RSV - How to Protect Your Family
What is RSV? How can I protect my family? What should I do if I suspect my child has RSV?
Featured Speaker:
Neela Sethi, MD
Dr. Neela Sethi was born and raised in Palos Verdes, California. She attended the University of California at Los Angeles for her undergraduate training, and graduated both Magna Cum Laude and Phi Beta Kappa with a major in Psychobiology. She stayed a loyal Bruin and continued at UCLA medical school, where she graduated with honors. She completed her residency in Pediatric & Adolescent Medicine at Cedars Sinai Medical Center. Her special interests include childhood obesity, nutrition and breastfeeding advocacy. She is also trained as a certified lactation educator. Transcription:
RSV - How to Protect Your Family
Intro: It's Your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.
Melanie Cole, MS: Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me today is Dr. Neela Sethi. She's a pediatrician on the medical staff at Henry Mayo Newhall Hospital, and she's here to tell us about RSV. We're hearing a lot about it. What is it? What does it mean for your family?
Dr. Sethi, it's such a pleasure as always. You're a great guest and I love to have you on. So, thank you for joining us and this is something we're hearing about. We're hearing about this combination. We're hearing about COVID, flu, RSV. But we are here to concentrate today on RSV. Tell us what it is.
Dr. Neela Sethi: Yes. Thank you so much for having me. So, RSV stands for respiratory syncytial virus. It's a big word for a really common cold, and it causes a lot of just cough, congestion, runny nose. What we like to tell people is this, in older kids, it's just like a common cold. The problem is, is that if RSV catches either premature babies or babies that are under six months, it can be very dangerous to them. And the reason is, is because not only does it affect the upper airways, meaning the nose and the throat, it also affects the lower airways, meaning the lungs and the lower part of the lungs. And so, it leaves kids feeling like they can't breathe and they can drop their oxygen levels, and that can be life-threatening in worst case scenarios. So, our main goal is to protect those babies as best as possible.
Melanie Cole, MS: So then when you're describing the lower respiratory tract, that sounds a lot like that initial COVID, you know, when we learned about the original COVID and that lower respiratory area. Can you tell us the difference, Dr. Sethi, between RSV and COVID and even other respiratory viruses like flu? Because we're seeing them all right now.
Dr. Neela Sethi: Absolutely. RSV loves the tiny little airways. Sort of street name for it is bronchiolitis. That means it affects the bronchioles, the tiny little guys that go way deep into the lungs. It loves to go there and make a little colony and affect the lower airways. COVID, from what we know, doesn't seem to go as far down into those lower airways. And COVID, at least the newer strains of COVID have been causing a lot more sort of upper respiratory symptoms and postnasal drip, and it can land in the lungs and it can cause a bronchitis, which is a little bit higher up, but it doesn't seem to go into those deeper, deeper parts of the lung, those deeper parts of the alveoli. And like I said, the bronchiolitis that RSV does. And RSV causes this sort of wheezy tightness and this wheezy cough that we're not seeing as much with COVID right now.
And Melanie, you and I have had many of discussions about COVID and other things, it's a kind of ironic situation where RSV is more aggressive and hospitalizing more kids right now than COVID. I never thought I would be in a world where I'd be more scared of RSV than COVID, but here we are. And a part of that is that kids weren't really in school and they weren't mixing all of 2020 and part of 2021, so now they're back in the mix, and these viruses had time to kind of hibernate and then come back full force. So, we're seeing it in record numbers and we're seeing it at these odd times of year that we've never seen before.
RSV is generally a winter bug. And what people don't know is, for pediatricians, winter usually starts after the holidays, maybe a trickle after Thanksgiving because of family holidays, and then it takes a break. And then, it usually goes full force January all the way sometimes to tax season, so April 15th. What we're seeing now is RSV in September, RSV in October, record numbers of RSV in the late fall, early winter. So, that's the other thing that's making us scratch our head saying, "Why is this bug so aggressive?" Why are we seeing such high numbers and why are we seeing it earlier in the year? And the thought is, "Well, we weren't together for almost two years." And so what's winter is now fall and what's fall is now winter and these bugs are just really on their own timeline.
