RSV in Children

Podcast Transcript

Raed Dweik:

Hello, and welcome to the Respiratory Inspirations podcast. I'm Raed Dweik, chairman of the Respiratory Institute at the Cleveland Clinic. This podcast series of short, digestible episodes is intended for patients and families, and covers topics related to respiratory health and disease. My colleagues and I will be interviewing experts about timely and timeless topic, in the areas of pulmonary, critical illness, sleep, infectious disease, and related disciplines. We will share with you information that will help you take better care of yourself and your loved ones. I hope you enjoy today's episode.

Hello everyone, and welcome to this episode of Respiratory Inspirations. I'm your host Raed Dweik, chairman of the Respiratory Institute at the Cleveland Clinic. My guest today is Dr. Kimberly Gifford, who's a primary care pediatrician and also the director of Educator Development for the Pediatric Institute. She's also the physician advisor at the Cleveland Clinic Lerner College of Medicine, and co-director of Becoming a doctor course at the Case Western Reserve School of Medicine. Kimberly, welcome to the program.

Kimberly Gifford:

Thank you.

Raed Dweik:

So, our topic today is respiratory syncytial virus. It has been in the headline and on everybody's mind lately. So, I'm looking forward to hearing from you how we can help our families who are dealing with patients and family members who have RSV. And let's start with the basics. What is RSV and how does it affect the body?

Kimberly Gifford:

Yeah, so RSV, those letters stand for respiratory syncytial virus. And it's not important to know all of those words, but the first one, respiratory, is important because that means it affects the lungs and breathing. So that doesn't happen for all people who have RSV. RSV can cause sometimes just fever, a lot of times it'll cause runny nose. RSV likes to go to what we call mucus membranes, so that's the wet parts like your nose, inside your nose and inside your mouth. So, it can move from there down into your lungs. And as your body tries to start fighting off the infection, it starts to produce mucus. And so that music comes like a runny nose in some people. And as the mucus gets built up in the lungs, you can have a little bit of trouble breathing. And those are the, those are the parts of the body that tend to get affected.

Raed Dweik:

And I know RSV happens every year, but this year has been particularly hard on families, but also on hospitals where many patients are getting admitted. So, what is different about RSV this year and what's our status now?

Kimberly Gifford:

Yeah, so there's nothing really about the RSV itself. But because people have been wearing masks and doing a good job keeping germs away, our older kids who may have had RSV in previous years, aren't really getting it, haven't really had it for the past couple of years. And so, there are more people who don't have an ability to fight off RSV like they have in the past. And so more kids have gotten sick from RSV this year. And their infections have been worse. So sometimes older kids who may have just had a runny nose in the past, this year some of those kids are getting sicker and sicker, and having that, those problems with their lungs.

We started having RSV earlier this year, so summer we started seeing RSV. It's usually just a winter disease. And then it- it got all the way to its high point or peak in November. Fortunately, it's starting to come down a little bit. We're all hopeful that that trend is going to continue. But the rates of RSV are still pretty high. For now, as we're testing sick kids, if we test 100 kids, about 10 of those kids will have RSV. These are sick kids, not any kid walking around. But 100 sick kids, 10 have RSV, about 10 of them have COVID, 25 have flu, and then 55 have other infections. So that's 10 percent, about 10 out of 100 that have RSV.

Raed Dweik:

And then of course this has been, it was always the case, but this year of course we're seeing more hospitalizations. And I like the way you probably explain it, is because people are not as immune as in previous years because we have been wearing masks for a couple of years.

Kimberly Gifford:

That's right.

Raed Dweik:

So how do people get it? Whether it's kids or adults, how do they get RSV?

Kimberly Gifford:

So, the virus of RSV is spread in the way that most other germs are, from someone else who has RSV. You know, if you locked yourself in a closet, you would never get RSV. You have to be in contact.

Raed Dweik:

You're not advising people to.

Kimberly Gifford:

Yeah, don't do that.

Raed Dweik:

Okay.

Kimberly Gifford:

But if you are in contact with someone with RSV, you can get RSV from them. And the way that you can do that is if they cough or sneeze, they're spreading that RSV into the air. If they have mucus, like they touched their nose, or they touched their mouth, and then touch a table and you touch that same table you're picking up their germs and taking them in. Usually, those germs just on your hands won't make you sick. They have to generally get to your nose or mouth. And that's where trying to prevent those germs from getting into your nose and mouth is key in helping to protect us.

Raed Dweik:

Yeah, talk more about that prevention. I think that's a big, you know, as I say always, prevention is better than cure. So how can we prevent or avoid getting RSV or having our kids contract it?

Kimberly Gifford:

Absolutely. So, if you know that someone has germs, or just assume that everyone has germs, because we all have some germs.

Raed Dweik:

It's a good assumption.

Kimberly Gifford:

You want to try to put a barrier between you and those germs. So, if they're wearing a mask, that helps. If you're wearing a mask, that helps because it's preventing those germs from getting into you. Good hand washing is helpful, because like I said, RSV doesn't go through the skin in the fingers. So, if you touch RSV, that's okay. Just go wash your hands. If you touch a surface that someone else touched, or particularly if you notice that someone touched their face you could encourage them to go and wash their hands. But trying to keep those germs from spreading to one person's nose and mouth to another person's.

