Respiratory syncytial virus (RSV) infections typically overlap with flu season, occurring in the late fall and winter. However, since last year, physicians have been seeing surges start earlier, including during the summer months. This year that trend is continuing as an early spike in cases among young children is pushing some hospitals to capacity.
Children's hospitals in the Washington, D.C. area, including Children's National Hospital, Inova Fairfax and Johns Hopkins in Baltimore, are at or near capacity, according to DCist.
Connecticut Children's Hospital in Hartford has also been pushed to capacity. The hospital's pediatric in-patient beds have been full for the last few weeks, WTNH reports. With no indication of the spread slowing down, officials have begun seeking the help of the National Guard and FEMA to set up tents in order to expand capacity.
In Texas, doctors at Cook Children's hospital in Fort Worth told ABC News they are treating around 300 RSV patients a day.
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Why the spike?
"Last year, more people were wearing face masks and children were more likely to stay home while sick," Dr. Laura Romano said in Cook Children's in-house publication.
"This year, parents are sending their children to daycare and school for the first time following two years of the pandemic. ... Children who haven't been previously exposed to respiratory viruses are getting sick," Romano added.
With winter on the way, are bracing for more cases.
Dr. Russell Migita with Seattle Children's Hospital told King 5 News they are seeing about 20 to 30 positive cases every day, which according to them, are "unprecedented" figures.
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RSV symptoms
Watch closely if your kids appear to have a common cold this fall or winter. It could instead be RSV, and that makes it more likely to progress to a serious lower lung infection.
"The symptoms are virtually synonymous with the common cold – runny nose, congestion, maybe a little cough – but RSV is associated with a much higher risk of progression from an upper respiratory cold to a lower lung infection," says Dr. Patrick Gavigan. He is a pediatric infectious disease physician at Penn State Health Children's Hospital, in Hershey, Penn. "This includes viral pneumonia or bronchiolitis, which involves inflammation of the small airways in the lung."
If you aren't sure if your child has a cold or RSV, you should look for signs of trouble with feeding or difficulty with breathing. A doctor can confirm a diagnosis with a nasal swab.
"Are they breathing faster or do you see them sucking in their belly a lot to breathe? Apnea – a pause in breathing – is common in premature babies or infants under 1 month of age who have RSV," Gavigan shares. "Are they feeding enough to stay hydrated? We often see loss of appetite, or they're working really hard to breathe while they're feeding."
Children at high risk of complications from RSV are often prescribed monthly injections of palivizumab (Synagis). This monoclonal antibody helps prevent serious lung infections and hospitalizations, Gavigan adds.
RELATED: Worse Than Flu: Protecting Your Baby This Season From RSV
Who's most at risk?
Premature infants born at 29 weeks gestation or less and infants younger than 6 months are among those most at risk from the virus.
Children younger than 2 years old who have chronic lung disease or congenital heart disease are also at higher risk, as are kids with a weakened immune system or neuromuscular disorders.
However, all infants and toddlers might be more at risk this year. In the past, the U.S. Centers for Disease Control and Prevention has warned medical professionals that older infants and toddlers might be at greater than usual risk of severe RSV-associated illness because it was unlikely that they had typical levels of exposure to RSV during the previous months.
"By age 2, most children have had RSV, and symptoms usually peak around five to seven days before resolving on its own," Gavigan says. "However, 1% to 3% of children will be hospitalized with it."
How to protect your child
There's no vaccine for RSV, but you can still make sure your kids are protected against vaccine-preventable diseases, Dr. Katie Lockwood, chair of pediatrics with the Children's Hospital of Philadelphia says.
"First and foremost, I would recommend that you keep your child up to date with their routine childhood immunizations, as well as getting the COVID vaccine and seasonal influenza vaccine, so we can try to keep those illnesses away and minimize the risk of getting at least a few infections this winter," Lockwood shares.
Teaching your child good hand hygiene can also help them avoid a case of RSV, she adds.
"I'm a parent and I don't know if you've ever watched your child wash their hands, but they often are not doing what we recommend, which is a full 20 seconds and getting into all of the nooks and crannies between their fingers and on their wrists," Lockwood says. "I try to reinforce washing hands before eating and after using the bathroom or any time that they feel like their hands are dirty. Particularly if they're coughing or sneezing, they should be cleaning their hands afterwards."
Kids can also help prevent spread to other children by covering their cough or sneeze. You should also keep a child with a cough or fever home from school until they are well, to protect their classmates, Lockwood advises.
Dr. Sarah Ash Combs, an emergency medicine physician at Children's National Hospital in Washington, D.C., points out that even though COVID-19 restrictions have relaxed, you should consider continuing to mask and socially distance if you have a high-risk child.
"I would say if you're a parent or a caregiver and you're worried about a child or a baby in your home, I do think it makes sense for you to mask, certainly when you're out in a public space," Combs says.
Children at high risk for a severe RSV infection do have a monoclonal antibody treatment available to them, Combs notes.
The catch is that the drug, palivizumab, must be given before RSV season begins, because it can't be used to treat an active infection, Combs shares.
"It's given in a series, so you have to go in for a few doses," Combs adds. "Ideally, you actually want to have already started that. Most people with a child in their life who is in that category will have started even over the summer to be getting those doses."
With RSV raging across the United States, what is the advice for the holidays if you have a high-risk child?
"The temptation is, 'Oh, it's finally going to be a holiday we can all spend together. There's going to be a big 100-person family reunion in an indoor space in the middle of December,'" Combs says. "You have to look at that as a family and decide if the risk/benefit is worth it, because I would say that's probably a high risk for transmission of any viral illness. So, if you have a young, vulnerable child or infant at home, you might want to skip that event and instead do something on a smaller scale, do something with a smaller number of family members, do something virtual."
Caring for a child with RSV at home
The most important thing when taking care of a child sick with RSV is to keep them well-hydrated, Lockwood says.
"Dehydration is one of the reasons that they end up going to the hospital often, so any way you can, get fluids into your child," Lockwood adds. "I always say this is a time to bribe them with things that pediatricians don't usually like, which include sugary beverages like juice or ice pops. Any way that you can get them to take little sips of fluid."
Steam also can help loosen up a young child's airways, Lockwood shares.
"I love steam. Running a hot shower and doing your nighttime routine in that steamy bathroom air can help break up some of that mucus and loosen a cough," she says. "A cough that actually sounds a little bit more wet and loose can be a good thing as they start moving some of that mucus up and out."
For more on respiratory syncytial virus (RSV), visit the U.S. Centers for Disease Control and Prevention.
