Whew, this is a busy week! Busy for you too, I'm sure. I've seen many coughs, colds and another baby with RSV. RSV is the acronym for respiratory synctial virus, which is a winter-time upper respiratory infection that causes colds and coughs, but also an illness known as bronchiolitis.
Bronchiolitis is an inflammation of the lower respiratory tract that is seen in infants and young children, often due to a viral infection. At this time of year, throughout the country, the most common cause of bronchiolitis is RSV. RSV is seasonal virus, and is typically seen from November until April, but in recent days and weeks, the number of young children coming to my office with coughs and wheezing just sky rocketed. Once you hear the frequent, tight, wheezing coughs in the hallways, and listen to a few wheezy babies, you know that RSV has arrived.
Unfortunately, in my area it looks like it is going to be a busy RSV season. RSV is a viral infection, and like so many other viruses, including influenza, some years the virus just seems worse than others. In the last few days I have already admitted several babies who had RSV bronchiolitis, and have required hospitalization for supportive care with oxygen supplementation. Fortunately, they are doing well and no one required intensive care.
At this time of year, every parent I see who has brought in their sick, coughing, wheezing baby hears basically the same thing. “Your baby probably has RSV which is a viral infection, somewhat like a cold .” When you say RSV, they all cringe, but you need to understand what you are looking for.
When older children and adults get this infection, we get a nasty cough, lots of congestion and have a dreaded winter cold. But, when a baby gets this infection the virus may cause inflammation and constriction of the lower respiratory tract which results in wheezing and in some cases difficulty breathing. The key point is “difficulty breathing”.
Babies who are having difficulty breathing will not only have a frequent tight cough, but they will also exhibit signs of “increased work of breathing”. This means that you may notice that the infant is retracting, which means that they are using their rib muscles or abdominal muscles to help them breath. This is a visible sign of respiratory distress, and you will see their chest cage move in and out as they work to breath. Babies may also grunt with each breath, or cough so hard that they turn dusky or blue.
All of these symptoms are significant and are need for concern and a visit to the pediatrician. With that being said, most babies handle the virus and will cough and wheeze and have a lot of mucus and secretions, but will not exhibit signs of respiratory distress. They may appear “pathetic” and cough a lot and be up and down at night due to cough and congestion, but they will not show signs of retracting or increased work of breathing.
When your baby has a cold and cough it is imperative that you look at their chests. That means turn on the lights, lift up their jammies or unzip their onesie and look at how they are breathing. Is their chest sinking in with each breath? Can you see their ribs moving in and out as they are retracting? Are the using their abdominal muscles to help them breath? Can you hear a wheeze or grunting or are they just congested and coughing?
Lastly, look at their color. A baby who is coughing and turning red in the face is good, a baby with a dusky or blue face or lips or mouth is bad. It is basic: red is good, blue is bad!
For infants who are showing signs of respiratory distress, they may need to be hospitalized for supportive care, and supplemental oxygen. (there is are recent study about using hypertonic saline treatments for hospitalized babies. It looks interesting). Because RSV is a virus, antibiotics won’t help. There are no medications to “fix” the problem. It is once again “tincture of time” for the illness to run its course. That may mean several days to a week in the hospital for some babies.
That's your daily dose for today. We'll chat again tomorrow.