Melanie Cole, MS: So, now you just answered the why we're seeing it, but can you tell us about why it's spreading so rapidly? Now, how is it spread? Is this an airborne virus? Is it transmitted on surfaces? Tell us how it's spread.
Dr. Neela Sethi: It's via respiratory droplet. So, very similar to COVID. It's a cough, sneeze, if you cough on a surface and then happen to right away touch that surface and touch your face. The reason that it's going in record numbers is because we've just seen so many cases of it and it's spreading through daycares like crazy. I mean, we're seeing every single kid in a daycare get it. A lot of times, we'll have five or six kids out and we'll have eight or 10 kids out of 12 kids have it. So, it's just more contagious than it's been before. And people are together in a way that they haven't been before. And babies, unfortunately, they can't help but touch their face, put their hands in their mouth, put toys in their mouth, they're touching everything and they're in such closed quarters. And so, it's just spreading like crazy.
And what we are seeing is it's just more aggressive than it's been before. A lot more people are coming down with symptoms, a lot more people are symptomatic. Like I said, generally speaking, RSV in the older kids and the adults, you wouldn't even know. It would just be common cold. What we're seeing now is it's making people look more like flu. It's not hospitalizing the older kids, and it's not hospitalizing the older adults. But because we're, one, so aware of our body and our symptoms because of COVID, so we're testing. And two, we're noticing that RSV is giving this flu-like prodrome, where people are feeling body malaise, they're feeling aches, they're feeling feverish, and they're feeling a lot more flu-like than just common cold-like like we saw pre-COVID. So, we're just noticing that this RSV bug seems to be more aggressive than normal.
On that same side, we're noticing that when it does affect these little ones, they're hospitalized because it is so aggressive. It's causing such high fevers, it's causing such aggressive nasal discharge, it's causing such an aggressive wheezy cough that these poor little ones can't breathe through their nose, they feel tight in their chest, and then they're trying to breathe through their throat and they have all this postnasal drip in their throat. So, it just leaves them feeling really uncomfortable and they're not taking deep breaths because of that, they're dropping their oxygen levels and then they're requiring hospitalization.
Melanie Cole, MS: How scary is that? So, you've just told us about a lot of the symptoms, Dr. Sethi. Now, how do we know if we've got a little baby or if we've got a little kiddo that was in daycare or something and they start with the nasal congestion or the sneezing or the running down the back of the throat or any of these things, do we get them tested? What do we do? Do we rush to our pediatrician, call our doctor? Tell us a little bit about how we know whether they got the flu or whether it is RSV?
Dr. Neela Sethi: Well, the beauty is now we are able to test a lot better than we ever have before. Our specific office is now able to test RSV via PCR, so you don't even have to have large numbers of viral particles circulating in your nose. If you even just have one or two, our machine will catch it. And a lot of pediatrician offices and urgent cares are moving in that direction, which is one of the beautiful things that's come out of COVID, is this ability to test better, and the ability to test smarter. So yes, you should go and see your pediatrician. That's what I'm here for because we can do a viral swab and we can tell you fairly quickly whether we're dealing with flu or COVID or RSV or just a regular cold. There's hundreds of other cold viruses. We can't catch all those, but we can really tell you what it's not. So, that's the first thing.
