Almost all children are exposed to RSV (respiratory syncytial virus) before age 2. For most, it’s like having a cold. But some children, especially the very young, can become dangerously sick.
In infant and toddler lungs, the RSV virus triggers an inflammation of the bronchioles, the small breathing tubes that make up the lungs. “Itis” means inflammation, so that is why this infection is termed “bronchiolitis.” It may or may not cause a fever. As with any illness, we recommend that parents and caregivers observe how the child is acting. If they are drinking and playful, they are likely not in danger.
Difficulty breathing: If your infant or toddler is having difficulty breathing, increased rate of breathing, and/or coughing fits that won’t stop, these could be signs of RSV. Lift your child’s shirt to observe the work of breathing.
Dangerous signs include a “grunting” noise with every exhalation, flaring nostrils wide with every breath and “retracting.” Retractions are when the child’s neck, chest and abdominal muscles are sinking in with every breath. Parents should call 911 if dangerous signs of respiratory distress occur.
What can the pediatric office do? During an office visit, we’ll perform a good history and physical, and check the child’s oxygenation and respiratory rate. Bronchiolitis is diagnosed with an examination during which we use a stethoscope to hear the inflammation in the form of wheezing. This examination is also used to detect increased work or rate of breathing. Because RSV is a virus, it is not possible to treat it with an oral medication. Even asthma inhalers and nebulizer treatments are ineffective.
Our concern is that the muscles needed for breathing can get tired. So, some babies need to be rechecked in the office or admitted to the hospital for respiratory support.
Since there is no perfect treatment, prevention is the key. An RSV immunization has been used for years but was only available to high-risk babies and had to be given each month from November to April.
At Community Health, we are able to offer the nirsevimab RSV immunization to all well children younger than 6 months of age. A pregnant mom can also get this new vaccine and protect her baby because this vaccine provides “passive immunity” to the unborn child.
Most vaccines give “active immunity” meaning the child’s immune system takes in the immunization and actively creates fighter white blood cells and antibodies. This new RSV shot skips that step and gives the child the actual antibodies. Also, just one single dose is all that is needed for the 2023 RSV season.
This week’s Health Talk was written by Eva Mayer, M.D., Community Health Pediatrics. Visit www.CHCRR.org online.
