With a cough, wheezing, and trouble breathing that can linger for weeks, all RSV infections probably seem like they are hard to control, especially since up to 2% of kids, mostly high-risk infants, with RSV require hospitalization.
Still, it’s important to remember that for many kids, RSV is just a cold.
The first thing to understand about RSV is that it isn’t a disease.
Instead, RSV, or the respiratory syncytial virus, can cause many different kinds of upper and lower respiratory infections, ranging from the common cold and croup to bronchiolitis and viral pneumonia.
And almost all kids get sick with RSV at some point during the first few years of their life, especially if they are in daycare.
Fortunately, although RSV can cause life-threatening infections, especially in high-risk infants, the great majority of children get over their symptoms without any special treatments.
And infants who are the most high risk, including premature babies who were born at less than 29 weeks, can get five monthly doses of palivizumab (Synagis) during RSV reason to reduce their chances of getting sick. Infants with hemodynamically significant heart disease or chronic lung disease of prematurity can also get palivizumab.
Many of the classic treatments for RSV have now fallen out of favor with pediatricians. In fact, the American Academy of Pediatricians now advises against using albuterol breathing treatments, epinephrine, steroids, or chest physiotherapy (CPT) for infants with RSV bronchiolitis.
Not much, except pushing your child to drink and treating cold symptoms as possible.
The AAP even advises against routinely testing kids for RSV. That makes sense, since there is no treatment, kids can sometimes be contagious for 3 to 4 weeks, long after they have returned to daycare without symptoms, and other viruses can cause similar symptoms.
Instead, if your child has symptoms of RSV, especially if she was around someone else with RSV symptoms about two to eight days ago or is simply in daycare during RSV season (usually November to April), then it is safe to assume that your child has RSV.
Also understand that antibiotics have no role in the treatment of uncomplicated RSV infections. RSV is a virus. Antibiotics do not work against viral infections.
Going to Day Care with RSV
Since many kids who get RSV are in day care, the million dollar question often becomes, when can my child with RSV go back to day care?
“Most minor illnesses do not constitute a reason for excluding a child from child care, unless the illness prevents the child from participating in normal activities, as determined by the child care staff, or the illness requires a need for care that is greater than staff can provide.”
AAP Red Book 2015
Although I once had the manager of a day care argue with me that a child needed to test RSV negative before being allowed back into her day care, kids can usually go back, even if they still have cold symptoms, as long as they:
- don’t have a fever for 24 hours
- don’t have any trouble breathing
- are not fussy or irritable
Since these kids will likely be contagious, the AAP recommends that “In child care centers, good hygiene practices should be used by the staff and the children, including frequent and thorough hand washing.”
Treating Hard to Control RSV
If your child has RSV symptoms and isn’t getting better, ask yourself these questions and bring the answers to your pediatrician or seek quick medical attention:
“Some youngsters with bronchiolitis may have to be hospitalized for treatment with oxygen. If your child is unable to drink because of rapid breathing, he may need to receive intravenous fluids.”
American Academy of Pediatrics
- Do you think your child’s symptoms are hard to control, not because they are getting worse, but rather because they are lingering for several weeks, which can be normal when young kids have RSV?
- Does your newborn or infant under two or three months have a fever (temperature at or above 100.4F/38C)?
- Is your child having trouble breathing, such as breathing fast or hard, with chest retractions (chest caving in), nasal flaring, trouble catching his breath, or a non-stop, continuous cough?
- Do you see any signs that your child isn’t getting enough oxygen, including that “his fingertips and the area around his lips may turn a bluish color?”
- Is your child dehydrated, with less urine output, dry mouth, or no tears?
- Does your child have any medical problems that put her at higher risk for a severe RSV infection, including extreme prematurity, having complex heart disease, chronic lung disease of prematurity, or immune system problems?
- Is your child lethargic, which doesn’t simply mean that he is just playing less, but rather that he is actually hard to wake up and is maybe skipping feedings?
If your child with RSV is getting worse, although there aren’t any special treatments to make the RSV infection go away, supportive care is available to help your child through it, including IV fluids and supplemental oxygen. Those who are most sick sometimes end up on a ventilator to help them breath, and tragically, some infants with RSV die.
What To Know About Treating Hard to Control RSV
RSV is never really easy to control for infants and toddlers, as there is no treatment or cure, but fortunately, most kids do not have severe symptoms that require hospitalizations.
More Information About Treating Hard to Control RSV
- AAP – Respiratory Syncytial Virus (RSV)
- AAP – RSV: When It’s More Than Just a Cold
- CDC – RSV State Trends
- CDC – RSV Census Regional Trends
- CDC – RSV Transmission and Prevention
- MMWR – Respiratory Syncytial Virus — United States, July 2012–June 2014
- Best practice in the prevention and management of paediatric respiratory syncytial virus infection
- Questions to Ask Your Doctor About RSV
- RSV 101: What Every NICU Parent Needs to Know
Last Updated on December 11, 2016 by Vincent Iannelli, MD