Do your eyes roll when your pediatrician says,” it’s just a virus”? School-aged children will have on average 5-6 Upper Respiratory Tract Infections (URI or “colds”) per year. And if they are otherwise healthy, they usually get over their symptoms in 1-2 weeks. Still, we do want to be cautious with exposures as these respiratory infections are rather contagious and can cause more severe disease in infants and toddlers.
Bronchiolitis can be caused by a handful of different viruses, the same viruses that can cause common colds in older children. These kids can have low grade fevers, harsh and hacking coughs, nose symptoms, eye redness and irritation, scratchy throat and sometimes croup with a barky cough. Bronchiolitis is primarily a disease that is most noticeable in children under the age of 2 years. It is not the same as bronchitis. Bronchiolitis affects the small airways deep inside the lungs making it difficult for the infants and toddlers to breathe in and out. They will often have a wheezing sound which is a “grunt” heard when the child is exhaling or breathing out. Typically bronchiolitis will start with some nasal congestion for a day or two, then progress to wheezing and labored breathing which tends to worsen on days 2-5 of the illness. This second period is usually the worst as the infants do not feed well and struggle to breathe and clear the mucous plugs from their airways. Not all infants with bronchiolitis will have to go to the hospital. Oftentimes infants are kept hydrated by feeding with more frequent and smaller volume feeds. For those days when the cough, gagging and wheezing are at their worst, the infants may just need a little help with a daily visit to the office to have suction performed to clear out the nasal and throat passages. RSV (Respiratory Syncytial Virus) is the most notable of these viruses because of the severity of disease which can occur. RSV infection can also cause viral pneumonia, which involves the alveoli (air exchanging parts of the lungs). Since RSV is viral, antibiotics will not help. Another virus which can cause bronchiolits, is the Human Metapneumovirus (“met-a-new-mo-virus). Like RSV, HMPV is common in late winter and early spring. RSV and HMPV can cause ear infections, asthma exacerbations, croup and in adults they can complicate COPD. Respiratory viruses can be shed (i.e. considered contagious) for up to 1-2 weeks beyond resolution of symptoms. So practice good hygeine with covering mouth when coughing and sneezing and frequent hand-washing.
Pertussis is not a virus and can be treated with antibiotics. However, this treatment needs to be initiated early in the course of disease when symptoms are non-specific and similar to any cold. Pertussis is spread by droplets with sneezing and coughing in proximity to others. The time from exposure to the onset of first symptoms can be 1-2 weeks. During the first stage of illness, the kids can have mild fevers, cough and nasal symptoms. This first stage can last 1-2 weeks. The next stage, the Paroxysmal stage, can last from the second week up to the sixth week of illness. During this time is when one hears the classic “rapid fire” cough spasms. As many as 5-10 uninterrupted coughs occur in succession, followed by a “whoop” as the patient rapidly draws in a breath. If you are interested in hearing what this sounds like, you can go to http://www.pkids.org/diseases/pertussis.html. These paroxyxms of cough can occur several times an hour and can be severe enough to cause vomiting, pneumothorax, or turning blue. Infants under the age of 6 months may not have the classical “whoop” yet they may still have gasping, gagging and even apnea where they stop breathing. If antibiotics are started during the first stage, the course of the illness can be shortened. Even if a child has progressed to the paroxysmal stage, using antibiotics will not shorten the course of that child’s illness, however it will help prevent spread of the illness to other family members. Kids are no longer considered contagious once they have completed 5 days of antibiotics. It is also important to note that immunized individuals can still get pertussis and have mild disease, yet they can spread the disease to those individuals/infants who are at greatest risk for infection.
Influenza is making its presence known this year. Influenza causes primarily respiratory symptoms with cough, nasal congestion, high fevers, body aches, head aches, sore throats and sometimes red eyes or eye pain. Influenza can cause some upset stomach/ nausea but should not be confused with the “stomach flu”. Influenza is different from a cold in that symptoms tend to occur all at once – often within a couple hours. These symptoms often will persist for 7-10 days. The best defense against severe Influenza infections is vaccination. Influenza is a virus, yet there is anti-viral medication in this instance which may shorten the course of infection. In order to shorten the course, the anti-viral medication needs to be started within the first 48 hours of illness. Another drawback is that nausea and upset stomach are a common side effect with these anti-viral medications. Once again, think seriously about the flu vaccine.
If it is just a cold, what can you do to help comfort your child? Generally, over- the- counter cough preparations are not indicated for children under the age of 2 years.
Following are tips from the American Academy of Pediatrics (AAP) to help calm your child’s cough and cold symptoms so the whole house can sleep soundly.
Buckwheat honey was found to ease nighttime coughing and sleeplessness in children ages 2 and older, according to a 2008 study.
Honey can be fed safely to children over age 1, according to the AAP Nutrition Handbook. The AAP does not recommend giving honey to infants under 12 months of age because it could contain a bacterium that causes infant botulism.
The AAP advises starting with ½ to 1 teaspoon as needed. If honey is not available, corn syrup may be used.
Saline solution offers a way to keep the tiniest noses clear. Babies can benefit from nasal washes prior to nursing or bottle feeding. Make saline solution by combining ½ teaspoon of table salt per 1 cup of warm tap water. Put two to three drops in the nostril and use a bulb syringe to suction it out.
Older children also can gargle saline solution to ease sore throats.
For children older than age 2, topical vapor rubs can help ease chest and nose congestion. A 2010 study found that vapor rub containing camphor, menthol and eucalyptus oils relieves symptoms and aids sleep in children with colds.
Rubs never should be given by mouth or rubbed under the nose. Follow instructions on the label and rub on the chest.
If all else fails
Consult your pediatrician if your child’s symptoms last longer than a week, he or she has a mild fever for more than two to three days (call the pediatrician right away if your infant under 2 months has a fever), your child has severe ear pain that does not go away or has a sore throat accompanied by fever and swollen neck.
If you want to see which viruses are predominant in our community each week, you can check the Germ Watch website from Primary Childrens Hospital.