By Evan Buxbaum, MD

Orcas Island

This year’s surge in cases of Respiratory Syncytial Virus (RSV) infection in children has a lot of parents worried. But while RSV cases are spiking earlier than usual and in higher numbers this year, most of us have had this common viral cold at least once and likely several times over our lifetimes. In most cases, it can be treated as a normal viral cold.

RSV usually presents as an upper respiratory infection with runny nose, congestion, sneezing, cough, fever and fussiness—all the usual suspects when our kids get sick. It generally lasts the usual 7-10 days, but the cough and congestion can linger for several weeks as the body clears the airways following the acute infection. It is contagious for about a week, but in some cases it can be spread up to four weeks after the first symptoms so best to take precautions to avoid spreading the virus as long as symptoms are present—masking when possible, good hand washing and staying home during the acute phase.

RSV tends to produce a lot of mucous and when fluid collects in the lower airways we begin to see the more concerning consequences of this infection. About 1-2% of children, especially newborns and babies under six months, develop a more serious bronchiolitis (inflammation of the small airways in the lungs) or sometimes a secondary pneumonia (bacteria growing in the lungs secondary to the initial viral infection), and these children require medical care to help them through these complications. The risk is higher in premature babies in their first year, and in children with congenital heart disease or lung problems.

These complications from RSV are what are overwhelming our emergency rooms and hospitals right now. Since most children catch this infection before their second birthdays, we are used to seeing a surge of RSV hospitalizations every winter. What’s different this year is that after two years of masking and distancing secondary to COVID restrictions, we now have a large population of immunologically naïve children (children who have never been exposed to a lot of these viruses) who are getting sick with infections their bodies have never had to fight off before. So the numbers of RSV infections are up, even if the percentage of children with those more serious complications is consistent with what we would expect in a normal year.

Know when to seek care

So how do you know when to treat your child’s RSV infection as a normal cold, and when should you call the doctor? The most important sign of trouble is respiratory distress, especially in an infant or in any child with respiratory or cardiac issues. Respiratory distress looks like rapid breathing, flaring nostrils, sucking in the skin between the ribs or above the collarbone with every in-breath, head bobbing in sync with breathing, or the baby grunting each time they exhale. You may be able to hear wheezing in your child’s airways. If you notice any of these signs of respiratory distress they should be seen by a medical professional.

Sometimes the increased work of breathing and congestion from RSV interfere with feeding, so watch fluid intake and push smaller, more frequent feedings. If you don’t see any urination in 8-10 hours, your child may be getting dehydrated and you should consider an electrolyte solution like Pedialyte or bringing them in to be evaluated. Low energy is normal, but any true lethargy (a baby or child who is limp, unresponsive or unable to drink) should be evaluated immediately. A fever at the start of the infection is to be expected, but a fever that spikes after the first few days may signal the start of a more serious secondary bacterial infection and should also prompt calling the doctor.

For a routine upper respiratory infection with RSV, the usual comfort measures usually suffice: steam up the bathroom and allow the child to breathe steamy air for 10-15 minutes, nasal saline drops with gentle suctioning, push fluids, offer acetaminophen or ibuprofen for fever or significant discomfort, and lots of love.

RSV infection is one of the routine infections to be expected in your kids, but this year it’s more of a big deal because infections have been suppressed for the past two years. In the vast majority of cases, RSV passes just like any cold and requires nothing more than supportive care. But as always, if you’re worried about a more serious course of the illness, come in and get your child checked out.

Evan Buxbaum MD, MPH is a board-certified pediatrician practicing at Island Primary Care- Orcas, serving the children and adolescents of Orcas Island and San Juan County.