What is RSV?

I would give up a year's salary if I had a safe and effective vaccine against RSV! RSV (respiratory syncytial virus) is a very common winter cold virus. Adults and children who get it tend to have a cough, stuffy nose, and sore throat - indistinguishable from most other winter colds. However, they can pass it to infants and young toddlers, and the result can be severe. It is very contagious and is spread by coughing and sneezing. Young infants usually get it from their parents, older brothers or sisters, or older playmates at daycare - who may seem to have just a cold or sometimes have no symptoms at all. Babies with RSV usually just get very bad colds, with horribly runny noses. In fact, babies can make so much nasal mucus that they can choke or gag on it. Unfortunately, they can also get "bronchiolitis" - inflammation of the small airways deep in a baby's lungs. Bronchiolitis causes severe coughing, fast shallow breathing, and wheezing. Occasionally it can be so severe that babies end up in the hospital. Begin by doing exactly what you would do for any bad cold in a baby:

• Encourage lots of liquids. Fluids help keep a child well hydrated, which keeps the mucus loose. The baby may not feel like drinking as much as usual, so offer feedings twice as frequently as usual. Breast milk, formula, juice, or water are fine for older infants (more than 6 months). Younger infants should get only breast milk or formula unless otherwise instructed.
• Keep the nose cleaned out with nasal saline drops and a suction bulb. RSV infections in babies cause an incredible amount of mucus. Nasal saline drops moisten hard, dry mucus; the bulb helps suck out the mucus in a baby too young to blow his or her nose. You may have to do this several times an hour for a while - think how much you have to blow your nose when you're sick. See our information sheet on how to use a nasal bulb suction.
• Run a cool mist humidifier in the baby's room. Just like nose drops loosen the mucus in the nose, the humid air will loosen the mucus in the baby's lungs, allowing her to cough up the mucus.
• Elevate the head of the baby's crib with blocks or books. This will help the baby's mucus drain out the nose, not drip down the throat where it causes coughing and choking.
• Don't let anyone smoke in the house or in the car with the baby. Don't let anyone hold the baby after smoking unless they have washed their hands and changed their clothes. Smoke always makes wheezing worse.

If your child's RSV infection progresses to bronchiolitis, you will want us to check him in the office. In addition to doing the above things, you will want to watch your baby's breathing very closely:

• How fast is your baby breathing? You can count the number of times your child breathes in a minute. Normally, healthy infants breathe about 30-35 times a minute. Infants with bronchiolitis breathe 45-80 times a minute. If your baby breathes more than 60 times a minute, he probably needs to be put in the hospital (babies breathing this fast usually can't eat or drink.)
• How hard is your baby breathing? Watch your baby's chest rise and fall. If it rises and falls gently, your baby is in good shape. If the baby is pumping his belly in and out quickly, and his ribs are spreading and contracting wildly, that is a sign that the baby is getting worse.
• Is the baby wheezing? This is different than simply noisy or congested breathing. True wheezing occurs when the baby exhales. Ask us to demonstrate for you the difference between noisy breathing and wheezing.
• Is the baby getting enough to eat and drink? If the baby has been taking a bottle, keeping it down, and wetting his/her diaper every 4-6 hours, that is a good sign that his breathing isn't severe enough to keep him from eating. However, if the baby can't or won't eat because of breathing or coughing, he needs to be seen.
• If you think your baby's breathing is getting worse, have him or her checked out right away. It is very common to have ill babies come back to the office three or four days in a row for rechecks, to keep them out of the hospital.

Unfortunately, there is no single medication that works well for RSV. The following are some medications that have been used to treat RSV infections:

• Breathing treatments. Albuterol is an inhaled medication that relaxes tight airways. Although albuterol has been used for years in babies with RSV, recent studies are challenging this practice. The latest information shows that albuterol rarely helps otherwise healthy babies with RSV. Rarely, we might recommend albuterol breathing treatments for your baby. If someone else suggests albuterol for your baby but we haven't recommended it, please let us give you more information on your baby's specific case.
• Antibiotics. RSV is a virus, and antibiotics never help viruses. However, babies with RSV are at higher risk to get bacterial infections (like ear infections), for which we will recommend antibiotics.
• Over the counter medications. Most over-the-counter cough and cold remedies won't help in these young babies. In fact, we don't recommend cough suppressants in RSV because the baby needs to cough up the mucus to get better. Acetaminophen (Tylenol®) may be used for fever above 101, if the baby appears uncomfortable.
• Oxygen. Babies who are not getting enough oxygen because of their illness can get inhaled oxygen in the hospital.
• IV fluids. Babies who are getting dehydrated because of their illness can get IV fluids in the hospital.
• Other medications. For many years, doctors prescribed other medications such as steroids and antivirals (like ribavirin) for RSV. We know now to avoid them, since studies have shown they don't help, and can have undesirable side effects.

Most bad colds last 7-10 days. RSV can hang on longer; in some bad cases, cough and congestion can last two weeks or more. A recent study done in South Africa showed that 10% of babies with bronchiolitis were still having some symptoms a month after infection! After a week, though, a baby should be getting a little better every day. If not, we should see your baby in the office to make sure there are no complications, like pneumonia or an ear infection.

Unfortunately, yes. RSV is similar to influenza - you can get it more than once. The good news is that the first infection is the worst, and subsequent infections are milder.

Synagis is a injection given monthly during the winter to prevent RSV infection in infants who are at high risk for RSV. It's not a vaccine, so it doesn't give permanent immunity. It works well, but the cost is so high (sometimes $6000 for the series of injections) that insurance companies will only approve the shots for babies with special problems, like prematurity, heart defects, bad lungs, etc. We will let you know if your baby is a candidate for Synagis.