RSV and other variations on snot and coughing

Nasal congestion, coughing till you throw up and lots and lots of snot.

I've noticed that one or two of your kids (maybe just a few more) have been congested, not sleeping well, not eating as well, and have crazy, crazy amounts of nasal congestion that is hard to get out with that bulb syringe thingy. It's called bronchiolitis, is caused most commonly by a virus called Respiratory Syncytial Virus (RSV) and everybody seems to have it because we never develop lifelong immunity. Adults get "bronchitis" or inflammation of big airways. Kids get bronchiolitis, an inflammation of the tiniest airways. And adults' tiny airways are still a bit bigger than kids' airways, so kids get this disease worse than adults do.

RSV isn't the only virus to cause bronchiolitis: influenza, parainfluenza and human metapneumovirus all cause it too.  We can't check for them too easily and we tend to blame them when the test for RSV is negative.  They all have similar symptoms to RSV.

The peak age to get this virus is 6 months, so it's a disease of infants. The infants who are at risk to have severe disease are ones with chronic lung disease including those children born at about 34 weeks of gestation or younger, and children with congenital heart disease.

The disease attacks the lining of the lung, damaging the lung, and exposing the nerves than the lining usually protects. This makes the lung twitchy (that's' my term) because all the things that the lung is exposed to, like dirt, particles in the air, cat dander, cold air, cigarette smoke gets right to those exposed nerves, and the kids start having coughing episodes that can really be quite scary. Plus, the lungs get stiff, so the kids have to work harder to get air in, and then they breath fast and hard.

And the congestion. I think this is the biggest problem.

You see, when we have nasal congestion, we open our mouth and we get air in. Our kids do the same thing, except that when they open their mouth, the air hits their tongue (the tongue is too big for the mouth in the littlest kids) and they only get a little bit of air in. Well, you can see what happens. We feed them-but in so doing, we clog the mouth airway. The kids can't breath then through their mouth or nose. Now they have to choose between eating and breathing, and trust me, breathing wins. Therefore, we have a child with lots of nasal congestion and who isn't eating and who is having big time coughing spells.

Plus, back to the tongue thing, when we put the kids on their back to sleep, the tongue falls all the way back into the mouth and they can't breath at all from their mouth or from their clogged- up nose. So they don't sleep well because they can't breathe. And a good way to get the tongue out of the way is to start crying.

Ok- coughing spells, not eating well, breathing fast, crying, difficulty sleeping and nasal congestion, making the breathing loud and making us able to feel stuff rattling around in their chests. What can we do? Well, suck out their nose with the bulb syringe thingy before they eat. Keep their head elevated (My oldest son ended up sleeping on my shoulder when he was sick with this, so yes, I've been through this as a mom and a doctor, and no, I don't like it!). Get fluid in as best you can. 

And the vomiting may not be all bad.  If you can't blow your nose, you mostly cough and swallow snot.  It either comes out as snot-vomit or snot -poop.  Either way, it ought to come out, and some kids feel much better if they cough 'til they gag.

There's always discussion about dairy and nasal congestion. The fact of the matter is, this disease can go on for weeks, so staying away from formula is not realistic.

Breastfeeding should continue without supplementing. And if you are considering weaning your child from breastmilk, please wait until after March, as breast milk is really the only "medicine" we have to treat this infection. Pedialyte is OK for short term (ie: less than 24 hours) but is probably not necessary.

You can imagine that since so many children get this disease every winter, that we have tried to find something in terms of medicine to give to make kids feel better. No such luck. We've tried a bunch. The only treatments that work are fluids and oxygen. We could use an inhaler-but the response to the inhaler is hard to predict, and may make some kids sicker, however, If your family has a history of asthma the inhaler may work. And as always, no over the counter medication works, is safe, or should be used.

The kids need hospitalization if they would need oxygen therapy or IV hydration, or really frequent suctioning. And we would know to hospitalize if the kids weren't cute and weren't eating. Meaning, they need to be consolable, and happy despite lots of snot and loud breathing and need to pee every 8-10 hours.

The disease, mostly the cough, goes on for weeks, according to this study the average is about 25 days.  And there is good evidence to suggest that kids who get RSV may wheeze/cough/sputter with each upper respiratory infection for the rest of the winter and maybe for many years afterwards. Yes, years.

There is a "shot" that kids can get to prevent the disease, but it's regulated right now to those kids at highest risk for severe disease because it's about a gazillion dollars a dose and needs to be given every month of RSV season.

So what to do? Hang in there. And call if you want me to take a look.