RSV: When It’s More Than Just a Cold

Dear Centre Pediatric Families, 

We hope each of you is enjoying this fall season and spending time with family, and friends, and engaging in your communities. We also know that this season has brought many viruses and illnesses to our patients as you spend more time inside with the colder weather. You may have heard of a possible “tridemic” which is affecting the US—this refers to a surge in COVID, RSV, and Influenza all at the same time this fall and winter. 

For many families, this may be the first time your child is getting a fever or a cold and we wanted to review some basic information and guidelines so that you can be prepared.

As a result of COVID precautions over the last nearly 3 years, many of us have not been exposed to as many viral illnesses as might be typical each year. Masking, social distancing, and changes in hand hygiene played a large role in decreasing the transmission of all viral illnesses.  As we re-enter fully and unmasked in daycares, school, work, and social situations, the expectation is that children and families may develop more illnesses than before. This increase is because our immune systems have not been exposed to these viruses in a few years and is a normal part of viral spread.  While being sick with a virus is a normal part of being a part of a community, our tolerance for being sick, has decreased. All of these factors make illness feel overwhelming for our community. 

Viral illnesses, such as Influenza, COVID, and RSV, as well as many others, generally are most contagious when patients have a fever, have active cold symptoms, and, in the first 5 days of illness. RSV is experiencing a surge currently and this virus can reach peak illness generally between day 4-7;  often the cough can become worse before it improves.  In order to give some general guidance on what to look for in any respiratory illness, we wanted to summarize a few key symptoms to watch. Please note that these are meant to be general guidelines.

Fever is a key symptom to watch for. Any temperature equal to or above 100.4 in an infant under 3 months is an immediate phone call to our office. Over 3 months, infants are more resilient and a fever is a normal part of the body fighting off the viral illness. While a temperature is considered above 100.4, we develop concerns if your child has a fever of above 102 for more than 72 hours or if the fever reaches 105. If a fever is above 102 we generally will recommend treating it with Ibuprofen or Acetaminophen according to the medication chart on our website. If the fever comes down with medication that is reassuring but will often return after 4-6 hours and this can be expected. Most importantly, if a child looks well, especially when the fever comes down, this is reassuring.

 Another key component in illness is fluids. With many respiratory illnesses, children can have a harder time hydrating themselves due to congestion, difficulty breathing, or fatigue. For infants, we will often recommend smaller, more frequent feeds and using Pedialyte if needed. Watch hydration by counting wet diapers and if there are less than 3 urines a day this is a reason to call our office. 

For respiratory illnesses, we also watch for difficulty breathing. Oftentimes, children will have a coughing spell or a mucous plug that triggers coughing which is normal, but we begin to worry when children have increased work of breathing.  This means that you can see the skin pulling in between or under the ribs persistently or that the rate of breathing has significantly increased. RSV is one virus that can sometimes cause wheezing as well-this generally a sound that you need a stethoscope to hear and is different from a junky cough sound.  If you are worried about work of breathing, please call the office. 

Some tricks that can help with congestion include using a cool mist humidifier, drinking a warm liquid with honey (in children over 1 year), running the hot water in the bath to create a steam shower in the bathroom, and nasal saline. If you do have asthma, please make sure you are referring to your Asthma Action Plan and using your inhalers at the first sign of illness. Remember that if you have on of these viruses, antibiotics will not help as those are only effective against bacteria. Lots of rest, fluids, and time are the best helpers!

During this heightened period of illness as we get used to viruses as a normal part of our lives, please know that our office is experiencing high call volume. We are trying to return the most urgent calls first, but if you have an emergent concern and have not heard back, please call 911 or proceed to your nearest emergency room. 

Remember that hand hygiene is still a very effective way to stop the spread of disease as well as mask-wearing if you have a respiratory illness. 

Thank you very much and wishing you health, 

Centre Pediatrics Team