Raed Dweik:

So, it seems that same things, the same basic things that we use to prevent COVID. You know, wash your hands, keep your distance, maybe wear a mask.

Kimberly Gifford:

They sure do.

Raed Dweik:

Yeah. And then, how would a parent, or family member, or caregiver know that a child has RSV? How can they tell?

Kimberly Gifford:

Yeah, so you won't know for sure if your child has RSV specifically, but you may have some signs that they have a cold or illness that could be RSV. So, some of the things to look for would be fever, a runny nose, cough, or trouble breathing. Those are some of the signs of RSV.

Raed Dweik:

These are common for other things as well, right?

Kimberly Gifford:

They are, exactly. And so, you won't necessarily know whether that child has RSV or something else. But if they have mild symptoms, it's probably okay. So, if they only have a little bit of a runny nose, maybe a little bit of a cough that's okay. It would be more concerning if they were having more and more trouble breathing.

Raed Dweik:

So, we've talked about how to prevent it, how to identify it. Let's say somebody has RSV now, they find out they got it. What advice do you have for families, how can they take care of a family member or a child who has RSV?

Kimberly Gifford:

Yeah. So that, my advice about this is also the same as other colds that usually it's not the virus itself that causes a problem, but it's all the mucus that our bodies produce. And that's particularly problematic in small patients. So, the smaller your nose and airway, a little bit of mucus causes a lot of blockage. And so, the idea is to try to get rid of that mucus and so then, you know, the person can breathe easy. You can use a suction ball to try to suction out the nose. There are all kinds of other devices that provide a little bit more suction. Helping babies or a young child too, you can tap on their chest and help them to cough up a little bit of that mucus.

But primarily, trying to clear away that mucus. Sometimes trying a different position because if their heads in one position sometimes that can make it a little harder for the air to go in or out. If you're having trouble getting out that mucus, a couple drops of what we call saline, it's just salt water, but a couple drops of water can help to break up some of the mucus so you can suction it out better. If you don't have that at home, you could always turn on the shower, turn on some steam. And have the baby breathe in some of that steam, that can help to break up some of the mucus as well so you can get it out better.

Raed Dweik:

These are great, great tips. What about over the counter medications? A lot of, you know, people go to the pharmacy and say, "Okay give this and that." You know, I'm not an advocate for over-the-counter medications.

Kimberly Gifford:

Mm-hmm.

Raed Dweik:

But I don't know how you feel about it.

Kimberly Gifford:

That's actually a really great question. We encourage families not to use any over the counter medicines. It's okay to use fever medicines, like acetaminophen or like ibuprofen. But you don't want to use a cough medicine or a medicine that's labeled to treat a cold. These medicines can be very, very dangerous in children and young babies. Anyone under eight, really. So, try to avoid using any kind of cough or cold medicines and focus on the things that I said about trying to clear the mucus.

Raed Dweik:

Wonderful. Thank you, great advice. Another decision families and caregivers struggle with is when to call the doctor or go to the doctor. And what kind of advice do you have on when to do that?

Kimberly Gifford:

Yeah, these are really great questions too because, you know, sometimes it could cost money to go to the doctor, if you're gonna have to miss work. Those situations can be can be difficult for families to decide. And so, for most kids, they'll be able to manage their colds at home with just the mucus clearance. When you know you need to see a doctor, is when a baby may be struggling to breathe. You've certainly try clearing out the mucus first, but if they're struggling to breathe, like they're sucking their skin in between their ribs, take their shirt off and look at their skin. If they're sucking that skin in, if they're using their belly muscles to get the air in and out, or they're pushing their head in and out, that means that they're trying really hard to get air in and out. And it would be good to have a doctor examine them and see if they may need some additional treatments.

Raed Dweik:

And feeding sometimes, they don't eat as well, right?

Kimberly Gifford:

Oh yes. Yeah, that's a good point too. So sometimes, babies are breathing okay, they're breathing fast. But they're still getting all the air in that they need. But that takes a lot of energy. And so, they might get fatigued and not really have the energy for doing things like feeding. And sometimes the mucus is so much congestion that it has, they have trouble feeding for those reasons. So, if you're baby's having trouble feeding, or having trouble waking, then those would also be reasons to see the doctor.

Raed Dweik:

Those are great tips as well. So, let's say they bring them to the, to you to take care of them. What kind of options do you have to treat these kids?

Kimberly Gifford:

Yeah, that's another great question. So, you know how I mentioned that the cough and cold medicine over the counter are a bad idea? We've also learned over the past maybe decade, that medicines that we've tried to use to treat RSV actually don't work very well either. They end up just causing a lot of side effects that we don't want. So, our main treatment is maybe a little bit better mucus clearance than families are able to do at home. We have special types of suction. And then oxygen. So, oxygen is the most important treatment. And again, that doesn't really make the RSV go away. It just helps the child or baby to be able to manage and while their body's fighting off the infection.

