‘Tis the season for Wheezin’…RSV is a very common winter respiratory infection. It’s clear when RSV has made its appearance in town because infants and young children come in with tons of snot, coughing, and wheezing. We call these kids “happy wheezers”. Unlike someone with asthma, most RSV infected children have no difficulty getting a good breath in and getting an adequate amount of oxygen. But, there are certain kids at risk…newborns and formerly premature babies can encounter the most trouble with RSV.
Winter babies. Some newborns who get infected with RSV have trouble catching their breath. That’s called apnea and it is not a good thing. That definitely buys a ticket for admission to the nearest children’s hospital until it is certain that the baby is able to breathe. Believe it or not, I actually tried to time my pregnancies so I wouldn’t have a baby born in the peak of RSV season. (Yes, only a pediatrician would worry about this kind of stuff).
Preemies beware. If you have a baby who was born prematurely (particularly one born before 35 weeks of pregnancy), the NICU staff probably warned you about RSV. Premature babies, especially those who required respiratory support or who had chronic lung disease, may really struggle to breathe with an RSV infection. Those kids also need hospitalization. That’s why former premature babies should receive a monthly injection of an RSV immune globulin to protect them during RSV season. (That medication is incredibly expensive, which is why full term babies are not eligible to get it.)
Marathon cough. With most respiratory infections, a cough typically lasts for 10-14 days. With RSV, a child might be coughing for 3-4 weeks. You read that right. RSV is unique. It makes the tiny airways in the lungs, called bronchioles, swell. So, an RSV infection is also known as “bronchiolitis”. And that tiny airway swelling is what makes little ones cough and wheeze—for weeks—until the swelling goes away.
What to do? Unfortunately, RSV is a virus. And that means we don’t have a miracle antibiotic to make it go away. The virus (and the residual bronchiole swelling) has to run its course. But, you should check in with your child’s doctor if he appears to have difficulty breathing. Do asthma medications help? Usually not. Most kids do not respond to the standard array of asthma treatments, although a small percentage do. If your child is truly struggling to breathe, his doc will likely administer a breathing treatment to see if it will help. Kids who wheeze with RSV may be more prone to wheezing again in their lives. That doesn’t mean your child will necessarily develop asthma, though, just because he wheezes with RSV.
Boomerang fever. Because there is just so much darn snot with RSV, many kids will end up getting an ear infection in the course of their recovery from RSV. If your child develops a new fever or becomes super cranky, it’s time to check in with his doc.