Once you know it's RSV, there's no need to panic, and we're telling patients that right and left. Because a lot of times, RSV will just look like a regular cold in many kids, especially six months and older. They tend to just get really coughy, really congested, just like we've seen before. You can give them supportive care with Tylenol. You could alternate your Tylenol or your Advil and your Motrin. You can put them in steamy showers. You can bulb suction them or use a NoseFrida. You can use saline rinses and get them comfortable. The problem is, is the younger kids, and especially kiddos under six months, and kiddos that are preemie, what happens with them is they get the nasal congestion and they get the post-nasal drip, then they get that wheezy cough and they can't catch their breath. So, what they do is a couple things, they'll either flare their nostrils, which is called nasal flaring where the nostrils will open and close, where you're really not supposed to see that in a baby or with anyone where you're trying to catch your breath through your nose and you're flaring your nostrils. You're pulling in all the O2 you can, and the body will naturally kind of do whatever it can to get the most O2 in. So nasal flaring.
You'll also hear a wheezy sound where they just sound congested and then you'll see that their chest muscles will pull in. And when they're breathing, you'll see that they're kind of pulling in their chest muscles under their ribcage and you'll be able to see their rib muscles working or you'll able to see their chest wall working in a way that you're not normally used to see. And then, you're also going to see belly breathing where the belly goes in and out, and the rate can be rapid. And those are the things we forewarn patients to look for: nasal flaring, the pulling in or retractions in the chest or belly breathing, and those are the things that are considered an emergency, and you want to go to an urgent care or to an emergency room in that situation, because that's when we start worrying that the oxygen level's going down and the baby needs some more supportive care that you can't do at home.
Melanie Cole, MS: Wow. That was an excellent description for parents listening, especially the ones with kids under five and even younger because, you know, you gave us really a picture, Dr. Sethi, of what it is we're why watching for. And I think I remember when my kids were little, that was always what I wanted, was just to know what I was supposed to be watching for. So, you really did that so well. And since it's so prevalent, this is really informative. Now, when a child has a fever and we've learned about fevers over the years, they're the body's protection, blah, blah, blah. Do we try and bring them down? Do we want to bring them down?
Dr. Neela Sethi: The answer is yes. There's definitely a lot of sort of mommy blogs and sort of misinformation that's being circulated online that let the fever go and that that higher temp kind of decreases viral replication or it's kind of like kills the virus. What we find is this, think about how you feel with the fever. Your body aches, you have a headache, you feel malaise, you feel tired, you're less likely to eat, you're less likely to drink. Those are all happening in children too. So, what we want to do is we want to bring the fever down to make them feel better, so they're more likely to eat, they're more likely to sleep, and they're more likely to hydrate, because those are the things that are most important. Back to grandma's recipe, chicken soup, cop-a-squat in front of the TV and drink your Gatorade or your Powerade or your fluids or your electrolyte drinks to hydrate, because that's the thing that's going to get you feeling better and recovering the quickest.
When you're letting fevers ride out, think about it, if you're at 102 or 103, it's going to take hours for that to come down on its own. Even when you give Tylenol or Motrin, it can take 20 or 30 minutes for that number to come down. So, you're still in that 20 to 30-minute zone where you need that fever to come down. And in that 20 or 30 minutes, they feel horrible. So, it's very, very important that you're giving Tylenol and Motrin. You can even alternate them in a four-hour routine. And then, what you do is you watch to see that they're hydrating, you watch to see that they're urinating. And you really and truly make sure that they're just getting what we call supportive care, because that's what's going to keep them out of the hospital.
Melanie Cole, MS: Dr. Sethi, this has been so informative. Now, as a last question and we're speaking about supportive care, I'd like you to kind of summarize RSV, but expand a little on the supportive care parents can do. We talked about fever, you talked about the bulb and nasal lavage. And oh, boy, do I remember those from little kid days. But, you know, there's the congestion and the respiratory feeling of heaviness and the cough and whatever else. I'd like you to summarize RSV, but also talk about the over-the-counters, because I think parents have a lot of questions about like Vicks. I like the VapoRub and the Vapo smelly thing that you sort of put next to your nose. But then, there's always these other things, the Robitussins and the Delsyms and these things. So, are we using any of those? Give us your best advice.
