RSV Hits the Kinkade Home (With an ER Perspective)

RSV (respiratory syncitial virus) has hit the Kinkade home! We just got back from Dallas/OKC and now have three feverish, coughing, snorting, snotty, dripping, oozing kiddos. As if the dozens of kiddos I see in the ER weren't enough, I now get to come home to the same thing! The best part is...they all seem to wake up at different times in the middle of the night coughing and hacking. Poor Becca is worn out (I was working overnight when the mini-epidemic hit!).

So, what is RSV? It is a ubiquitous (is everywhere) virus in the winter. It affects kiddos from birth to several years old. It causes bronchiolitis, an infection of the bronchioles (unlike bronchitis (the bigger airways) or pneumonia (the actual lung tissue) it affects something in-between...the brochioles are the smallest airways before the actual lung tissue). Not all bronchiolitis is caused by RSV...adults can get bronchiolitis from other sources as well...but in kiddos RSV is the most common cause.

RSV causes a fever, bad rhinorrhea (runny nose), a mildly productive cough, wheezing, and in extreme cases difficulty breathing. Most kiddos do well...they get sick (and definitly act like it!) but most do very well. In the youngest kiddos (birth to several months) or in kids with other problems (severe asthma, cystic fibrosis, etc..) it can be tough on them and they may need to be admitted to the hospital. For parents, one of the toughest things to handle is that it comes on gently (rhinorrhea and fever) and then gets much worse (wheezing, coughing and shortness of breath) before getting better.

Because it is a virus, antibiotics are of no use...the only thing you can do is "supportive" therapy. By this I mean sucking infants' nose out with a blue bulb and saline, using humidifiers, using cough medicines and decongestants and giving anti-pyretics (fever medicines like Ibuprofen and Tylenol)(some providers tell parents to avoid antihistamines because it dries you out too much but this is a personal preference). Nebulizers and steroids have been given in the past but most all the most recent studies tell us that this does not alter the course of the disease at all (unless a kid also has asthma). In those few severe cases that need hospitalizations the only thing we can do is give supplemental oxygen and in extreme cases put a small tube down the throat and attach it to a ventilator (this is VERY, VERY rare and usually only in those otherwise "sick" kiddos). If the kiddo is having trouble breathing it is worth a trip to the pediatrician (and in extreme cases the ER) to have their oxygen saturation checked (that little red light on their fingers). What is trouble breathing? If your kid is "retracting" (showing their ribs when they breathe), using accessory muscles to help them breathe (those muscles up by the neck/collarbone), have "nasal flaring" (the nose is opening up a lot trying to allow more air in), are "grunting" (self-explanatory), or if they are breathing too fast (more than about 55 times as a newborn, more than 50 times as a 6-12 month old or more than about 40 times as a toddler).

There is a vaccine for kids but is very expensive and we really only use it for kids at high risk (premature babies, kids with CF or other underlying lung disease). It has a really cool name: Palivizumab.

I plan on blogging about more ER/medical topics that are relevant to parents and the general population. Let me know if you have any thoughts/questions.