Play PodcastPlay Download PodcastDownload

Transcription:

Jamie Kondis, MD (Guest): Hi, this is Jamie Kondis, and I am at St. Louis Children's Hospital, a Specialist in Pediatric Emergency Medicine and Child Abuse Pediatrics, and I am a Mom Doc.

Melanie Cole (Host): Hey, welcome to Mom Docs, the podcast from St. Louis Children's Hospital, I'm Melanie Cole. And today we're talking about breathing issues that can be common in children because as these seasons bring many things that can trigger those attacks and what parents should know. Dr. Kondis, it's a pleasure to have you join us today.

At this time right now with the advent of COVID, have you also seen an uptick in RSV, other respiratory illnesses, as we're talking about breathing issues, and right now with these respiratory illnesses, as kids are back at school in person, physical distancing, even masks are not always so prevalent. What have you seen?

Dr. Kondis: Yes. We've definitely seen an uptick in kids both with COVID and with other respiratory infections. It's been a really interesting season this summer and fall, because normally we see RSV, which stands for respiratory syncytial virus. And it is something that causes a condition called bronchiolitis or a lower respiratory tract infection. So a cold, which you think of a common cold is what we call an upper respiratory tract infection. Whereas bronchiolitis, involves the lower respiratory tract and can be much more serious. And the interesting thing is that we're seeing more RSV right now. Whereas normally we see more of it in the winter, like December, January, February, but we're actually seeing a lot of that right now. In fact, we're seeing some kids who are getting both COVID and RSV, which can really give them a lot of breathing problems.

Host: Well, that leads very well into my next question. What about that co-infection aspect of all these respiratory viruses, pretty scary for parents right now. So, as we're talking about asthma and allergies and RSV and even COVID and the flu, I mean, there's just so much going around right now; how is a parent to tell the difference? And when is it important that they consult their doctor when their child experiences any of the symptoms we're going to be discussing here?

Dr. Kondis: Yes. I would say that breathing is probably the thing that parents worry most about with kids. From the time your child is born, you're always watching them to make sure they're breathing and worrying about breathing problems. Definitely, RSV is something to be worried about. I would say, we know that almost all children get RSV at least once before they're two years old.

And for most healthy children, getting RSV is like getting a cold, but some children get very sick with RSV and it tends to be the younger children, especially if they're less than 12 weeks when they get RSV or if they're formerly premature or low birth weight infants, especially if they were born before 29 weeks gestation, or if they have any type of heart disease or lung disease or a weak immune system. All of those children can be a really high risk for a serious infection from RSV.

And the thing about RSV is that it can last a while. It can actually last over a week sometimes with the symptoms. So, definitely if the children are having more severe breathing symptoms. So typically with a cold, the symptoms will be more things like sneezing, congestion, runny nose, maybe fussiness, maybe some fever.

Yeah. But with RSV or bronchiolitis, which is a lower respiratory tract infection, they tend to have those cold symptoms plus fast breathing and other signs of respiratory distress. And by that, I mean, things like flaring of the nostrils, their head is bobbing with breathing, they're grunting during breathing or they're belly breathing, meaning that their ribs are tugging and you can actually see that belly moving or their lower neck, you can see it moving or they're wheezing, where you can actually hear that audible wheeze sound when they breathe. Those are the more severe symptoms where you would want to come into the emergency department or to your doctor.

Host: Well, that was an excellent explanation. And so, as you're telling us about these things to look for, tell us about some of the things that do go on with children like periodic breathing and coughing and wheezing. You mentioned, I mean, kids do some of these things, just anyway, especially if, a child has allergies or asthma.

Dr. Kondis: Oh, definitely. So, the most common thing people worry about that is not worrisome, with little young infants is something called periodic breathing, which is very common in very young infants, especially infants that were premature, where they'll just pause in their breathing every so often. And if those pauses are very short, like five or even 10 seconds, which can seem like a long time, but those are still considered normal.

Now what's different than that is actually a condition called apnea and apnea is when the infant actually stops breathing for 20 seconds or more. And that is more concerning. With that, we start to think that there's some other cause that is a more concerning cause, but a lot of young infants just do have these little pauses in their breathing and, and that's normal, and they can outgrow that.

Now, other things that kids can have, you mentioned asthma. A lot of kids do develop asthma and with asthma, they can have more of a cough. Some kids have more coughing, other kids have more wheezing, and that would definitely be a diagnosis that your doctor would make you use. You wouldnt just make that on your own.

And generally it takes several attacks before they actually get that diagnosis of asthma. So, anytime kids are coughing for a prolonged period of time or having wheezing, you would want to get checked out by your doctor. Some kids have trouble breathing because of an allergic reaction called anaphylaxis.

Common causes of that are things like bee stings or food allergies, such as peanuts. They can have the sudden onset of trouble breathing and they tend to have other symptoms too, such as hives on their body, but that can be another cause of trouble breathing. And then there are plenty of other bacterial and viral infections that can cause trouble breathing too. We mentioned bronchiolitis, but another common infection that we see during the winter is croup. So croup is a viral infection, that's more in the voice box and wind pipe area. And the main symptoms of that are a barky cough and a hoarse voice.

But some children get this harsh, tight sound while breathing, and that's called stridor. And so that's associated with croup and we can see those children in the emergency department and treat them. Generally, they get treated with a steroid medication for that. Another thing that can cause coughing or choking in young children, especially children age one to four years is swallowing some sort of a foreign object and getting it caught in their airway, like a peanut or a seed.

