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Battling RSV: Tis the Season to Be Snotty

RSV, or respiratory syncytial virus, affects all ages. However, it is most likely to cause more significant respiratory symptoms in infants up to 2 years of age, especially in infants younger than six months of age. RSV is most common from November to April and usually peaks from January to February.  But 2022 is unusual: RSV has already begun to peak much earlier than usual.

The leading cause of LOWER respiratory infection in kids is RSV. It is more likely to cause a chest cold, while the common cold causes a head cold.

RSV 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 from the time of exposure is 2 to 8 days (not really very precise), and kids are contagious for 3-8 days (again, not very precise).

The symptoms are often most severe around day 5 after symptoms first began. Most symptoms usually improve by 7 to 10 days, but the cough can persist for 2 to 4 weeks.

There are so many strains of the virus that getting RSV can happen over and over and over. But, theoretically, if you’ve had it once, the next time may be less severe.

The virus starts in the upper airway (think sinuses), but by day 3, it 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 like a kids’ version of bronchitis. In fact, in 1901, it was first described as “acute catarrhal 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, and 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 child, encourage breastfeeding, and eliminate smoke exposure. They don’t even advocate testing kids for RSV.

Let us tell you, that the “supportive care” approach doesn’t always fly when parents bring their snotty, wheezing infant to be seen. We opt for a more middle-of-the-road approach. Below are our at-home tips and when you should come to KidMed.

Step One: Try to Clear the Snot

Squirt saline solution up the nose and squish the nostrils to rub it in and loosen the mucus. Then, use a nasal aspirator like the NoseFrida to suck out the snot. Do this often. Like hourly. The NoseFrida (or other similar products) really gets the goo out.

Using the blue bulb rubber syringe is better than nothing, but:

  • It doesn’t create a vacuum seal on the nostril (read: it doesn’t create good suction), and,
  • It usually just sucks up against the soft skin inside the nose (read: makes nasal swelling worse without getting snot out).

Step Two: 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. 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 drink more fluids than usual, particularly non-carbonated, sugarless, clear liquids.

Step Three: If You Can’t Manage It at Home, Come To Kidmed Urgent Care

Some kids just need a little extra help, and that’s ok. KidMed is here for you! We can use nasal or nasotracheal suctioning and REALLY get the snot out. It’s a tiny, flexible tube that goes up the nose to suck out the goo you can’t reach at home. 

And then, we wait. Just like all other viruses, antibiotics won’t do any good. Steroids do not make enough difference to justify the cost and potential side effects. Cough and cold medications make things worse and are not approved for children under age 5 anyway.

We know it can be frustrating, but remind yourself you can do anything for a week. Days 3 to 5 tend to be the worst, so just hunker down with your little one at home with lots of cuddles, fluids, saline spray, and a nose sucker. You’ve got this.

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