Dr. Neela Sethi: What I tell parents is I don't like any of the over-the-counter medications. So, what those medications do-- well, let's back up by saying we really don't use any cough and cold medicine under five years old at all. It's just not recommended, period. You can use Tylenol, you can use Motrin. You can alternate those. You can use a bulb suction. You can use a syringe, you can use a NoseFrida. You can use nasal saline. But you cannot do any cough or cold medicine under five years old. That's just a blanket statement.
The reason that we don't like that, one, is cough and cold medicine can make kids drowsy. And when they are coughing, that's protective, that's fluid in their airways that their body's trying to clear, and we don't want to take that away, we don't want to take that drive away, so that they become sedated and they can choke on their mucus or they just get overly sedated, which we never want kids to be overly sedated. We want them breathing and we want them coughing. We'd rather them up and screaming than drowsy and not breathing, if that makes sense. So, that's the first thing.
The second thing is cough and cold medicines, the reason they work is not because they make the virus go away, they just make the mucus go away. They make the mucus thicker so it doesn't run down your throat. It just gets stickier and hangs in your sinuses. The more that you're on those medicines, the more likely that you're going to reach a place where you need antibiotics because that mucus gets sticky and it lands in the throat, it lands in the ears, it lands in the sinuses, and it's harder to clear. And unless, you're really doing aggressive saline rinses, it's not going to come out on its own because kids are not good about blowing their noses like we do.
So, we really try and say, when we mean supportive care, we mean, like I said, back to grandma's recommendations. Steamy showers, do you remember when you're a kid and you got into a steamy shower and all of a sudden your nose is just running like crazy? That's what you need to do. Get in a steamy shower. You can do that two or three times a day with your kids. My favorite is putting all the kids toys in the tub and just filling up the tub a little bit and then letting the shower, if they're older, run over their head so they can play with the shower head going and in the tub. And as the tub fills with the shower water, the steam helps them just kind of drain. And as soon as they get out of the shower, you suction them out.
Lots of fluids, any kind of electrolyte drink that you can think of. There's so many electrolyte packets now that are sugar-free, that are clean, that you can put in water for your kids that they drink. Soup, anything that's warm, feels soothing on the throat, and it does help with hydration, especially the chicken noodles and the bone broth because they have natural sodium in there, and it makes them hydrate and it increases their thirst
drive. And then sleep, the more sleep, the better. The truth be told is this, if we all just rested when we got a cold, we wouldn't need cough and cold medicine. We would just go to sleep for a few days and wake up and feel better. But the fact of the matter is that doesn't happen in our modern day society. We're expected to go to school and go to work and do all these things and be functional. So, here we are just self-medicating, trying to get ourself to feel better to get through the day, but that doesn't really help with the progression of the virus, nor does it speed up recovery, if that makes sense.
Melanie Cole, MS: It does. And I'm sorry to have to do this, but I have to ask you a last question. How long do we keep them home? Because you said that, you know, if we rested, we would be so much better off. But then, our kids want to get back to school and their friends, and we have to get back to work, so we want to get the kid back to daycare. When is it safe to send them back?
Dr. Neela Sethi: We're looking at the three to five-day range. So generally speaking, from onset of symptoms to the end of symptoms is three to five days. So, you're looking at three to five days from home. They They have to be 24 hours fever-free to go back and they should be feeling better. So if your kid on day four is bouncing off the walls and the runny nose has improved and they seem like they're acting better and they don't have a fever and they're eating and they're urinating, you can likely send them back. But if even on day five, they're still droopy, they're still hanging around, they're still having those low-grade temps, they're not eating well, no need to send them because they're not fully recovered. So, trust your paternal and your maternal instinct and put your kids back in daycare when they're ready.
Because what happens is kids are being rushed back to daycare, they're being rushed back to school, naturally because parents need to get back to work. What ends up happening is they catch another virus on top of the virus they're recovering from, so it prolongs the whole process of recovery because there's so many other viruses other than RSV that are circulating. So, you really want to get back to where your immune system's functioning well and you can fight off another virus. Otherwise, you're just on the cycle of getting another virus on a virus on a virus.
