Battling RSV: ‘Tis the season to be snotty

RSV, or respiratory syncytial virus, affects all ages. It is most common from November to April, and peaks in January to February. It’s the leading cause of LOWER respiratory infection in kids. Basically, the common cold causes a head cold, but RSV is more likely to cause a chest cold.


The virus gets in the soft skin of your eyes, nose, and mouth either by direct contact or aerosolized droplets (AKA flying spit). The incubation period is 2-8 days (not really very precise), and kids are contagious for 3-8 days (again, not very precise). There are so many different strains of the virus that you can get it over and over and over. But, theoretically, if you’ve had it once, the next times may be less severe.


The virus starts in the sinuses, but by day 3 typically spreads to the chest. Essentially, little ones make an adult amount of snot, in a little tiny baby space, and can’t clear it on their own. They also default to nose breathing. So, when they’re snotty from their heads to their chests, and can’t figure out how to breathe through their mouths, chaos ensues.


RSV causes bronchiolitis, which is kind of like a kids’ version of bronchitis. Kids may have a fever, stuffy nose, yucky cough, wheezing, decreased appetite, vomiting, and even diarrhea. All of this is a result of the snot. Snot is irritating all the way through. It fills up noses, throats, lungs, bellies, and makes poop look snotty too.


SO, it makes sense that the way we “fix” bronchiolitis is to get rid of the snot. Easy peasy, right? Sort of.


If you look at the history of RSV, medicine has oscillated from doing a lot and giving a lot of drugs, to doing nothing but “supportive care.” Right now, we’re in the “supportive care” phase. The AAP guideline literally says don’t do anything except hydrate the kid, encourage breastfeeding, and eliminate smoke exposure. They don’t even advocate testing kids for RSV.


Let me just tell you, that doesn’t always fly when parents bring their snotty, wheezing infant to see me. I opt for a more middle of the road approach.


Step one: I try to clear the snot


Squirt saline solution up the nose, squish the nostrils to rub it in and loosen the mucus. Then use a nasal aspirator to suck out the snot. Do this often. Like hourly. I am particularly fond of Xlear and the NoseFrida. Xclear spray has xylitol and grapeseed oil, both of which have antimicrobial properties and are not habit-forming. The NoseFrida (or other similar products) really gets the goo out. The blue bulb syringe is better than nothing, but it doesn’t create a vacuum seal on the nostril (read: it doesn’t’ create good suction), and usually just sucks up against the soft skin inside the nose (read: makes nasal swelling worse without getting snot out).


Step two: I try to liquefy the snot


Dehydrated snot is sticky, but hydrated snot runs, drains, and is easier to cough up. Infants are on a liquid diet, so they have an advantage. Just remember, their bellies are full of snot and they can’t breathe through their noses, so smaller, more frequent feedings are probably necessary. Bigger kids should just drink more fluids than normal. Particularly non-carbonated, sugarless, clear fluids…yes, I mean water.


Step three: if you can’t manage it at home, come to KidMed


Some kids just need a little extra help, and that’s ok. We can use nasotracheal suctioning and REALLY get the snot out. It’s a very small, flexible tube that goes up the nose to suck out the goo you can’t reach at home.


One thing that I find particularly helpful, is putting water in the reservoir of a nebulizer mask, and having your child breathe the moist air. It’s like a room humidifier for just your face, or a steamy shower that won’t run up your hot water bill. If you don’t have a nebulizer, you can put hot water in a bowl with a drop of peppermint essential oil, then have your child lean over it and breathe in the vapor-y steam.


And then, we wait. Just like all other viruses, antibiotics won’t do a lick of good. Steroids do not make enough difference to justify the cost and potential side effects. Cough and cold medications just make things worse because we don’t want to suppress a cough. We want these kids to cough it out so they don’t get sicker.


I know it can be frustrating, but remind yourself you can do anything for a week. Days 3-5 tend to be the worse, so just hunker down at home with some fluids, saline spray, and a nose sucker. You’ve got this.


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  1. Thank you for this. My toddler currently has RSV and this email made me feel better. Base medic provided everything we needed and he is on abutrol, but we are on day 3 and I feel like it’s not getting better. After reading this.. I really know it’s running it’s course, but poor baby 3 days of serious fever make you feel so helpless for your kids, and his congestion so heartbreaking. At least he’s been able to breath from his nose. Thanks for taking the time to write about this.


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