My Doctor Online The Permanente Medical Group

Causes

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RSV is common and spreads easily through physical contact with an infected person or surface.

When an infected person sneezes or coughs, tiny droplets of the virus are released into the air, settling on nearby surfaces and on the person's clothing and hands (skin). The virus can survive on a surface (including toys) for up to 5 hours and on a person's hands for around 30 minutes. The virus can survive in used tissues for several hours.

The risk of infection increases in large groups of people, such as in a daycare or classroom setting.

Teach your child to wash his or her hands frequently, especially after going to the bathroom and before eating. Good hand hygiene can help reduce the risk of getting sick.

Symptoms

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Symptoms of RSV may be mild to severe, depending on your child's age and health condition. Symptoms usually appear within 4 to 6 days after first exposure to the virus. The most common mild symptoms of RSV include cough, fever, and runny or stuffy nose.

If the illness worsens or if your child has other health problems, more serious symptoms may appear, including breathing difficulties and wheezing or grunting when breathing. Your child might also begin to breathe rapidly or develop a worsening, barking cough or bluish skin around the lips and fingertips.

Babies under the age of 1 year. Babies may develop severe RSV symptoms, including breathing difficulties and a high fever. You may notice that your infant's nostrils open wider when they breathe, or the skin between your baby's ribs pulling in. These are both signs of respiratory distress. Infants with RSV may need to be hospitalized while they recover, so if you see either of these signs in your baby, be sure to contact us right away.

Older children. Healthy older children usually develop mild coldlike symptoms, including cough, fever, and a runny or stuffy nose. If your child has other ongoing health issues, such as asthma, chronic heart condition, or a weakened immune system, they may be at risk of developing more complicated breathing problems from an RSV infection. 

Severe RSV symptoms

In young children, RSV infection can lead to complications such as bronchitis, ear infections, croup, pneumonia, and even lung failure. If your child has moderate to severe RSV infection symptoms, he or she may also be at higher risk for developing asthma. If your child already has asthma, RSV can make it worse.

Your child may have difficulty eating and drinking because breathing is using up his or her energy. Your child might also have trouble swallowing. If you notice these signs, call us right away.

Diagnosis

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RSV is diagnosed by evaluating your child's symptoms and doing a physical exam. We will confirm the diagnosis by swabbing your child's nose to collect a sample of mucus. Results of the lab test are usually available within the next day or 2.

Prevention

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The best way to prevent the spread of RSV is to wash your own and your child's hands often. Always wash your hands before you touch your baby and make sure everyone who touches your baby does the same (including care providers). RSV can also be spread through touching or kissing.

Do not share glasses or utensils and do not allow your child to share them either. If you have a cold, fever, or influenza, wear a mask around your baby and ask that anyone with these symptoms avoid contact with your baby. Because RSV is commonly found in young children, you may wish to keep young children with coldlike symptoms away from your baby.  This is especially important if your baby is premature, has a supressed immune system or a heart condition.

If your baby is premature, avoid exposing your baby to large crowds, especially during the fall through spring months and during reported RSV outbreaks.

Do not smoke around your baby, including inside your house and car. Smoking increases your baby's risk of becoming infected with RSV.

Currently, there is no vaccine available to prevent RSV illness. However, we may give the antibody palivizumab (Synagis) to very premature infants and children with weakened immune systems to help prevent severe symptoms of RSV.

Research indicates that infants with a vitamin D deficiency may be at higher risk for developing an RSV infection. If you nurse your baby exclusively (no formula at all), it is important to give vitamin D infant drops, as directed.

Treatments

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Mild symptoms of RSV illness do not require medical treatment. Antibiotics do not help to treat RSV. For mild RSV symptoms, home treatment to comfort your child and help relieve symptoms is usually all that is needed.

In some moderate cases, we may prescribe an inhaler or a breathing treatment.

If the RSV symptoms worsen, we may choose to hospitalize your child, particularly if your child is an infant younger than the age of 1 year. While your child is in the hospital, he or she will receive oxygen and humidified air to help with breathing. Your child may also be given intravenous (IV) fluids to prevent dehydration.

Home Treatments

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Mild RSV symptoms are similar to those of a cold and usually go away in about a week. RSV infections can recur, and most children have been infected at least once by the time they are 2 years old.

Home treatment focuses on making your child comfortable and relieving coldlike symptoms by doing the following:

Avoid dehydration. Make sure your child drinks plenty of fluids to avoid dehydration. If your child becomes listless or urinates infrequently, please call us. Dehydration in infants and younger children can be serious.