Melanie Cole, MS: Great information. And thank you, Dr. Sethi, so much for joining us. You are just such a great guest, as always. So informative. That was a really important podcast. And more information is available in the Henry Mayo Online Health Library. You can find that at library.henrymayo.com. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Until next time, thanks so much for joining us.
RSV - How to Protect Your Family
Intro: It's Your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.
Melanie Cole, MS: Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me today is Dr. Neela Sethi. She's a pediatrician on the medical staff at Henry Mayo Newhall Hospital, and she's here to tell us about RSV. We're hearing a lot about it. What is it? What does it mean for your family?
Dr. Sethi, it's such a pleasure as always. You're a great guest and I love to have you on. So, thank you for joining us and this is something we're hearing about. We're hearing about this combination. We're hearing about COVID, flu, RSV. But we are here to concentrate today on RSV. Tell us what it is.
Dr. Neela Sethi: Yes. Thank you so much for having me. So, RSV stands for respiratory syncytial virus. It's a big word for a really common cold, and it causes a lot of just cough, congestion, runny nose. What we like to tell people is this, in older kids, it's just like a common cold. The problem is, is that if RSV catches either premature babies or babies that are under six months, it can be very dangerous to them. And the reason is, is because not only does it affect the upper airways, meaning the nose and the throat, it also affects the lower airways, meaning the lungs and the lower part of the lungs. And so, it leaves kids feeling like they can't breathe and they can drop their oxygen levels, and that can be life-threatening in worst case scenarios. So, our main goal is to protect those babies as best as possible.
Melanie Cole, MS: So then when you're describing the lower respiratory tract, that sounds a lot like that initial COVID, you know, when we learned about the original COVID and that lower respiratory area. Can you tell us the difference, Dr. Sethi, between RSV and COVID and even other respiratory viruses like flu? Because we're seeing them all right now.
Dr. Neela Sethi: Absolutely. RSV loves the tiny little airways. Sort of street name for it is bronchiolitis. That means it affects the bronchioles, the tiny little guys that go way deep into the lungs. It loves to go there and make a little colony and affect the lower airways. COVID, from what we know, doesn't seem to go as far down into those lower airways. And COVID, at least the newer strains of COVID have been causing a lot more sort of upper respiratory symptoms and postnasal drip, and it can land in the lungs and it can cause a bronchitis, which is a little bit higher up, but it doesn't seem to go into those deeper, deeper parts of the lung, those deeper parts of the alveoli. And like I said, the bronchiolitis that RSV does. And RSV causes this sort of wheezy tightness and this wheezy cough that we're not seeing as much with COVID right now.
And Melanie, you and I have had many of discussions about COVID and other things, it's a kind of ironic situation where RSV is more aggressive and hospitalizing more kids right now than COVID. I never thought I would be in a world where I'd be more scared of RSV than COVID, but here we are. And a part of that is that kids weren't really in school and they weren't mixing all of 2020 and part of 2021, so now they're back in the mix, and these viruses had time to kind of hibernate and then come back full force. So, we're seeing it in record numbers and we're seeing it at these odd times of year that we've never seen before.
RSV is generally a winter bug. And what people don't know is, for pediatricians, winter usually starts after the holidays, maybe a trickle after Thanksgiving because of family holidays, and then it takes a break. And then, it usually goes full force January all the way sometimes to tax season, so April 15th. What we're seeing now is RSV in September, RSV in October, record numbers of RSV in the late fall, early winter. So, that's the other thing that's making us scratch our head saying, "Why is this bug so aggressive?" Why are we seeing such high numbers and why are we seeing it earlier in the year? And the thought is, "Well, we weren't together for almost two years." And so what's winter is now fall and what's fall is now winter and these bugs are just really on their own timeline.
Melanie Cole, MS: So, now you just answered the why we're seeing it, but can you tell us about why it's spreading so rapidly? Now, how is it spread? Is this an airborne virus? Is it transmitted on surfaces? Tell us how it's spread.
