Wintertime Upper Respiratory Infection Sends Some Kids to the Hospital

Sue Hubbard, M.D.

Because RSV is a virus, antibiotics won't help. There are no medications to 'fix' the problem.

Because RSV is a virus, antibiotics won't help. There are no medications to "fix" the problem

RSV is the acronym for respiratory synctial virus, a wintertime 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, the most common cause of bronchiolitis is RSV. RSV is seasonal virus, typically seen from November until April. Once I hear frequent, tight, wheezing coughs in the hallways, and listen to a few wheezy babies, I know that RSV has arrived.

Unfortunately, in my area it looks to be a busy RSV season. Like so many other viruses, including influenza, some years RSV seems worse than others. I've already admitted several babies who had RSV bronchiolitis and required hospitalization for supportive care with oxygen supplementation. Fortunately, they're doing well and none 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 I say RSV, they all cringe, but you need to understand what you're looking for.

When older children and adults get this infection, it brings a nasty cough and lots of congestion -- the dreaded winter cold. But, when a baby gets RSV, the virus may cause inflammation and constriction of the lower respiratory tract, which results in wheezing and, in some cases, difficulty breathing.

Babies having trouble breathing will not only have a frequent tight cough, but also exhibit signs of "increased work of breathing." You may notice the infants are retracting -- using their rib muscles or abdominal muscles to help them breathe. You will see the chest cage move in and out as they work to breathe. Babies with respiratory distress may also grunt with each breath, or cough so hard that they turn dusky or blue.

All these symptoms are significant and call for a visit to the pediatrician. That said, most babies will cough, wheeze and have a lot of mucus and secretions, but will not exhibit signs of respiratory distress. They may appear "pathetic," cough a lot and be up and down at night due to cough and congestion but work to breathe.

When your baby has a cold and cough, be sure you look at his/her chest. That means turn on the lights, lift up their jammies or unzip their onesie and watch how they're breathing. Can you hear wheezing or grunting? Lastly, look at their color. A baby who's coughing and turning red in the face is OK. A baby with a dusky or blue face, lips, or mouth is not OK.

Infants showing signs of respiratory distress may need to be hospitalized for supportive care, and supplemental oxygen. (There's a new study out about using hypertonic saline treatments for hospitalized babies that looks interesting).

Because RSV is a virus, antibiotics won't help. There are no medications to "fix" the problem. "Tincture of time" is needed for the illness to run its course. That may mean several days to a week in the hospital for some babies.

Dr. Sue Hubbard is a nationally known pediatrician and co-host of "The Kid's Doctor" radio show.

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