Those would be the most common things, and getting that lodged in there. And then, you also mentioned influenza. This is definitely the time of year when we see an uptick in flu as well. So I encourage everybody to get their flu shots for their children cause that's completely preventable. But flu often presents with a cough as well, a really bad cough as well as other symptoms like runny nose and sore throat.

And then the worst cases of viral infections can actually go into the lungs, and develop into a pneumonia and that can cause trouble breathing. A lot of times with pneumonia, the kids just have trouble catching their breath and really getting a breath in. But a lot of the pneumonia causes can be prevented with vaccinations that children get when they're young as well. So getting all of your vaccines up to date is definitely important to prevent a lot of these things.

Host: Well, it certainly is. And I know you were talking about viral and croup, but I remember when my son had pertussis and that coughing and that inability to breathe, he was crying and he kept saying he couldn't get a breath. And he was coughing so hard. I mean, it still breaks my heart to even think about it. Cause there's nothing, you feel like there's nothing you can do.

Can you tell us if a child has this, if they're having a cough, if they have croup, if they have any of these things, can you give us some remedies, some home treatments? I mean, does it help to take a child out in the cold? Does it help to sit in a steam shower for any of these kinds of respiratory illnesses? Are there things parents can do to make their child more comfortable?

Dr. Kondis: Oh, there's definitely things they can do. The most important thing I would say is, knowing when to go in and get the child seen. So, certainly if they're having trouble breathing that is worse than what you would normally think. So, if they're seeing some of those things, like the tugging on the neck or the tugging in the belly, or seeming really like the airway is blocked, those would be times you'd want to see the doctor, but certainly there are things they can do at home as well.

So, for a coughing fit or a coughing spell, sometimes breathing in a warm mist does help with that. So, you mentioned the shower, so you want to close the bathroom door and then turn on the shower so that you get that warm mist. And there's humidifiers sometimes that can help with that as well. Those things help relax the airway and loosen up any phlegm that you might then be able to cough up better.

Another thing you can do, especially for the young ones, is give them nasal saline to help open up a blocked nose. So, suction alone, sometimes can't remove dry or sticky mucus in the nose. So, you can use saline, which is salt water nose drops, or a spray to loosen up that dried mucus. You just put about three drops in each nostril. If they're really young, you can just do one drop and then you suction off each nostril while closing off the other nostril. And then repeat with the other side. That can really help those young infants, especially with things like RSV or bronchiolitis. And you can buy saline nose drops, or spray at any drug store. You don't need a prescription for that. Another thing is just making sure that your children are not being exposed to anything that might trigger trouble breathing. So, especially kids with asthma or allergies, making sure that they're not around things like tobacco smoke. Tobacco smoke definitely makes coughing and trouble breathing much worse.

Times you would want to go to the ER pretty immediately would be again, if you're seeing things like retractions, where the ribs start pulling in with each breath, or if the wheezing becomes really loud or tight, or if you're just really having trouble getting air in, then you would just really want to head to the ER at that point.

Host: Wow. What an informative episode. That was excellent information for parents about things that we can try at home. And my kids are bigger now, but I wish I'd known some of those things when they were little. Dr. Kondis wrap it up. What would you like parents to know as your best advice about those triggers for kids that have asthma that may be at increased risk of the RSV and some of these viruses, whether it's mask wearing that might help, or vaccination and what you want parents to know about really the importance of keeping an eye on this and calling their pediatrician when they need to.

Dr. Kondis: Well, I think something that you mentioned at the beginning is that we are really seeing this big uptick of respiratory illnesses right now in 2021, because during 2020, a lot of the kids were at home, locked down. They weren't getting exposed to those viruses like they typically do in the school year.

So all of a sudden, now that they're back in school, they're getting exposed to a lot of viruses. So, I would just warn parents that they may see some more infections this year than they typically do. Vaccination though, is a huge thing we can be doing right now. I know that most of our pediatrician offices in town right now have the flu shot available.

So going in to get your flu shot, any age child, six months and up can get the flu shot. So, pretty much all of your children can get the flu shot. But if you've got a child with asthma or any underlying breathing problem, definitely getting them the COVID vaccine, because it is those kids that we're seeing with the underlying health problems that are getting the really severe COVID infections. And I've seen some kids in the ER that have developed pneumonia and some really serious problems from COVID that were not vaccinated.

So, I really encourage that as well. You mentioned pertussis as well. We've got a vaccine for too. So definitely making sure that your kids get all of their regular vaccines as well as these ones that they get every year, like the flu and the COVID, but making sure that they're up-to-date on their regular vaccines.

And for kids with asthma, you know, just making sure that they have an updated, what we call an asthma action plan, which is, something that their doctor gives them saying when they should be taking their albuterol, when they should be taking their other medications and just making sure that's up to date too, and that they have a copy of that at home and at school so that everybody can be aware of any treatments they might be needing.

Host: Excellent advice. What a great educator you are and your passion, and the fact that you care so much about kids and their parents, really comes through Dr. Kondis. You're such an excellent guest and thank you so much. And parents, I got my flu shot yesterday, so, you know, it helps for parents to get theirs as well, get the whole family, because this is that time of year again.

And thank you, Dr. Kondis for coming on and joining us. That concludes another episode of Mom Docs with St. Louis Children's Hospital. For more advice and articles, check out the Mom Docs website at children'smd.org. And you can get more health tips if you follow us on your social channel and share these shows with your friends and your family, because that's how we're all learning from the Mom Doc experts at St. Louis Children's Hospital together. I'm Melanie Cole