We have been wondering if the flu was gonna be bad this year and it does appear to be hitting hard in some places in Texas, but not so much here in Hays County yet. What we are seeing a lot of is RSV bronchiolitis in infants and toddlers. It is sending them to hospitals to be cared for in Pedi ICUs and it came early and it came hard. For the rest of us it’s nothing more than a viral upper respiratory infection. Babies, however, can get really sick from it.
For starters RSV is a virus. Its full name is respiratory syncytial virus. It causes inflammation in the airway and can make it hard for babies to breathe. It causes swelling in the lung tissue and lots and lots of mucous production that can plug up the airway passages, especially the nose. It is mainly a problem for babies under the age of 2 and premature babies. It lasts for about a week in most cases, kind of like the common cold.
What are the risk factors for bronchiolitis? Adults infected with RSV will just experience “cold” symptoms, but infants and toddlers can suffer badly with this infection. Typically we worry about infants in their first year of life but bronchiolitis can be a problem up to age 3. Premature babies are especially at risk due to their immature airways and infants with compromised immune systems or lung or heart disease. Exposure to large crowds, daycare and tobacco smoke can increase risk of contracting this virus. Lastly not being breastfed is a risk factor for RSV, as breast milk provides babies antibodies from the mother.
What are the symptoms of RSV bronchiolitis? First thing to develop is a runny nose or stuffy nose then a mild cough and a fever. Then you will notice the runny or stuffy nose seems to get worse, much worse. Then the cough will likely worsen from all the mucous production. Up to now this all sounds like a “cold,” but with RSV the airways are beginning to swell making it harder to breathe. Your infant’s breathing may become labored and you might hear wheezing. RSV can cause so much mucus production in the nose that it can be difficult for a baby to feed, as babies are nose breathers. If your baby isn’t feeding enough, dehydration can become a secondary problem. From the time of exposure it usually takes a few days for symptoms to develop and you can expect your infant to be sick for a week or more.
There is no cure for RSV bronchiolitis so no antibiotics will be prescribed. There are some things you can do at home to treat your child. First thing you can do is bulb suction the nose. Put some saline drops in the nose and then bulb suction as much and as often as you can to help clear the infant’s nasal passages. You can try a humidifier or some parents will just turn on a steamy shower and carry their baby in the bathroom near the steam. Do not use cough medicines or codeine in babies under the age of 2 as the U.S. Food and Drug Administration (FDA) has advised against it due to life-threatening events. If your child is struggling at home, then seek medical care. In the clinic or ER we will check oxygen saturation and if it’s low we will put the child on oxygen. We might use a nebulizer treatment too. If these measures fail to improve breathing, then we will admit to the nearest hospital where they will continue oxygen therapy and aggressive nasal suctioning until the child is breathing comfortably off oxygen. Sometimes we use neosynephrine drops in the nose to open the passages but we prefer you don’t use these at home on your child. Good news is hospitalization is only needed in about 3 percent of cases.
When will you know to bring your child to the clinic or ER? I always tell parents “You know your baby better than anyone else;” so if you think your child is struggling then bring them in. Fever, alone, is not a reason to bring your infant to the ER. I have parents bringing their children to the ER for just a fever and no other issues and the baby will be smiling and playful with a 102 fever. Try contacting your doctor first. However, definitely get your child evaluated if they are 3 months old or younger with a fever of 100.4 or more.
Preventative measures include frequent hand washing, avoiding others that are ill and keeping your home surfaces wiped clean. Getting a yearly flu shot is also helpful, as influenza can cause bronchiolitis too. Do not let your child go to daycare if they have a fever. There is a vaccine, Synagis, that is available during the RSV season (December-May) but it is reserved for premature infants or infants with heart or lung disease.
This is a bad RSV season. I have been seeing lots of cases of it and have had to admit several infants to nearby hospitals. Parents please stay vigilant and if you have a infant or toddler with breathing difficulty and fever, get them to the doctor to be evaluated for RSV and flu.
As always, Feel better soon.
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Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.
