Signs and Symptoms of RSV

What is RSV and how can I protect my baby? That's today's topic. I'm Dr. Cindy Gellner for The Scope.

What Is RSV?

So RSV is a common virus that usually affects the nose, throat, and lungs. RSV stands for respiratory syncytial virus. And, normally, for kids over the age of two and adults, it's just like a bad cold. But for those under two years old, and especially preemie babies, this can be very severe.

Symptoms of RSV are usually common cold symptoms: cough, runny nose. The difference is the runny nose is going to be significantly mucusy, copious amounts of mucus. You can get some redness of the eyes, coughing, sore, scratchy throat. In kids under the age of two, especially premature babies, we worry about something called bronchiolitis.

Bronchiolitis

So in bronchiolitis, the virus attacks the small airways of the lungs, and it can cause cough, wheezing, fast breathing, and trouble breathing where they are doing what's called retractions. They're breathing so hard that you can actually see them sucking in air, and you can see indentations underneath their rib cage and in between their ribs, where they're really just trying to suck in as much air as possible.

When your pediatrician listens to your baby's lungs, if they have RSV and bronchiolitis, it actually sounds like Rice Krispies in the lungs; it's just all crackly. Quite often, pediatricians are able to get a good idea if your child has RSV or not just based on the symptoms. Days three through five of an RSV illness are the worst; that's when they're the most symptomatic and again we can usually hear the crackles in the lungs. We can often take samples of mucus from the nose and test it for the virus to see if it is RSV and then we know how to be a little bit more aggressive with treating the viral illness your baby has, if it is positive.

RSV Treatment

Because RSV is a virus, and not a bacteria, antibiotics, unfortunately, will not help treat RSV. Babies under the age of one quite often will need some extra oxygen and even may be treated in the hospital if their bronchiolitis is so bad that their oxygen level is under 90 percent, and your doctor will be checking your baby's oxygen if you bring them in for these symptoms. And oftentimes if they are hospitalized, they are sent home with oxygen, and then in the office we can help you wean your baby off of the oxygen. RSV illnesses are usually lasting seven to 21 days, but again, it's worst in the first 3 to five days.

So if there's no real good medicine to treat RSV, how do I help my child? Well, there are some cases when we do need to give some medicine. If you have a family history of asthma or your child has had a history of wheezing in the past, before getting RSV, and we hear wheezes going along with those crackles, we might them a treatment of a breathing treatment called albuterol. Albuterol is also the medication that's in the fast-acting inhalers for asthma patients. If your child does well with them, with the albuterol, then we can sometimes get a breathing treatment machine sent home with you and the medication for you.

The most important thing that's going to help your child is sucking out their nose, and we all know how much they love that. Unfortunately sucking out the nose is going to be the best thing for them. You're going to need to use nasal saline before you suction out the mucus. Nasal saline will actually help loosen up thick mucus so you can get it out easier, and then your child will be able to breathe more easily. Sometimes, your physician will be able to give you a prescription to the respiratory outpatient clinic here in Salt Lake City. You can take your baby to the clinics and they are run by respiratory therapists and they are able to do deep suctioning. So they will stick a tube way down in your baby's nose and really suction everything out. It's kind of like Roto Rooter for your baby's nose. But it really helps get the mucus out.

And those prescriptions are usually good for seven days, and the clinics are open 24 hours a day. They're really good about sending your physician a note through the fax or through the computer to let them know you took your child there and what happened. Did the suctioning help? Did they need a breathing treatment? Did they need oxygen? Did they need to get admitted?

RSV Prevention

So how can you help prevent your child from getting RSV? One thing you can do is make sure that people wash their hands and sanitize before holding your child and try to keep your baby away from people who have cold symptoms.

Unlike certain other viruses that we have vaccines for, there is no vaccine that can prevent RSV. However, babies who are born very prematurely--usually before 30 weeks of the pregnancy--or babies who have certain types of heart disease or chronic lung disease, may be able to be treated with a drug called Synagis. Now Synagis is a kind of antibody which can help prevent severe RSV infections. We used to think that it would actually prevent your child from getting it, period.

Now we now that it will help your baby's immune system to fight off RSV if the baby gets it and prevent hospitalization and shorten the length of illness. Your doctor will let you know if your baby qualifies for Synagis. It's a very expensive medication and only certain babies qualify through their insurance, but those babies who do qualify, we make sure that they get the medicine that they need.

And you're going to need to keep saline and the bulb sucker and a cool mist humidifier handy to help get the mucus out of your baby's nose if they get RSV. And if you think your baby has RSV, please have them seen by your pediatrician within the first few days that they are ill so we can help you take care of them.

updated: October 25, 2022
originally published: December 1, 2014