Children are easy marks for virus which starts with cold symptoms, can take their breath away

Finley Mala (right) was staying home with mom, Rebecca, during her first few months of life, but even so, when her older sister caught respiratory syncytial virus, she did, too.
Finley Mala (right) was staying home with mom, Rebecca, during her first few months of life, but even so, when her older sister caught respiratory syncytial virus, she did, too.

Retailers have holiday shopping season, accountants have tax season and pediatricians have RSV season.

"It is probably the worst season for pediatricians," said Dr. Dorothy Gleditsch, a neonatologist at Mercy Hospital in Rogers. "Every pediatrician dreads RSV season."

RSV -- respiratory syncytial virus -- is the most common cause of bronchiolitis and pneumonia for children under 1 year old, and its season peaks between October and March.

According to the Centers for Disease Control and Prevention, 2.1 million children under 5 visit doctors because of RSV each year, and almost 60,000 of them are hospitalized for treatment.

Initial symptoms are a runny nose, congestion and cough. For many children, it looks like a bad cold. For others, it can become more serious.

"There's not a medicine that makes RSV go away," said Dr. Beth Storm, medical director of the emergency department at Arkansas Children's Hospital. "It's a virus, so there are no antibiotics. We treat symptomatically." Some kids, all they need is their nose suctioned out before being fed; others wind up in intensive care on a ventilator.

Most people have been exposed to RSV by age 2, but strains of the virus are always changing and so people can catch RSV many times over.

"Any age child or adult can be affected by the virus, just like anybody can get a cold virus," Storm said. "When I'm explaining to my families, I tell them it's like the worst cold that you can get high up in your upper respiratory tract but you get it down in your lower respiratory tract. You get lots of mucus, a lot of airway swelling and a lot of what we call air trapping."

Adults, Storm explained, get bronchitis, which affects the bronchial tubes in the lungs and most commonly causes coughing. Little children, on the other hand, get bronchiolitis, which affects the smallest airways in the lungs and can cause wheezing and difficulty breathing.

"Adults don't get bronchiolitis," she said. "I can get RSV, and I may just have [mucus] for several days,

but because my airways are bigger in my lungs I'm not prone to getting the lower respiratory symptoms with it."

Because babies breathe only through their noses for the first few months, those with RSV benefit from cool mist humidifiers, saline spray and nose suctioning to relieve congestion so they can eat and sleep.

SEE THE DOCTOR IF ...

Babies younger than 2 months who have a fever over 100.4 degrees with respiratory symptoms should see a doctor, Storm said. Those symptoms include breathing too fast to be able to take a bottle or breastfeed, or who have fewer than usual wet diapers, dry mouths and no tear production -- all indications of dehydration.

"Emergent patients are the ones who are having pauses in their breathing because of their nasal congestion. If they start having dusky or blue coloring around their mouths or hands or their face," she said, "those children need to be seen immediately."

WORSENING SYMPTOMS

Ashley Burks remembers when her daughter, Lily, now 9, had RSV. The virus is spread the same way as the common cold -- through airborne secretions from a cough of sneeze by an infected person. Lily was 14 months old when she picked up the virus at day care.

"It started with runny nose and congestion, but eventually she was so stopped up she couldn't breathe well," Burks said. "She was put on an inhaler and antibiotics. It was very scary to see her turn red and not be able to breathe."

Lily was well enough to return to day care after a week and a half.

Rebecca Mala's daughter, Finley, had a much longer bout with the virus. Finley was 3 months old in November when she developed a dry cough, congestion and itchy, pink eyes. Her pediatrician swabbed her nose to test for RSV, but the test was negative. Mala's 4-year-old daughter, Addison, was also sick and she, too, tested negative for RSV, as well as for strep and the flu.

"Our pediatrician said she thought it was just a really awful cold virus that just needed to pass through the system," said Mala, of Centerton. "I just tried to make her feel better at home with i̶n̶c̶e̶n̶s̶e̶ essential oils*, Tylenol and a humidifier and a bulb to suction out her nose."

Addison recovered within the next couple of days, but Finley did not.

"She was just getting worse and worse," Mala said. "Her breathing started to get really labored -- her stomach was going in and out really fast and caving in almost, and she was wheezing."

Finley tested positive for RSV in the emergency room at Northwest Medical Center.

Testing for RSV is not routine at all clinics and hospitals. It's not typically done, for example, at Arkansas Children's Hospital.

