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Montefiore in the News

January 27, 2020

By Christin Perry

If you somehow made it out of the baby stage without encountering respiratory syncytial virus (RSV), you're super lucky. According to the CDC, almost all babies have had this virus that attacks the lower respiratory system at least once by the time they celebrate their second birthday. But even if you are one of the lucky ones, RSV is a highly contagious illness, which means toddlers (who touch everything and everyone) are very susceptible. Here's everything you need to know if your older baby happens to come down with RSV this season.

Is It RSV?

While typical cold symptoms tend to be centered around the upper respiratory system, like the nose and throat, RSV sets up shop in the bronchioles and lungs. But unlike bacterial pneumonia, antibiotics won't help. In infants and newborns, RSV can be quite severe—even life-threatening—since their airways are so incredibly tiny and fragile. But as the lungs mature, often the disease can be less severe, says Alyssa Silver, M.D., attending physician at Children's Hospital at Montefiore. "However, older infants can still be affected by RSV. It depends mostly on whether they've had the illness before and whether there are any complicating factors (like other illnesses at the same time)," she says.

RSV Symptoms in Toddlers

The typical symptoms of RSV in toddlers are fever, nasal congestion, cough, and difficulty breathing. When the virus settles in the lower respiratory tract, it causes inflammation, which means oxygen delivery can be compromised. However, this typically isn't as severe in toddlers as it is in infants and babies. There are two main reasons for that: As children get older, they build up immunity from previous infections, and their airways are larger, so they are less likely to become blocked from the swelling associated with RSV.

Treatment for RSV in Toddlers

So your toddler has come home from daycare with a fever and a nasty cough. A trip to the doctor has confirmed that it's RSV. What should you do?

For the most part, the treatment for RSV in toddlers is "supportive" in nature, says Amina Ahmed, M.D., professor of pediatric infectious disease and immunology at Atrium Health's Levine Children's Hospital. That means you'll be doing plenty of nose wiping and running a humidifier for the next few weeks. Hopefully, the virus will run its course and you'll simply have to ensure your toddler is comfortable, hydrated, and clean (those runny noses though!) until he's back to his normal self again.

Here are some tips to treat RSV in toddlers:

  • Use a nasal aspirator on younger toddlers. An electric one or the Fridababy Nose Frida will probably be better than that blue bulb you received in the hospital when your toddler was born. That's because these newer tools tend to be more effective, especially on a stronger (and faster!) toddler.
  • Teach your older toddler to blow his nose. To practice, gently place a finger over your child’s lips to show him that he can make air come out of his nose, says Katherine O'Connor, M.D., a mom of three and a pediatrician at the Children’s Hospital at Montefiore. You can also teach him to blow bubbles underwater during a bath and then have him apply the same technique when his nose feels stuffed up.
  • Give your toddler a fun new cup to encourage hydration. Dehydration from poor feeding, high fever, or lack of drinking can only exacerbate the condition and lead to hospitalization, so try this trick to get your toddler drinking on the regular.
  • Consider steroid treatment if your doctor recommends it. "We occasionally try medicine like albuterol which opens airways, but it does not work for all babies, says Dr. Ahmed.

Risks of RSV in Toddlers

By now you're aware that RSV in toddlers isn't as much of a concern as it is in young babies. But there are some risks you should be aware of. Since RSV can produce a ton of congestion, there's a slight risk of your little one experiencing a secondary infection like pneumonia or an ear infection, says Rudolph Valentini M.D., Chief Medical Officer at Children's Hospital of Michigan. "Children often get ear infections following a respiratory infection," he says.

And since your toddler is still so young, you may not yet know if she has any factors that can complicate the recovery process from RSV, such as asthma. "Any additional illnesses a child may have can make the effects of RSV more severe," says Dr. Silver. "Similarly, any infant who has had a recent illness that may affect the lungs (influenza, for example) and subsequently gets RSV, can also then be more severely affected as well."