Dr. Neela Sethi: It's via respiratory droplet. So, very similar to COVID. It's a cough, sneeze, if you cough on a surface and then happen to right away touch that surface and touch your face. The reason that it's going in record numbers is because we've just seen so many cases of it and it's spreading through daycares like crazy. I mean, we're seeing every single kid in a daycare get it. A lot of times, we'll have five or six kids out and we'll have eight or 10 kids out of 12 kids have it. So, it's just more contagious than it's been before. And people are together in a way that they haven't been before. And babies, unfortunately, they can't help but touch their face, put their hands in their mouth, put toys in their mouth, they're touching everything and they're in such closed quarters. And so, it's just spreading like crazy.
And what we are seeing is it's just more aggressive than it's been before. A lot more people are coming down with symptoms, a lot more people are symptomatic. Like I said, generally speaking, RSV in the older kids and the adults, you wouldn't even know. It would just be common cold. What we're seeing now is it's making people look more like flu. It's not hospitalizing the older kids, and it's not hospitalizing the older adults. But because we're, one, so aware of our body and our symptoms because of COVID, so we're testing. And two, we're noticing that RSV is giving this flu-like prodrome, where people are feeling body malaise, they're feeling aches, they're feeling feverish, and they're feeling a lot more flu-like than just common cold-like like we saw pre-COVID. So, we're just noticing that this RSV bug seems to be more aggressive than normal.
On that same side, we're noticing that when it does affect these little ones, they're hospitalized because it is so aggressive. It's causing such high fevers, it's causing such aggressive nasal discharge, it's causing such an aggressive wheezy cough that these poor little ones can't breathe through their nose, they feel tight in their chest, and then they're trying to breathe through their throat and they have all this postnasal drip in their throat. So, it just leaves them feeling really uncomfortable and they're not taking deep breaths because of that, they're dropping their oxygen levels and then they're requiring hospitalization.
Melanie Cole, MS: How scary is that? So, you've just told us about a lot of the symptoms, Dr. Sethi. Now, how do we know if we've got a little baby or if we've got a little kiddo that was in daycare or something and they start with the nasal congestion or the sneezing or the running down the back of the throat or any of these things, do we get them tested? What do we do? Do we rush to our pediatrician, call our doctor? Tell us a little bit about how we know whether they got the flu or whether it is RSV?
Dr. Neela Sethi: Well, the beauty is now we are able to test a lot better than we ever have before. Our specific office is now able to test RSV via PCR, so you don't even have to have large numbers of viral particles circulating in your nose. If you even just have one or two, our machine will catch it. And a lot of pediatrician offices and urgent cares are moving in that direction, which is one of the beautiful things that's come out of COVID, is this ability to test better, and the ability to test smarter. So yes, you should go and see your pediatrician. That's what I'm here for because we can do a viral swab and we can tell you fairly quickly whether we're dealing with flu or COVID or RSV or just a regular cold. There's hundreds of other cold viruses. We can't catch all those, but we can really tell you what it's not. So, that's the first thing.
Once you know it's RSV, there's no need to panic, and we're telling patients that right and left. Because a lot of times, RSV will just look like a regular cold in many kids, especially six months and older. They tend to just get really coughy, really congested, just like we've seen before. You can give them supportive care with Tylenol. You could alternate your Tylenol or your Advil and your Motrin. You can put them in steamy showers. You can bulb suction them or use a NoseFrida. You can use saline rinses and get them comfortable. The problem is, is the younger kids, and especially kiddos under six months, and kiddos that are preemie, what happens with them is they get the nasal congestion and they get the post-nasal drip, then they get that wheezy cough and they can't catch their breath. So, what they do is a couple things, they'll either flare their nostrils, which is called nasal flaring where the nostrils will open and close, where you're really not supposed to see that in a baby or with anyone where you're trying to catch your breath through your nose and you're flaring your nostrils. You're pulling in all the O2 you can, and the body will naturally kind of do whatever it can to get the most O2 in. So nasal flaring.