Raed Dweik:

So, oxygen, does that mean they have to go into hospital? Or they can have oxygen at home?

Kimberly Gifford:

Yeah, so for most babies it will be necessarily to come into the hospital. Both for the treatment of oxygen, but also the monitoring that we do when babies and children are at this stage of needing oxygen.

Raed Dweik:

Basically, by the time you need oxygen, you need more attention that cannot be provided at home.

Kimberly Gifford:

That's correct.

Raed Dweik:

Anything else we do for them? How do you decide to put, you know, admit patients to the hospital? You mentioned oxygen, are there any other criteria? And what else do we do for them once they're admitted?

Kimberly Gifford:

So, the feeding was the other big thing that I mentioned. And so, if babies don't have the energy to feed or too much mucus to feed, we primarily try to keep them hydrated. So, we might put in an IV line to give them fluids that they aren't able to take in by mouth. And those babies don't need a lot more than, you know, special fluids. But some babies who may get sicker, may need a breathing tube or something like that. That's not most babies, so mostly they'll just have oxygen and then maybe also some fluids.

Raed Dweik:

Yeah. And so, whether they're hospitalized or not, what is the long-term prognosis of kids who get RSV or, are there any long-term downsides to the lungs? Or do they usually fully recover?

Kimberly Gifford:

Yeah, you know, kids are pretty resilient. They bounce back pretty well and so most kids will do well after they recover from RSV. Sometimes that can take a while. Generally, they don't get worse after about a week. They start to get better within that week. But it can take a while for them to fully get back to their normal energy, they might have a little noisy breathing, they might get a little more winded with activities. And that can last for weeks. As far as the long term goes, there really isn't long RSV like a long COVID. But sometimes when a child has had RSV, particularly if it's been more severe, the lungs sometimes will have a little bit more wheezing or things like that in the future.

Raed Dweik:

That's nothing to worry about, just keep an eye on it for the time?

Kimberly Gifford:

That's right. Yeah, and the doctor can help give advice about individual patients. But generally, there aren't a lot of long-term problems.

Raed Dweik:

Oh, this has been great. Lots of great tips to our families with patients with RSV. Anything else you'd like to add that we have not mentioned so far?

Kimberly Gifford:

I guess the, you know, the most important thing when thinking about infections in general, is thinking about what we can do to prevent them. And like I said, we really can't prevent RSV for most people. But we can prevent a lot of other respiratory infections. And so, I would strongly encourage all families who have a child older than six months to get flu vaccine and get COVID vaccines because both of those can protect against other infections and have, you know, fewer infections overall. This year, you know, flu is taking off now so I really encourage families to get in and get those shots.

Raed Dweik:

And clearly, of course, based on this conversation, there's not vaccine for RSV yet, at least. Is there something on the horizon?

Kimberly Gifford:

Oh yes. Yes, there is. So, there isn't a vaccine. There's a medication that some babies can take prior to being exposed to RSV. That's only for certain babies though, less than 35 weeks, or babies that have certain lung and a heart disease. So, your doctor would tell you if that was appropriate for you. In the future, there may be a vaccine that actually isn't given to babies, but it's given to pregnant moms.

Raed Dweik:

Oh wow.

Kimberly Gifford:

In the hopes that that helps their babies once they're born to have a better immune response to RSV. So that's still being studied, we don't know for sure whether that's gonna pan out. But there's a lot of hope around it, particularly with how bad RSV's been this year.

Raed Dweik:

Yeah, that's great. There's some hope at least for the future. So, as we wrap this up, Kimberly, can you give us maybe some take away points for our families and caregivers?

Kimberly Gifford:

Certainly. So, a few key points about RSV are that it's a virus and it's spread by coughing, sneezing, and touching. So, you want to try to prevent those things from happening. Secondly, the treatment for RSV is to help clear your child's mucus. Sometimes we'll use oxygen in the hospital but those are the best thing you can do at home, is to try to clear that mucus. And then lastly, reasons to take your child to the doctor would be if they're working hard to breathe. Look at their naked skin, take their shirt off and look at their skin to see if they're struggling to breathe, or if they're having trouble feeding, or hard to wake up.

Raed Dweik:

Wonderful, thank you so much. These are great tips and great takeaway points. And thank you for coming today and thank you to our audience for joining us for this episode of Respiratory Inspirations. Again, I'm your host Raed Dweik, chairman of the Respiratory Institute at the Cleveland Clinic. Our topic today was on respiratory syncytial virus, RSV. And my guest was Dr. Kimberly Gifford, primary care pediatrician, and has several roles here including being the director of Education Development for the Pediatric Institute, physician advisor at the Cleveland Clinic Lerner College of Medicine, and co-director of Becoming a doctor course at the Case Western Reserve University School of Medicine. Thank you everyone, and have a great day.

Thank you for listening to this episode of the Respiratory Inspirations podcast. For more stories and information from the Cleveland Clinic Respiratory Institute, you can follow me on Twitter @raeddweikmd.