Dr. Jamie Kondis: Hi, I'm Jamie Kondis, and I am at St. Louis Children's Hospital, Washington University School of Medicine, specializing in Pediatric Emergency Medicine and Child Abuse Pediatrics, and I am a mom doc.

Melanie Cole, MS (Host): As we head into the 2024 RSV season, many parents are asking how best to protect their little ones. RSV can be particularly concerning for young children and understanding what to expect is crucial. Welcome to Mom Docs, the podcast from St. Louis Children's Hospital. I'm Melanie Cole. Dr. Condis, you are always a pleasure to have on the show. I'd like you to start by telling us a little bit about RSV and other respiratory illnesses. Have you seen an uptick in these things in the last few years or so? And tell us what RSV is.

Dr. Jamie Kondis: Thank you for having me, and this is a very important topic. RSV stands for respiratory syncytial virus. So, it is a virus. And the interesting thing is that ever since our COVID season in 2020, we used to say that we had an RSV season, and it was typically the winter, early spring from about October to March. But the interesting thing that ever since we had COVID and kids stayed home for a while, then they were all out together again, is that we're really not seeing a season as much. They're kind of having it year round. So, RSV is a really good thing to think about all the time.

Melanie Cole, MS: Well, then tell us a little bit about the difference between RSV, influenza, bronchitis, rhinoviruses, COVID. I mean, there's a lot of them going around, and it seems like everybody gets something, but our little kiddos, what's the difference? How would a parent know?

Dr. Jamie Kondis: Yeah, it is tough because, as you said, there are so many viruses going around right now. RSV, respiratory syncytial virus, is interesting because, as you mentioned at the beginning, it really hits those young infants and young children the hardest. For older people, older kids, or people like us, we likely get RSV every season too, but it's more like the common cold, or what we call an upper respiratory tract infection. So, you might get some cough, congestion, runny nose, sneezing, maybe a low-grade fever, but really not a very complicated or bad thing.

But in the young infants, kids less than a year, definitely less than six months, or in kids that have some kind of underlying respiratory problem like asthma, or infants that were premature might have some lung disease, they can get what is called RSV bronchiolitis or a lower respiratory tract infection. So, they can get those cold symptoms plus tachypnea or fast breathing, flaring of the nostrils and head bobbing when breathing and a grunting during breathing and what we call belly breathing or tugging between the ribs and wheezing. And those symptoms can be very serious. Serious because it can cause the child to actually eventually stop breathing or have apnea. They can also have a lot of difficulty eating, as you might imagine, when they're having so much trouble breathing, so they can get dehydrated really quickly too. So, we really worry about RSV in those young children.

Melanie Cole, MS: Dr. Condis. Is there a vaccine? Because we've been hearing a little bit about that.

Dr. Jamie Kondis: Yes, that is the great news with RSV. So as you know, we've had an influenza vaccine for a while. And of course, we encourage everybody to get that. We also have a COVID vaccine. So of course, we want our kids six months and up to get that as well. Now, there is an RSV vaccine that's been around the last few years.

RSV is one of the most common causes of hospitalization in children under age one year. Two to three out of every 100 infants with RSV might have to be in the hospital either to get oxygen to help with their breathing or IV fluids if they're not eating or drinking. So, it is very serious, and we do unfortunately see some deaths from RSV each year.

So, the great news is there's actually a couple different vaccines to help prevent babies from getting severe RSV illness. If you're pregnant, there's a vaccine you can get between 32 and 36 weeks pregnancy to help prevent your baby. If you, the mom, the pregnant mom, gets the vaccine, it reduces the risk of RSV hospitalization for babies by 57% in their first six months after birth. So, it will actually cause protection for you from getting it and also the baby.

Now, if you've already had your baby, there is also an RSV immunization for babies as well, and it has been shown to reduce the risk of RSV-related hospitalizations by about 80%. So definitely, if you have children under two, that would be who we're wanting to get vaccinated, ask your pediatrician if they have it available or if they recommend it for your baby. And if you're pregnant, definitely ask your doctor about getting it yourself. And it can be given to older people as well. It's actually recommended for older adults 60 and over because they can actually have a lot of complications from RSV too. It kind of hits both ends of the age spectrum. So certainly, if you're listening and you're an older adult, ask about it at your doctor.

Melanie Cole, MS: What great advice you give, and your passion for what you do just comes through so clearly, Dr. Condis. Now, how does it spread? As we know, flu, COVID, you know, surfaces, and sneezing, coughing, all the things that go on at baby daycare. How does it spread? And is there anything that parents can do to slow down that spread or hopefully prevent their babies from getting it.

Dr. Jamie Kondis: Yes, that is a great question. So, just like a cold virus that spreads from person to person, it enters the body through the nose or eyes, usually from contact with infected saliva, mucus, or nasal discharge. And as we've always thought, it typically occurs in the late fall through early spring months. So, that October to March is still the most common time we see it. So, right now is when we should be thinking about it the most and getting vaccinated the most. But like I said, it's kind of our whole viral season was thrown off several years ago. So certainly, if you're planning to have a baby later on in the year or if you already have a young baby, still ask about those vaccines regardless of the time of year.