You'll also hear a wheezy sound where they just sound congested and then you'll see that their chest muscles will pull in. And when they're breathing, you'll see that they're kind of pulling in their chest muscles under their ribcage and you'll be able to see their rib muscles working or you'll able to see their chest wall working in a way that you're not normally used to see. And then, you're also going to see belly breathing where the belly goes in and out, and the rate can be rapid. And those are the things we forewarn patients to look for: nasal flaring, the pulling in or retractions in the chest or belly breathing, and those are the things that are considered an emergency, and you want to go to an urgent care or to an emergency room in that situation, because that's when we start worrying that the oxygen level's going down and the baby needs some more supportive care that you can't do at home.
Melanie Cole, MS: Wow. That was an excellent description for parents listening, especially the ones with kids under five and even younger because, you know, you gave us really a picture, Dr. Sethi, of what it is we're why watching for. And I think I remember when my kids were little, that was always what I wanted, was just to know what I was supposed to be watching for. So, you really did that so well. And since it's so prevalent, this is really informative. Now, when a child has a fever and we've learned about fevers over the years, they're the body's protection, blah, blah, blah. Do we try and bring them down? Do we want to bring them down?
Dr. Neela Sethi: The answer is yes. There's definitely a lot of sort of mommy blogs and sort of misinformation that's being circulated online that let the fever go and that that higher temp kind of decreases viral replication or it's kind of like kills the virus. What we find is this, think about how you feel with the fever. Your body aches, you have a headache, you feel malaise, you feel tired, you're less likely to eat, you're less likely to drink. Those are all happening in children too. So, what we want to do is we want to bring the fever down to make them feel better, so they're more likely to eat, they're more likely to sleep, and they're more likely to hydrate, because those are the things that are most important. Back to grandma's recipe, chicken soup, cop-a-squat in front of the TV and drink your Gatorade or your Powerade or your fluids or your electrolyte drinks to hydrate, because that's the thing that's going to get you feeling better and recovering the quickest.
When you're letting fevers ride out, think about it, if you're at 102 or 103, it's going to take hours for that to come down on its own. Even when you give Tylenol or Motrin, it can take 20 or 30 minutes for that number to come down. So, you're still in that 20 to 30-minute zone where you need that fever to come down. And in that 20 or 30 minutes, they feel horrible. So, it's very, very important that you're giving Tylenol and Motrin. You can even alternate them in a four-hour routine. And then, what you do is you watch to see that they're hydrating, you watch to see that they're urinating. And you really and truly make sure that they're just getting what we call supportive care, because that's what's going to keep them out of the hospital.
Melanie Cole, MS: Dr. Sethi, this has been so informative. Now, as a last question and we're speaking about supportive care, I'd like you to kind of summarize RSV, but expand a little on the supportive care parents can do. We talked about fever, you talked about the bulb and nasal lavage. And oh, boy, do I remember those from little kid days. But, you know, there's the congestion and the respiratory feeling of heaviness and the cough and whatever else. I'd like you to summarize RSV, but also talk about the over-the-counters, because I think parents have a lot of questions about like Vicks. I like the VapoRub and the Vapo smelly thing that you sort of put next to your nose. But then, there's always these other things, the Robitussins and the Delsyms and these things. So, are we using any of those? Give us your best advice.
Dr. Neela Sethi: What I tell parents is I don't like any of the over-the-counter medications. So, what those medications do-- well, let's back up by saying we really don't use any cough and cold medicine under five years old at all. It's just not recommended, period. You can use Tylenol, you can use Motrin. You can alternate those. You can use a bulb suction. You can use a syringe, you can use a NoseFrida. You can use nasal saline. But you cannot do any cough or cold medicine under five years old. That's just a blanket statement.
