It's respiratory season again!  So you may have noticed an increased number of children who have a runny nose and a cough.  This time of year the colds seem to hang around a lot longer than other times of the year.

Respiratory Syncytial Virus or RSV is a common cause of upper respiratory infections in young children.  In fact, almost every child has had RSV by the time they are two years old.  In most infants RSV causes a prolonged chest cold, but in a small number of children it causes a more serious infection.  Approximately 1% of young children require hospitalization. Most of the hospitalized children are less than six months old or have other medical conditions like being born prematurely or heart conditions.

 

Symptoms of RSV include runny nose, cough, fever, and wheezing (noisy breathing).  This is usually accompanied by decreased activity and liquid intake.  These symptoms run their course over 1-2 weeks.  A feared complication in very young infants is APNEA or short periods of time when the baby stops breathing and turns blue.  This is obviously an emergency and medical care is needed urgently. 

 

The seriousness of an RSV infection is evaluated by observing the baby’s activity, liquid intake, and the baby’s breathing.  It is very important to TAKE THE BABY’S SHIRT OFF and watch the baby breathe.  Normal breathing should be comfortable.  A baby with problems from RSV will have retractions or be using extra muscles to breath.   We call this increased work of breathing.   If you have any concerns about your babies breathing you should contact the doctor on call or the triage nurse.

 

There is no cure for RSV other than letting the baby’s immune system clear the infection with time.   Oxygen and IV fluids are sometimes needed to help the body fight the infection.  In very severe cases breathing machines are needed to support the baby as the infection clears.  Spread of RSV can be prevented by good hand washing and other infection control practices.  For a small group of infants born prematurely (less that 34 weeks gestation) or with certain heart conditions a month injection of antibody (Synagis) prevents infection during the respiratory season.

 

More information about RSV is available on the AAP and the CDC web sites.

One of our more common visits is for possible strep throat.  This is a term many people use but not everyone understands.  Streptococcus is a bacteria which has many types or strains.  The type that can make you have strep throat is from a strain called Group A Beta Hemolytic Strep.  You may have heard of Group B Strep.  This is a different strain that can infect newborns as it resides in the birth canal.

Strep Throat has a tendency to occur in school age children between about 4 and 11 years of age.  This doesn't mean it does not occur in very young and older children and adults, it is just much less common in these age groups.  It is a common throat infection which is spread by saliva and respiratory secretions.  Symptoms usually include an abrupt onset of a sore throat, fever, sometimes abdominal complaints, vomiting, headache and neck pain can occur.  It is notable that COLD SYMPTOMS (Cough, Runny Nose) DO NOT USUALLY ACCOMPANY STREP THROAT.  If you or your child has a sore throat accompanied by a cold, it is most likely due to another infection, usually a viral infection.

Strep Throat is treated easily with penicillin (we often use Amoxicillin because of the taste of liquid penicillin is pretty bad), or other medications if allergies to penicillin occur. 

The main reason to treat strep throat is ease symptoms and make you more comfortable and to avoid rare but serious complications like acute rheumatic fever.  Acute Rheumatic Fever is different from Scarlet Fever and often confused.  Acute Rheumatic Fever is a serious illness which involves possible cardiac complications.  Scarlet Fever is a variation of strep throat which involves a rash and is usually just a part of the infection, not a complication. 

Confusing aspects to the diagnosis and treatment of strep is why not just culture everyone's throat who complains of a sore throat.  The reason is that a certain percentage of the population carries strep throat innocently in their throats and may have a false positive throat culture.  Being a strep carrier is a benign thing and these people do not need to be treated with antibiotics.  If we cultured people who are asymptomatic for strep throat, these people would receive unnecessary antibiotics.

People often worry if strep is not "caught" early.  There are studies which show that the bacteria is less likely to come back if a  patient is given antibiotics several days into the illness vs right away.   Rapid Strep tests are pretty accurate but not perfect.  This is why we send a backup throat culture to the lab to make sure your child does not have strep.  It is okay if the child is treated after a couple of days, and maybe even better for the immune response.

Over 90% of our throat cultures are negative for strep throat.  To avoid unnecessary worry, remember the ages which are more common, and symptoms to watch.