But you asked about prevention, so obviously the vaccine I'm very passionate about. The other would be just limiting your baby's exposure to crowds, other children, sick people. I know that's tough. But if you do have a child that's sick, certainly try to keep them home from daycare so they're not infecting other children. Teach them to cover their coughs and sneezes. Certainly wash your hands just as you would to prevent germs at any time. Use soap and water. Scrub for at least 20 seconds. And teach that to your children as well. Disinfect objects and surfaces in your home regularly.

Another thing, if you did recently have an infant or if you're going to, breast milk actually has unique antibodies to prevent and fight RSV. So, breastfeeding your baby would also be an option.

Melanie Cole, MS: That's great advice. Now, what about home care? So if our babies, our little kiddos come down with RSV, what support helps? I mean, is there symptom management, supportive care, nasal congestion, sneezing? What do we do? Are there over-the-counters we can use?

Dr. Jamie Kondis: Unfortunately, because it's a virus, there's no antibiotic or thing you would give if it were caused by a bacteria. So really, we do what's called supportive care. You can give Tylenol or ibuprofen if older than six months, if they have a fever. Because the children who get this are typically young, you want to avoid things like over-the-counter cold medicines and aspirin because they're too young for those, but you can give acetaminophen or ibuprofen. Certainly making sure your child stays hydrated, because that dehydration is a big problem when they're having trouble breathing. Sometimes it helps to suction out their nose prior to feeding them, and you can use nasal saline drops to put in their nose first and then suction that out. That sometimes helps get more mucus and secretions out of their nose. A cool mist humidifier is also something you can put in their room to help break up that mucus and allow them to breathe easier. But yes, unfortunately, there's not a lot of medications you can give, but there are supportive things you can do.

Melanie Cole, MS: How long are they contagious, Dr. Condis? How long do we keep them home from school or daycare?

Dr. Jamie Kondis: Yeah. Another thing that's frustrating about RSV is that they can be sick generally between seven and 14 days. But typically, the symptoms are their worst on days three through five. So early on in the illness is when they're going to be at their worst. Most pediatricians would recommend that they be fever free for at least 24 hours and not having a lot of infectious symptoms before they would go back to school or daycare.

Melanie Cole, MS: And give us some red flags, things we should look out for. When should parents seek medical attention if they suspect their child has complications from RSV? What are we looking for to know if we should go to urgent care or our pediatrician or, God forbid, the ER?

Dr. Jamie Kondis: That is another great question. So definitely, go to the ER or at least call your pediatrician right away if your child seems very dehydrated. And that is if they're having less than one wet diaper every eight hours. And definitely, if they're having any pauses in their breathing or if they are very pale or their skin looks blue or gray or if they are having significantly decreased activity and alertness, like if you're really having trouble waking them up, keeping them alert. Those are real red flags for when you'd want to go to the ER.

Other times you'd want to call your doctor for some advice would be if their symptoms are worsening or not improving after seven days, because they really should be improving by that point. So if they're not, it could be that they've developed a secondary infection. Sometimes they can develop a pneumonia after having RSV, or an ear infection. So, you might want to get them checked out for those things. Also, if they have a fever, which is a rectal temperature of 100.4 or higher, and they're younger than three months, typically, we want those kids to come in for some more workup. Or a child in any age that has a fever above 104, you'd want to call your doctor about that. Or if they're doing something that makes you think they have another infection, like tugging at their ears, having ear drainage, or complaining of chest pain, that might indicate that they have another infection you'd want to get checked out.

Melanie Cole, MS: This is so educational and informative and so important for parents. As we wrap up, Dr. Kondis, I'd love your best advice about the whole collection of respiratory viruses that are out there, but specifically RSV and our littler kiddos and what you want parents to know when the season typically peaks. Tell us a little bit about that best advice.

Dr. Jamie Kondis: Well, certainly my advice would be, if you can at all, and I know not everybody can, but if you can, keep those youngest kids at home as long as you can, younger than six months, definitely younger than three months, because you just really don't want them to be exposed. Most people our age will get RSV every season too, and it'll just seem like a mild cold. But if we pass it on to an infant, it can be quite serious. So, really trying to keep those newborns at home. Certainly talk to your doctor about the vaccination. Both if you're pregnant or have a young child, because it's amazing that we have one now. For so many years, we didn't. It's really been a great improvement in treating RSV.

And then, you know, watch for those symptoms. Sometimes people don't understand how to watch for the grunting, or the belly breathing or retraction. There's actually some nice videos online if you go to the AAP, American Academy of Pediatrics website. There's some videos of babies that are having those symptoms. So, that might be nice to watch just so that you know what to look for in your child and just paying attention. Are they having less wet diapers? Are they not eating as frequently? You know, those signs where you might want to bring them in.

Melanie Cole, MS: Thank you so much, Dr. Condis. You are such a great guest as always. Thank you for sharing your incredible expertise with us today. And for more advice and articles, you can check out the Mom Docs website at childrensmd.org. That wraps up another episode of Mom Docs with St. Louis Children's Hospital. Please always remember to subscribe, rate, and review Mom Docs on Apple Podcast, iHeart, Spotify, and Pandora. I'm Melanie Cole. Thanks so much for joining us today.