RSV: What it is and When to Seek Help

Respiratory Syncytial Virus (RSV) is the most common cause of bronchiolitis. In years past, we would see RSV in the late fall to winter months along with the flu. Due to many factors, we are seeing RSV even earlier this year. I am not here to tell people how to prevent getting sick. Instead, I want to talk about what you can do if your little one comes down with a respiratory virus such as RSV.

Bronchiolitis is the inflammation of the small airways (bronchioles). This creates congestion which for the little ones can cause difficulty breathing. Their narrow passages along with the inflammation make it hard for them to clear their airways. This is where you can help your littles ones as they work through a 7-10 day course of respiratory virus. 

As a pediatric nurse, I have had my fair share of  practice with suctioning little noses. The most common question I get is, “when you suction, what is the best way to administer the saline drops?” In the heat of the moment a bulb suction or a nose frida can get loose secretions out without drops needed. If the sacreations become yellow or green and thick, saline is needed to loosen up the secretions. Saline also helps keep the mucosal lining from drying out.  The best way to administer the saline drops is at the same time as applying suction. This may be hard if you are alone and doing the suctioning. Below are simple steps to get effective suction.

For Infants:

  1. Swaddle your little one in a blanket. You can use your arms to go on either side of your child but still have your hands up by their head. If you have someone with you, have them help keep the head midline position. 
  2. Administer 3-4 saline drops to one nostril.
  3. If using a bulb syringe, compress the bulb and place it gently in the opening of the nostril then release the bulb slowly. Squeeze out any secretions that were collected onto a cloth or tissue nearby. Repeat at least 3 times on each side. If using a nose frida, apply drops in one nostril and then at the same time, apply suction to the nose frida in the other nostril. This will cause more of a flushout. Repeat the same process on the other side. 
  4. Wash suction devices in warm water and let air dry.

When to seek help?

If you have any concern regarding your child’s wellbeing, contact your healthcare provider. Infants fighting off RSV most of the time have increased work of breathing and is associated with the narrowing of the airways. This will present with tachypnea (quick breathing) and retractions. Most common areas are trachea, intercostal, and subcostal. For respiratory distress you will find nasal flaring, head bobbing, and seesaw breathing (where the abdomen rises as the chest falls). With increased energy spent trying to breathe, infants often have a harder time feeding which can lead to dehydration. A way to help with feeds is to do smaller and more frequent feedings. Suctioning the nose prior to feeds can help with effective feeds.  Posttussive emesis could be associated with coughing fits that can also prevent infants from keeping full feeds down.

If your child is not waking up for feeds, is more lethargic, has persistent fevers, respiratory distress, and/or has any change of color at any point (dusky colored lips, blue or slow slow capillary refill on fingers, or generally more pale), seek medical help as soon as possible. 

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