Pediatric intensive care beds in Oregon are nearly full with young patients who are struggling to breathe. That’s because there’s an unprecedented surge in RSV, a respiratory illness that primarily affects young children and infants. But while it sounds scary, most kids who get RSV won’t need hospital care. And even for those that do, there’s a variety of treatment options available.
Dr. Jill Pearson is the director of pediatrics at Salem Health. She joined OPB’s “All Things Considered” host Crystal Ligori to talk about how to keep kids with RSV symptoms safely at home. Pearson also reviewed what to look for to know when it might be time to go to the hospital.
The following conversation has been edited for length and clarity.
Crystal Ligori: A lot of us have never heard of RSV until this year. Can you tell us why it seems to be so pervasive now?
Dr. Jill Pearson: We hunkered down for the last couple of years, given COVID, and I feel like we weren’t getting our due exposure to these viruses. This year in particular just came back with a vengeance.
RSV is another common term for a respiratory virus, one of the most common viruses that does cause admissions to hospital for pediatric stations. We do see it every year. Typically, it starts at the end of December or early-January but this year we’ve seen a very early spike in RSV cases and probably an unprecedented number of cases as well.
I’ve been practicing pediatrics for over 20 years and this is the worst respiratory season I’ve ever seen.
[At Salem Health,] we are seeing record numbers of pediatric patients hit the emergency room and be admitted for serious illness. RSV, and now flu, is starting to show itself as well.
Ligori: So what symptoms should parents and caregivers be on the lookout for to know if a child has RSV?
Pearson: Any of us can get RSV. Adults typically present with just regular common cold symptoms of runny nose, sore throat, cough – they may or may not have fever.
But the smaller the child, the smaller their airways, so they have a significantly worse time handling the virus. It causes a lot of wheezing and increased secretions from runny nose and congestion to difficulty clearing cough secretions. The smaller infants, especially infants with a history of premature deliveries or birth, can really struggle with handling the secretions that are a consequence of this virus.
They can present with rapid breathing, increased work of breathing, meaning that they’re using the muscles in between the rib cage and underneath the rib cage to just get air in.
They sometimes can have color changes [like blue lips or mouth] if their oxygen numbers are low and they can become dehydrated because they can’t eat efficiently and end up needing IV fluids or other means of support.
Ligori: That sounds like the worst case scenario. But most kids who get RSV can stay at home – is my understanding. So what do parents and caregivers need to offer while keeping their kids home who are sick?
Pearson: Yeah, that is a great question because right now we’re seeing surge volumes in our clinics and in our emergency rooms. So we’re really trying to encourage parents to keep their kids at home if they feel like they’re doing alright, meaning they’re not having difficulty breathing, they’re not breathing too rapidly, their fevers are under good control and they’re staying hydrated.
I would highly recommend encouraging lots of fluids during these cold symptom illnesses managing fevers with Motrin or Tylenol. We usually don’t advise giving Motrin under the age of 6 months. And then just making sure that they’re having enough urine output to keep them out of the hospital.
Ligori: Is there something specific you can point to that may be an indicator that it is time to visit the doctor?
Pearson: I would recommend if they’re concerned about their child to contact by phone their their clinics or seek care if they’re showing symptoms of severe respiratory distress or dehydration. [Symptoms of respiratory distress include] rapid breathing or like the increased work of breathing, what we call retractions, nasal flaring, like two little nostrils are flying out because they’re having a hard time getting oxygen. And then if they’re wetting diapers less than normal. So typically at least two [wet diapers] in the course of an 8-hour period would be adequate.
Ligori: Is there anything else that you think parents or caregivers should really know about how to care for young kids with RSV?
Pearson: I think the biggest thing is to decrease the spread. This virus has spread really quickly this year and I feel like, you know, not sending your kids to school when they’re sick and not being in the daycare when they’re sick. Masking if you’re out in public just to decrease the spread.
Diligence with good handwashing is really important in caring for these kids so that you don’t acquire yourself. And I think the biggest thing is not to access care that is not needed.
We’re trying to encourage clinics to maybe waylay some of the well child checks so that kids can get care. I think going to the emergency room for only severe needs would be really important to help open up the beds for those patients that really do need to be seen by the emergency department.
Ligori: What about for people who aren’t taking care of kiddos? What do they need to know about the current situation?
Pearson: I think just prevention is really important right now. I think getting COVID boosters, COVID shots and flu vaccines will be really critical and decrease the severity of the respiratory illnesses the rest of the season.