RSV and Upper Respiratory Tract Infections
It is that time of year when we are seeing many patients sick with upper respiratory infections and fevers. We have been seeing a recent increase in RSV cases in particular, which is common for this time of year.
Respiratory Syncytial Virus (RSV)
RSV is a virus that typically occurs late fall through mid-spring in the Northeast. For most children, it is a common cold with mild fever, significant runny nose, and cough. The vast majority of children have mild disease that needs no intervention and does not need to be tested for RSV. There are no antiviral medications that help to decrease the severity of RSV once you are infected. Additionally, children with RSV who are wheezing but not otherwise in any distress (feeding ok, reasonably active, and more-or-less themselves) do not require treatment for their wheezing (according to the most recent guidelines). Children with RSV may remain in daycare or preschool unless they have symptoms such as fever or increased work of breathing that would make them unsafe to be in daycare.
Treatment for upper respiratory infections in young infants and children includes nasal saline and suctioning, and a cool mist humidifier for congestion. Acetaminophen and/or ibuprofen may be used for fever or pain depending on your child’s age. In general cough and cold medications are not recommended in young children due to a lack of studies showing efficacy and potential side effects. Honey-based cough suppressants may be considered for children over one year old.
If your child has symptoms of RSV or another similar upper respiratory infection, a test is not necessarily needed as it will not usually change care.
When should your child be seen?
- Fever
- under 3 months of age - any temp above 100.4 F.
- between 3-6 months of age - any temp over 102 F.
- any child who has a temp over 101 F for over 72 hours.
- any child who has a fever that goes away for at least 24 hours and then returns.
- a fever that comes later into the course of illness is always reasonable to get checked out. It may be a second illness, but it could also be a sign that pneumonia or an ear infection is developing.
- Concern for RSV in infants under 2 months old
- Respiratory Distress
- increased work of breathing - breathing consistently fast or noticing work of what we call accessory muscles - you can see their rib cage or the area above their sternum when breathing, or that their belly is moving in and out a lot when they breathe or non-stop coughing.
- Sore throat with fever and WITHOUT significant runny nose or cough can be a sign of strep and should be tested
- we offer home Rapid Strep kits to enable testing for Strep without a visit
- Concern for ear infection
- remember, an ear infection in a child over 2 without fever that has been present for less than 72 hours should be treated with pain control first as many are viral and will often resolve on their own.
- Concern for dehydration
- especially in infants, very congested noses can lead to poor feeding and put them at risk for dehydration. Dry lips, no urine for 8 hours, crying without tears, sunken fontanels are some of the signs of dehydration to look for.
A Word About Vaccinations
Perhaps the most important thing you can do to keep your child, your family and your community safe is for you and your children to receive their Influenza (Flu) and COVID vaccines (including all recommended boosters). These vaccines have been proven to decrease the risk of hospitalization and death in individuals and are safe and well-tolerated. At this point, deaths from COVID or Influenza are considered vaccine-preventable. We cannot recommend these vaccines strongly enough. GET VACCINATED!!!! While you have seen from our previous emails that RSV immunizations are in very short supply nationwide, they are another very important way to keep your newborn safe against RSV. We highly encourage you to get them immunized prior to hospital discharge when the option is available.
As always, thank you for your patience as phone wait times (and, sometimes, in office wait times) increase and appointment availability becomes tighter during this illness season. We are doing our best to make sure all of our patients are healthy!