Lou E. Romig MD, FAAP, FACEP
The Centers for Disease Control and Prevention (CDC) has announced increased activity of respiratory syncytial virus, known as RSV, across parts of the Southern U.S. Here is what parents and caregivers should know.
RSV (Respiratory Syncytial Virus) causes symptoms of a cold in school-aged children and adults, but can also cause bronchospasm (wheezing, wheezy cough) in infants through toddlers.
RSV is typically a fall and winter virus, but it can occur at any time of the year. Another name for this type of “super-cold” in infants and young children is bronchiolitis, which can also be caused by several other viruses. Testing for RSV is available, but the diagnosis of bronchiolitis does not require the identification of the virus, as the type of virus does not really influence treatment.
Because RSV is a virus, there is no medication to make the infection go away faster. Antibiotics do not work against viruses. For infants and children, you can use nonprescription medications such as acetaminophen or, for kids over 6 months, ibuprofen for fever or apparent discomfort. You can use a humidifier or vaporizer where the child sleeps and encourage them to drink extra fluids. Cold and cough medications are not recommended for children under 5 years of age, but you can use saline nose drops or spray and nasal suctioning to help temporarily with nasal congestion. You can also give ½ -1 tsp of honey a few times a day to help with the cough, but only for children over 1 year of age. Infants are at risk of developing potentially life-threatening botulism if they ingest honey that contains the spores of the bacterium that causes botulism. You can try nonprescription cough and cold medications for children over 5 years of age, but they frequently do not work.
Unless your child has a history of wheezing in the past or if there is a very strong family history of asthma, nebulizer treatments with albuterol and oral or inhaled steroids are NOT recommended for young children with RSV and wheezing. Children and adults who have asthma or Reactive Airways Disease use albuterol to combat the contraction of the muscles that line the small airways in the lungs, causing a narrowing of those airways and partial obstruction to the flow of air. Infants and young children do not have much of that type of muscle in their airways, so albuterol has been proven not to work. Likewise, steroids have been documented not to work for RSV infections. The wheezing heard in infants and young children with RSV and other types of viral bronchiolitis is thought to occur because of excess mucus production in the lungs, which causes some partial obstruction of the small airways. There is no medication available to treat this mucus production.
If your child with RSV is not having labored breathing, is not vomiting frequently due to hard coughing and is drinking plenty of fluids, there’s usually no need for emergency treatment. Please have your child evaluated immediately if they exhibit any of these symptoms:
The acute phase of RSV generally lasts for about a week, with the worst symptoms coming at around the third and fourth days, then gradually improving. The cough may last for weeks. Children are thought to be contagious for 5-8 days, but some children can infect others for as long as a month. There is no way to tell if your child is still contagious. A good rule of thumb is that they can return to daycare/school once they have had no fever for at least 24 hours (without fever medicine), they are eating and drinking well, and the cough may be present but is no longer very frequent or distressing.
RSV is very contagious! Please do not send your child to daycare or school with a cold unless they have been cleared by a health-care provider. People of any age can catch RSV. In older kids and adults, it usually just causes cold symptoms, but the elderly and anyone with immune system problems may get very sick, so please keep your child away from these vulnerable people.