Keep the air moist. Do not use a steam or hot-water vaporizer. A cold mist home humidifier may be helpful, but be sure it is free of mold by cleaning it daily with diluted bleach and hot water.

Give acetaminophen for fever. If your child has a fever and is uncomfortable, you can give acetaminophen (Tylenol). Follow the package instructions and measure the medicine carefully. Do not give aspirin to a child with a fever because it may lead to a life-threatening illness called Reye's syndrome.

Suction mucus in infants. In infants with RSV, gently suction your baby's nose to clear mucus and help them breathe more easily. You can use a few drops of sterile saline solution to loosen thick mucus before using the bulb syringe. Suction one nostril at a time. We recommend that you do this before feedings and any time your baby is especially congested.

Raise the head of your child's bed. You can elevate the head of your child's crib or bed. Roll up a towel and place it under your child's mattress, just enough to raise it up a few inches. For an older child's bed, you can also place a thick book or 2 to elevate the head of the bed.

When to Call Us

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Call us to schedule an appointment if your child develops cold symptoms along with rapid breathing or appears to have trouble breathing normally. If your infant has cold symptoms and suddenly becomes unusually irritable or refuses to eat or drink, call the clinic to let us know. Call us immediately if your child experiences any of the following issues:

• Wheezing, grunting, or difficulty breathing (blaring nostrils, ribs or chest pullling in)
  
• Fever of 100.4°F or higher in an infant under 2 months old
  
• Signs of dehydration, such as no tears while crying or fewer wet diapers
  
• Seeming to get better and then getting worse again
  

Seek emergency medical care if your child struggles to breathe, if mild breathing difficulties worsen, or if the skin around your child's lips or fingertips turns a bluish color.

Your Child's Care with Me

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If you are concerned about your child's symptoms, and your concerns are urgent, please contact our Appointment and Advice line, which is available 24 hours a day, 7 days a week.

Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.

Depending on your child's symptoms and medical history and your preferences, the nurse may:

• Provide advice about how to care for your child at home.
• Send me a message so I can follow up with you directly.
• Offer you a telephone appointment with me or a trusted colleague.
• Make an appointment for your child to be seen in person.

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site, once you have registered to use the Act for a Family Member feature. You can also schedule an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.
• Depending on your child’s symptoms, you may also have the option to schedule a telephone appointment – with me or another pediatrician, if I am unavailable. Please let the telephone staff know what you prefer and what is convenient for you.

Coordinating Your Child's Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care for your child easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your child’s care to stay current on your child’s health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your child’s condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your child’s visit, you will receive information about when he or she is next due for a well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed. 
• At the end of your child’s visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your child’s height, weight, or vital signs. (If your child is under age 12, you can also view these summaries online, under Past Visits.)

If you schedule a telephone appointment

• In addition to in-person visits, we now offer the option of telephone appointments for certain common pediatric concerns. Depending on your child’s symptoms, you may have the option to schedule a telephone appointment with me or another pediatrician, if I am unavailable. We will call you at an agreed-upon time, at whichever phone number is most convenient for you.
• Many parents like this new option, but if you prefer to be seen in person, it’s always your choice. Just let the telephone staff know what type of visit you prefer.
• Telephone appointments are not appropriate for all health concerns. The advice nurse can help you decide what type of care is best for you and your child.

If I prescribe medications

We will work together to monitor and assess how your child’s medications are working and make adjustments as needed. 

Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically, in advance.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your child’s medications at the pharmacy.
• If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department. 

When the results are ready, I will contact you with the results by letter, secure e-mail message, or phone. In addition, you can view most of your child’s laboratory results online, along with any comments that I have attached to explain them.

If I refer your child to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your child’s condition. In some cases, I may contact them during your visit, so we can discuss your child’s care together. If we decide your child needs a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

Convenient Resources for You

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My goal is to provide high-quality care and to offer you choices that make your child’s health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to help you manage your child’s care at any time that is most convenient for you. From my home page you can:

Manage your child’s care securely

You can begin to manage your child’s care online by requesting access through our Act for a Family Member feature. Once you have added your child to your account, you can:

• View and compose secure e-mail messages.
• Manage your child’s prescriptions and refills.
• Schedule well visit and nonurgent appointments.
• View your child’s Preventive Services to see whether your child is due for any immunizations or well visits.
• If your child is under 12, you can also view most lab test results and review information about past visits.

Learn more about your child’s condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your child’s condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Help your child stay healthy

• Sign up for our online newsletters for parents, customized to your child’s age.
• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you keep your child healthy.
• Check to see when your child is next due for immunizations and a well visit (checkup).