A common respiratory virus, respiratory syncytial virus, is on the rise in the United States, flooding some children’s hospitals. The flu virus is also on the rise, along with other viruses that cause the common cold, such as adenovirus and rhinovirus.
At the same time, children have returned to school and families are returning to many in-person activities, often without the mitigation measures applied during the Covid-19 era, increasing the potential for the virus to spread.
What types of respiratory infections can be treated at home, and with what treatment? Which symptoms should call the doctor or parents and carers to take their children to the hospital? When should children stay out of school? And what measures can families take to reduce the spread of respiratory viruses?
To help with these questions and more, I spoke with CNN medical analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and the mother of two small children.
CNN: Why are respiratory infections on the rise?
Dr. AS Leana Wen: They have always been common among children. Before Covid-19, it was common, especially in autumn and winter, for school children to have runny noses and coughs.
Now, the mitigation measures taken during the pandemic – such as social distancing, masks and avoiding large gatherings – may increase in part because the respiratory virus has become less widespread over the past two winters. As a result, many children do not have the immunity they normally would.
My kids have had at least three respiratory illnesses each since they started kindergarten and preschool less than two months ago. Fortunately, they recovered well and did not become seriously ill, but I certainly understand the worry and grief that parents and carers feel when our children are ill.
CNN: Which respiratory infections can be treated at home?
Wen: Most respiratory infections in children can be managed at home with fluids, fever-reducing medications, and rest. What causes the infection is generally not the key factor in deciding whether a child needs hospital care; but how the child is doing.
Respiratory syncytial virus, also known as RSV, is a public health concern because some hospitals are filling up with children who have it. Before the Covid-19 pandemic, the US Centers for Disease Control and Prevention estimated that almost all children will get RSV before their second birthday, and about 58,000 children will be hospitalized each year. Clearly, RSV is a very serious infection in some children, and parents should know what to look for to recognize serious illness. But also keep in mind that the vast majority will have mild, cold-like symptoms and will not need to be hospitalized.
The same goes for other viruses. Influenza can cause very serious diseases, like Covid-19. However, most cases in children do not require hospitalization, and symptoms can be managed at home. On the other hand, there are viruses usually associated with a mild cold, such as adenoviruses, which can make some children very ill.
If you go to the emergency room, your child will likely be tested for Covid-19, influenza, and RSV. Some pediatricians would do that too. If your child is hospitalized, additional virus tests may be done. But many doctor’s offices would not provide that care because, again, the actual virus causing the illness is less important in determining whether or not your child needs to be hospitalized than how your child is doing.
The exception is very young infants, generally less than 2 months of age, who are usually tested and monitored further.
CNN: What other risk factors should lead parents to serious illness care?
Wen: Newborns are very vulnerable. They have little immunity and don’t have much physiological reserve, which means that once they get sick, they can get sick very quickly. Premature babies are also at risk. Many of them have underdeveloped lungs. A child born two months premature has a physiological age two months younger than one born on the same day.
Other factors must also be considered, including for young children with significant heart and lung disease or who are immunocompromised. In all these situations, families should have a low threshold for calling the doctor.
CNN: If a child is generally healthy and has a fever, cough or runny nose, should parents and caregivers call the doctor? When should they go to the hospital?
Wen: There are two main symptoms that should cause concern in respiratory infections. The first is breathing difficulties. Look for hard and fast breathing. For example, if your children are whistling or grunting; if they clear the nostrils; if they breathe belly, that is, the chest caves in when breathing and the belly protrudes; or if their breathing rate is higher than normal.
The second is the difficulty of staying hydrated. This is especially a problem in children. A stuffy nose can make it difficult to drink breast milk and formula, and they can become dehydrated very quickly. If your child is sleepy and not drinking, or if your child is decreasing the number of wet diapers, call your doctor sooner rather than later.
Ongoing problems (such as a mild fever that has lasted a few days) can probably wait until your pediatrician’s office hours.
I would recommend having a plan before your child gets sick. Many pediatricians have an on-call service where you can contact your doctor or other healthcare provider within an hour, even at night and on weekends. Find out if that option exists and have that number easy to call. If your pediatrician is not available after hours, you should know which hospital you would take your child to if he or she became seriously ill. Ideally, there should be a hospital near you that is staffed with pediatric emergency medicine specialists.
If you can’t easily reach your doctor by phone in an emergency, have a low threshold for taking your child to the hospital, especially if you have a newborn or small baby. Difficulty breathing and the inability to stay hydrated are good reasons to go to the hospital immediately.
CNN: When should kids stay out of school?
Wen: That depends on the policies of your child’s school. Many schools require that children stay home when they have a fever. They shouldn’t attend either, if they throw it away. Some schools may also require Covid-19 testing to ensure that it is not the coronavirus that is causing the symptoms.
That said, it’s probably not wise to ask kids to stay home if they have a hint of the sniffles. This means that children miss many weeks of school during the winter months. Parents and caregivers should always assume that there are children in their child’s class who are infected with some respiratory pathogens and take precautions. Some families may choose to wear a mask. Others may go back to what they did before Covid, which is to practice good hand hygiene and avoid being around vulnerable people when they are sick.
CNN: What kinds of precautions should parents and caregivers take?
Wen: Hand washing is big. Many of these respiratory pathogens travel through droplets: when someone sneezes or coughs, those droplets land on surfaces that someone else touches and then touch their nose or mouth. Encourage your child to wash their hands frequently, and if they have to cough or sneeze, cover it with their elbow or a tissue to reduce the spread of droplets.
If someone in your household has a respiratory infection, it can easily spread to other members of the household. You can reduce this risk by not sharing utensils or drinks with the sick person and by keeping the sick person away from vulnerable household members, such as newborns and the elderly. In general, families should also limit the exposure of newborns and premature infants as much as possible.
There is no approved vaccine for RSV, but there is for the flu. Parents should give their children the flu vaccine. They should have their children vaccinated against Covid-19 if they haven’t already, and they should assess their family circumstances to determine if they should give the new bivalent booster to their children aged 5 and over.