"The reason being that it doesn't change our management," Storm said. "If you came to the emergency room I wouldn't automatically test you for RSV because I'm going to give you the same symptomatic treatment and care that I would give a child who had another virus."

Meg Mirivel, spokesman for the Arkansas Department of Health, said that agency has no statistics on RSV.

"It's not on our reportable disease list, so it's not something we have good numbers on," she says. "We don't have a vaccine for it. There's not much you would do for it that you wouldn't do for another virus, so from a public health standpoint it's just not something that we keep track of."

After Finley's RSV diagnosis, she was given a breathing treatment, an inhaler and prednisone, a steroid, to reduce the inflammation in her lungs.

"All night and the next morning, she was breathing so heavy and wheezing so loud and her eyes looked horrible -- she just looked so sick," Mala said. "I was just in tears thinking this cannot be all they can do for her, so we went back to the emergency room a second time the next day."

Finley got another breathing treatment and Mala was told again that, unfortunately, RSV just has to run its course.

"She was getting worse and worse," Mala said. "Her lungs were making this crackling noise -- almost like a coffee percolator is what it sounded like ..."

On a third trip to the emergency room the next day, Finley was transferred to the pediatrics unit at Mercy Hospital Northwest Arkansas in Rogers, where she was admitted for seven days.

"They hooked her up to an IV with fluids, a heart monitor and a breathing monitor, and they put her on some sort of oxygen laced with warm water to keep her lungs really moist and to clear out some of the gunk inside her lungs, they were just so inflamed and she was so congested," Mala said. "They gave her saline and suctioned it out with a machine, just to get as much [mucus] out of her nose as they could."

Finley developed pneumonia and needed an antibiotic for that, and her RSV-related congested continued for several weeks after she left the hospital.

"I have to suction out her nose once or twice a day," said Mala, who recommends the NoseFrida nasal aspirator over the traditional suction bulb.

"The doctor told me in the hospital that if you want the RSV to clear up and not return -- because it can return -- you've got to suction out the nose. He was like, 'You've got to suction, suction, suction and get all of that out of her nose so that it won't go down into her chest and start all this all over again.'"

HARD TO PREVENT

Mala had made sure Finley stayed at home for the first two months of her life, attempting to avoid an infection.

"We kept her inside, and we didn't let her go around the other kids. I was super protective of her. But my older kids go to preschool and kindergarten, and I just can't help what they bring home," Mala said. "If someone could find a vaccine for this they would be a billionaire."

Although there is no vaccine for RSV, some high-risk babies are given Synagis, a monthly injection of antibodies that limit replication of the virus.

American Academy of Pediatrics guidelines specify that Synagis is available to babies born at less than 29 weeks of gestation or to those born at less than 32 weeks who have bronchopulmonary dysplasia, a lung condition common in premature babies. Babies with congenital heart defects or lung or neuromuscular diseases may also receive Synagis.

"It's limited because studies have shown it didn't decrease hospitalization or mortality rates in children who didn't meet these criteria," Gleditsch said.

Babies born prematurely are at a higher risk from RSV because their lungs may be immature.

"Also, they have weaker immune systems," Gleditsch said. "It's in the third trimester of pregnancy that babies get most of the antibody protection from mom so they're kind of missing that part, too."

Gleditsch tells families of new babies what Mala already knows -- that they should limit exposure to crowds and, therefore, to germs. She also recommends frequent handwashing -- 20 seconds of scrubbing with soap and water -- and sanitizing of door knobs, light switches and other areas that are touched often.

"The best thing is prevention. I tell my parents whenever they're leaving, if you have trouble being the mean mom, blame me," she said. "Tell people your doctor won't let them hold your baby, that I've given strict orders not to have many people over. Your doctor can take that blame, it's OK."

photo

Centers for Disease Control and Prevention/DR. CRAIG LYERLA

Antibodies to respiratory syncytial virus glow green under ultraviolet light in this photo taken through a microscope using indirect immunofluorescence. RSV is the most common cause of bronchiolitis and pneumonia among children under 1 year of age.

photo

Rebecca Mala of Centerton cuddles 4-month-old Finley, who has made a full recovery from the respiratory virus that put her in a hospital for seven days and required follow-up antibiotics. “I was just scared,” Mala remembers. “Her breathing patterns were so quick and rapid. She just sounded super congested.”

ActiveStyle on 02/05/2018

*CORRECTION: Rebecca Mala comforted her sick child with essential oils, Tylenol, a humidifier and nose suction. A previous version of this story had incorrect information.

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