Preparing for RSV Season

During the height of the COVID-19 pandemic, health and safety measures were implemented in many settings to protect against the transmission of many viruses. As the pandemic subsided and measures were relaxed, there has been a significant rise in patients with respiratory viruses.

“Pediatrician offices, urgent care centers, emergency departments, and hospitals are seeing record numbers of patients with respiratory viruses including RSV in the past several weeks. The season used to begin in October, but many places in the US saw patients starting to get sick from respiratory viruses in Summer 2022,” explains Alefiyah Malbari, MD, pediatrician and Chief of Dell Children’s Medical Group Pediatrics Mueller, a clinical partnership between Dell Children’s Medical Center and UT Health Austin,

RSV is a common respiratory virus that can cause cold or flu-like symptoms in adults and children. However, RSV is the most common cause of lower respiratory tract infection in children less than 1 year of age.

Symptoms

In the first 3-5 days of RSV, symptoms may include:

• Temperature of 100.4°F or higher
• Wet or dry cough
• Nasal congestion
• Runny nose
• Irritability or fussiness
• Poor feeding

If your child develops symptoms including fever, cough, runny nose, and congestion, call your pediatrician’s office in the early stages of feeling sick to discuss and determine if they need to be seen.

RSV vs. Flu

Although RSV and flu are both caused by viruses, the conditions are associated with slightly different symptoms. A distinct symptom of RSV is wheezing. This can lead to bronchiolitis, inflammation of the small airways in the lung. You may notice hard and fast breathing, nasal flaring, or audible wheezing sounds.

RSV Testing

RSV can be tested using a nasal swab. Rapid tests and lab tests are available. Some pediatrician offices, urgent care, clinics, emergency departments, and hospitals will provide RSV testing.

“There is no specific treatment for RSV and since knowing the diagnosis does not change recommendations for management, for the most part, testing is not done routinely in all patients,” explains Dr. Malbari.

At-home Treatment Options

Dr. Malbari recommends the following at-home supportive care and treatment options to include:

Staying hydrated. Pay close attention to ensure your child stays hydrated. Children with RSV often will not have an appetite due to congestion and fever. They may be eating and drinking a lot less. Encourage them to drink liquids throughout the illness. They should urinate at least 3 times in 24 hours and at least once in 12 hours.

Clearing nasal congestion. Make sure your child is breathing comfortably. Steam can help relieve nasal congestion and sinus pressure. Run a hot shower and sit in the steamy bathroom with your child. Have cool mist humidifiers in their room.

Relieving a cough. Honey can be given to help with a cough for children over 1 year old. Babies younger than 1 year old should NOT be given honey.

Seeking support. Ask your pediatrician if acetaminophen or ibuprofen can be given to your child to reduce fevers. Stay in touch with your pediatrician if your child is sick. They can address your concerns and guide you on the next steps.

Duration

RSV generally lasts 5-7 days. Symptoms tend to peak between 3-5 days and then start to improve. Children may experience 5-7 days of cold-like symptoms. These symptoms include fever, nasal congestion, and a cough may linger for several days afterward. Your child should stay home until they are fever free for more than 24 hours and their symptoms are improving.

If your child has a fever that has been coming and going for more than 2 days, has poor feeding, or fewer wet diapers, they should be seen by their pediatrician. If they develop any signs of distress with breathing, lethargy, or any other concerning symptoms, seek medical attention immediately.

Risk Factors

The following children are at high risk from RSV and RSV-associated bronchiolitis:

• Infants less than 2 years old (especially those less than 6 months of age)
• Premature infants born less than 35 weeks
• Children with asthma
• Children who are immunocompromised (on immunosuppressive medications including chemotherapy, have had a transplant, etc.)
• Children with underlying lung disease (chronic lung disease, cystic fibrosis, etc.)
• Children with congenital heart disease
• Children with Down syndrome
• Children exposed to secondhand smoke
• Children who are exposed to other children in daycares/schools

Prevention Tips

RSV is transmitted primarily through viral particles spread through nasal and oral discharge. These particles linger on food and objects and can easily be passed from person to person. Keep these preventive measures in mind:

• Wash your hands frequently
• Avoid close contact with those who are sick
• Disinfect toys and other objects commonly shared
• Stay home if you or your child is feeling sick

“RSV particles can also transmit into the air. Masking can help to prevent the transmission of respiratory viruses from person to person.” advises Dr. Malbari.

Frequently Asked Questions

Can a cold turn into RSV?

If your child has RSV, the symptoms may look like a typical cold. As the virus remains in your child’s system over the first few days, symptoms can become more significant and progress to the development of bronchiolitis.

How to protect my child from RSV that goes to daycare, school, etc.?

Respiratory viruses can transmit very easily in school and daycare settings. Speak with the leaders in your child’s school to discuss their infection prevention techniques. In the meantime, implement these healthy habits into your routine:

• Encourage your child to wash their hands before and after every meal
• Avoid sharing food with others
• Wash your hands before and after diaper changes

Can adults also get RSV?

Older children and adults can also get RSV with similar cold symptoms. Older children and adults who do not have any underlying medical issues are less likely to experience any health complications.

What should you be looking for?

Watch out for any of these signs of respiratory distress if you suspect you or your child have RSV:

• deep sucking in of the chest with each breath
• fast breathing
• abnormally slow breathing
• flaring of the nostrils
• inability to talk in full sentences if your child can talk already

If you are worried about respiratory distress, hydration status, or any other concerning symptoms, seek medical attention immediately.