Common virus can pose significant danger for tiny patients.
While the flu epidemic seems to be making the most news these days, I'm actually seeing RSV (respiratory synctial virus) causing some serious illness among my patients.
After another long day in the office with tons of wheezing and coughing and tow babies sent to the intensive care unit, I decided to take a look at the national RSV statistics. Guess what, most of the country is still in the throes of RSV season (Florida is lucky as their rates are on the decline). So I know that most of my pediatric colleagues across the country are dealing with RSV (respiratory synctial virus) and we are still several weeks away from declining viral rates and the end of the RSV season.
I am seeing many parents who are fearful of RSV because their child's day care or school have sent home notices letting them know that there are cases of RSV. I am still confused by the need to send out notices which may only scare parents.
At this time of year, RSV is virtually everywhere. RSV is a virus that occurs every fall, winter and often into early spring. It causes cold symptoms for most of us, and most of the population (both child and adult) can never name the virus that caused their terrible runny nose and cough.
By the time a child is 2 years old the majority of them (upwards of 90%) have had at least one RSV infection. Again, most parents never need to know the name of the virus that is causing their child to have that terrible cough and runny nose. It is just another bad cold!
But, with that being said there are children, especially those under the age of 2 who will have more problems with RSV. In some cases, especially in young infants, the virus will cause not only a runny nose, congestion and coughing, but wheezing as well, and in a few, respiratory distress. It is in those cases that we name that tune and test to confirm that the baby has RSV.
Our office does not routinely test every child
What is that hissing noise in the air? Plenty of wheezing and coughing ushering in upper respiratory season. With all this noise, I'm on the lookout for respiratory distress. As I start to see more and more sick kids, my office becomes a cacophony of coughing. While many of the coughs sound horrible, fortunately most of the children I will see do not have any real respiratory distress.
I will spend a lot of time this respiratory season talking to parents about respiratory distress and what to watch for. Just like so many things in parenting, observation is the key. Watching your child's breathing when they are coughing or even wheezing is the most important thing you can do. But knowing what is distress or shortness of breath really often means you need to know what to look for.
I just saw a precious little girl in the office, my first patient of the morning. She had a history of a few episodes of wheezing, and did have a nebulizer and medications at home. She had been well all summer and the mother hadn't thought about wheezing, but noted that her daughter started to cough over the weekend and had then gotten worse and had coughed all night, which made her come to the office bright and early the following am.
When I walked into the room I immediately could see that the little girl was in a bit of respiratory distress. Not only was she coughing (which every other patient seems to be doing), she was also retracting or pulling. She was still happy and playing but you could see that she was working to breath. Her tummy was moving in and out and you could see her ribs pulling in and out a bit. She was still well oxygenated and pink.
Her mother had not looked at her chest and had forgotten about her daughter's nebulizer (you know, out of sight out of mind), as she had not used it for 6 months and was not clued back into coughs and respiratory season.
A quick review and she remembered what we had discu
While I have been working over the holidays I have not been the most popular doctor around town. With that being said I need to explain.
As everyone knows the Christmas holidays fall right at the beginning of the winter SICK SEASON. The pediatricians office never really stops and if anything it gets busier as families are trying to get out of town, or are trying to get well in time for holiday activities which may include big family plans which may include out of town guests. This is a perfect storm to spread germs as well as families fly around the country and gather together.
While working over the holidays, I have found myself having to be the bad guy by recommending that families cancel their airline flights and trips to see the grandparents or for others to cancel their vacations to far away destinations. All of these cancelled plans were due to children in the family who were too sick to travel. The majority of these patients have one of the numerous viral upper respiratory infections that are currently TNTC (too numerous to count).
I am seeing children with rhinovirus, respiratory syncytial virus (RSV), meta -pneumovirus and the first few influenza cases of the season. These viruses may sometimes cause children to wheeze and some of the sicker children may even be hospitalized.
In most of these cases, children may be treated at home with rest, lots of fluids and some children may need nebulizer treatments to help their breathing. For those in the hospital the treatment is the same although the hospitalized children typically need oxygen. The rest of the treatment is really about letting the virus run its course, and that is really frustrating, as there is not a doctor around who can tell you what a virus is going to do.
Since you can never tell when and if a child's breathing will deteriorate, I had to recommend that several families cancel their trips. What if you are in the middle of