • Rhinovirus (usually a cause of the common cold)
  • Parainfluenza
  • Human metapneumovirus
  • Influenza (Flu)
  • Coronavirus
  • Human bocavirus
  • Human polyomavirus

I’ve decided that people are more scared of something they can put a specific name on…let me explain with 2 hypothetical scenarios…

#1-I have a baby in front of me that I have admitted to the hospital is breathing incredibly hard, can’t eat, is puking up mucous and looks really sick.  I come in the next morning to talk with the family with some new test results, “Well, the RSV and flu tests are negative.”  Mom says, “Thank God it’s not RSV.”

#2-I have a baby in my office who is smiling and playful, is eating great with lots of wet diapers, and has mild nasal congestion but no difficulty breathing.  Mom says, “I want you to admit me to the hospital because my baby tested positive for RSV at the walk-in this morning.”

The point is, your baby can be sick with RSV and they can be fine with RSV.  They can be very sick with any of the other causes of bronchiolitis despite testing negative for RSV.

What are the symptoms of bronchiolitls?

Typically the child starts with runny nose and cough.  This will progressively worsen over a few days and possibly develop into difficulty breathing and difficulty with eating.  The symptoms typically last a total of about 5-7 days with the worst day being the day in the middle.  It is not uncommon for the cough and runny nose from bronchiolitis to last 2-3 weeks

How do we treat bronchiolitis?

In most children, treatment is done at home and consists of sucking snot (click here for more advice on this) and counting wet diapers.  This isn’t very fancy but, unfortunately, until someone invents TamiRSV we don’t have anything more specific.  As far as wet diapers go…I am looking for a wet diaper about every 6 hours.

Who goes to the hospital?

Getting admitted for bronchiolitis is usually based on 2 things: dehydration, severe difficulty breathing or low oxygen levels.

A child who can’t eat because they are breathing fast and is puking because of all the mucous that is draining into their belly is at risk for dehydration.  Unfortunately, the only way to fix this is to put them in the hospital for IVF until they are able to drink better.

A child who is having severe difficulty breathing also needs to be observed in the hospital.  Unfortunately, babies with severe bronchiolitis can get tired from all the heavy breathing they are doing and this can progress to needing ICU care.  It is best to have those babies who are breathing that hard in the hospital so that they can be monitored closely by people who know what they are looking for…

Babies with bronchiolitis often need extra help keeping their oxygen level up by getting extra oxygen.  We monitor these babies closely and I put them on oxygen for severe difficulty breathing or if their oxygen level is less than 90%.

Summary

  1. Bronchiolitis stinks, it makes kids sick and I don’t have much to offer.
  2. Whether it’s RSV or not often doesn’t matter.
  3. Watch for difficulty breathing and decreased wet diapers.
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