The reason that we don't like that, one, is cough and cold medicine can make kids drowsy. And when they are coughing, that's protective, that's fluid in their airways that their body's trying to clear, and we don't want to take that away, we don't want to take that drive away, so that they become sedated and they can choke on their mucus or they just get overly sedated, which we never want kids to be overly sedated. We want them breathing and we want them coughing. We'd rather them up and screaming than drowsy and not breathing, if that makes sense. So, that's the first thing.
The second thing is cough and cold medicines, the reason they work is not because they make the virus go away, they just make the mucus go away. They make the mucus thicker so it doesn't run down your throat. It just gets stickier and hangs in your sinuses. The more that you're on those medicines, the more likely that you're going to reach a place where you need antibiotics because that mucus gets sticky and it lands in the throat, it lands in the ears, it lands in the sinuses, and it's harder to clear. And unless, you're really doing aggressive saline rinses, it's not going to come out on its own because kids are not good about blowing their noses like we do.
So, we really try and say, when we mean supportive care, we mean, like I said, back to grandma's recommendations. Steamy showers, do you remember when you're a kid and you got into a steamy shower and all of a sudden your nose is just running like crazy? That's what you need to do. Get in a steamy shower. You can do that two or three times a day with your kids. My favorite is putting all the kids toys in the tub and just filling up the tub a little bit and then letting the shower, if they're older, run over their head so they can play with the shower head going and in the tub. And as the tub fills with the shower water, the steam helps them just kind of drain. And as soon as they get out of the shower, you suction them out.
Lots of fluids, any kind of electrolyte drink that you can think of. There's so many electrolyte packets now that are sugar-free, that are clean, that you can put in water for your kids that they drink. Soup, anything that's warm, feels soothing on the throat, and it does help with hydration, especially the chicken noodles and the bone broth because they have natural sodium in there, and it makes them hydrate and it increases their thirst
drive. And then sleep, the more sleep, the better. The truth be told is this, if we all just rested when we got a cold, we wouldn't need cough and cold medicine. We would just go to sleep for a few days and wake up and feel better. But the fact of the matter is that doesn't happen in our modern day society. We're expected to go to school and go to work and do all these things and be functional. So, here we are just self-medicating, trying to get ourself to feel better to get through the day, but that doesn't really help with the progression of the virus, nor does it speed up recovery, if that makes sense.
Melanie Cole, MS: It does. And I'm sorry to have to do this, but I have to ask you a last question. How long do we keep them home? Because you said that, you know, if we rested, we would be so much better off. But then, our kids want to get back to school and their friends, and we have to get back to work, so we want to get the kid back to daycare. When is it safe to send them back?
Dr. Neela Sethi: We're looking at the three to five-day range. So generally speaking, from onset of symptoms to the end of symptoms is three to five days. So, you're looking at three to five days from home. They They have to be 24 hours fever-free to go back and they should be feeling better. So if your kid on day four is bouncing off the walls and the runny nose has improved and they seem like they're acting better and they don't have a fever and they're eating and they're urinating, you can likely send them back. But if even on day five, they're still droopy, they're still hanging around, they're still having those low-grade temps, they're not eating well, no need to send them because they're not fully recovered. So, trust your paternal and your maternal instinct and put your kids back in daycare when they're ready.
Because what happens is kids are being rushed back to daycare, they're being rushed back to school, naturally because parents need to get back to work. What ends up happening is they catch another virus on top of the virus they're recovering from, so it prolongs the whole process of recovery because there's so many other viruses other than RSV that are circulating. So, you really want to get back to where your immune system's functioning well and you can fight off another virus. Otherwise, you're just on the cycle of getting another virus on a virus on a virus.
Melanie Cole, MS: Great information. And thank you, Dr. Sethi, so much for joining us. You are just such a great guest, as always. So informative. That was a really important podcast. And more information is available in the Henry Mayo Online Health Library. You can find that at library.henrymayo.com. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Until next time, thanks so much for joining us.