D id you know that 90 percent of children who contract RSV are healthy, full-term babies? Respiratory syncytial virus or RSV is a virus that causes infection in the lungs and breathing passages. Highly contagious, it’s spread by virus-containing droplets from people coughing or sneezing during the winter months. While preemies can be more susceptible, thousands of children under the age of 2 are hospitalized annually with RSV.
The country’s foremost expert and researcher on RSV, Dr. John DeVincenzo, an infectious disease specialist at Le Bonheur Children’s Hospital, says while RSV can be fatal, “In the U.S., we don’t have that many deaths because children have access to good pediatric hospitals, and when they get sick enough, they get support.” DeVincenzo and Dr. Andrew Irwin of Pediatrics East offer helpful advice on what to watch for and when to seek care.
A respiratory virus It’s impossible to distinguish between RSV and a common cold during the first few days because both produce cold-like symptoms such as runny nose, congestion, cough, and fever. However, rather than improving by day three or four as with a cold, children with RSV develop more severe symptoms, says Irwin.
Erin Bakken discovered as much when her 4-week-old son, Grey, contracted RSV. “He quickly worsened and started getting super congested,” says Bakken. “When they get worse, it gets really scary.” An increase in congestion is one change to watch for.
“It’s congestion on steroids,” explains Irwin. “It’s a whole lot more — really thick, really snotty nose.” Coughs typically worsen, often sounding deeper or occurring more frequently. Bakken can relate. “I spent the whole night in the rocking chair with Grey sleeping on my chest because he couldn’t catch a good breath lying down.”
“The big thing is wheezing,” adds Irwin. “Colds will not cause wheezing,” With up to 40 percent of infected children developing bronchiolitis (a lower respiratory infection) or pneumonia, wheezing often occurs. “If you have bronchiolitis, which is most commonly caused by RSV, you’re going to see heavier, faster breathing. And you may hear wheezing even without a stethoscope.”
Risk factors While most children with RSV don’t require hospitalization, certain factors increase the risk. A premature birth, ongoing immune problems, congenital heart defects or disease, and chronic lung disease are most common. However, Emily Joyner, the mother of three, quickly learned these risk factors don’t always apply. “My son, Hayden, was born full term at 8 lbs. 3 oz. He was a perfectly normal, healthy baby.” Yet, at four weeks of age, he developed RSV and spent 21 days at Le Bonheur on a ventilator. “No one warned me about RSV,” recalls Joyner. “It’s always something you hear preemie parents getting warned about.” Surprisingly, 90 percent of babies hospitalized for RSV are full term and healthy. In fact, any child under the age of 2 is at higher risk, with those under six months posing the greatest potential for hospitalization, according to Irwin.
Control the symptoms Because RSV is a virus, it can’t be treated with antibiotics or vaccine. It all comes down to symptom control. To reduce congestion, “Suctioning is one of the most beneficial things,” Irwin says. He recommends nasal saline drops to loosen nasal congestion followed by suctioning out mucus. Children with more intense symptoms may benefit from breathing treatments or supplemental oxygen; a hospital stay may be required for more intensive supportive care.
Lasting effects Once believed to disappear after about a week, DeVincenzo’s research indicates some effects of RSV, such as coughing, hypertension of the lungs, and wheezing that acts like lingering asthma, may persist much longer — several months or even years. Some effects, such as an increased risk of developing long-term asthma, are more common when hospitalization is required as an infant.
Therefore, delaying a child’s first infection may help to reduce both the severity of symptoms and its lasting effects. RSV season runs from late fall to early spring and spreads via droplets and contact with contaminated objects. “If somebody’s been coughing, sneezing, and has a lot of nasal drainage, it’s all over their clothes,” says Irwin. His advice? “Keep babies away from anybody that’s sick, and wash your hands regularly.”