Infants under six months have a much harder time with RSV. Their lungs and airways are much smaller. Airflow is more easily blocked by the inflammation that occurs when their immune systems respond to the virus.

RSV (respiratory syncytial virus) and the flu (influenza) were already on the rise in late summer and fall of 2022, and pediatricians are seeing significant severity as far as the duration and hospitalizations needed for all ages, but especially for kids under age three and the elderly.

“The typical seasonality that we thought of for winter viruses has been flipped on its head since the COVID-19 pandemic, so it’s been difficult to know when the rising number of cases will level out and trail off, or if they’ll surge again,” said Karen Chilton, MD, Chief Medical Officer, WakeMed Children’s.

“We really weren’t seeing RSV and the flu during the pandemic because the various steps taken to prevent the spread of COVID-19, such as social distancing and wearing masks, were effective; very little was being passed around in terms of germs and viruses,” said Dr. Chilton. “Then we saw an unexpected spread of RSV in the summer of 2021 as society started to open back up.”

Following that summer surge, Dr. Chilton said there were not a lot of RSV cases in the winter months of 2021-2022.

Before 2020, it was fairly typical to have a more serious season of winter viruses every five years or so, but the timing has traditionally been from winter into spring with a rise around the holidays and a peak in January or February.

“Our bodies were presented with these viruses on a more regular basis, which over time helps us have a more robust response when we get sick.” said Dr. Chilton. “Now you could say our immune systems are a little out of practice, and to further complicate things the timing of these viruses is less predictable.”

Slow the Spread

There is a lot of uncertainty about what to expect next winter with the flu and RSV. Communities are already seeing an alarming number of hospitalizations for serious and life-threatening respiratory illnesses.

“It’s important for everyone to keep practicing the basics of germ spread prevention,” said Dr. Chilton. “Stay home when you are sick, and don’t send kids to school or daycare when they have any illness or symptoms. And, make sure everyone washes their hands frequently and thoroughly.”

RSV Symptoms

Typically, RSV presents with symptoms similar to the common cold, but it can be far more serious for people with compromised immune systems. The body’s response to RSV causes inflammation in the airways. Symptoms usually show up 4 to 6 days after infection and can take a couple weeks to resolve. When infants can’t breathe, they can’t eat well.

Dr. Chilton says that changes in feeding or the number of wet diapers are a big indicator that parents should watch for as they monitor symptoms. Dehydration is a concern with RSV and the flu. Here are symptoms to look for in all ages:

• Runny nose
• Coughing
• Sneezing
• Wheezing
• Reduced appetite
• Fatigue
• Possible mild fever

Flu Symptoms

Usually recovery from the flu takes between a few days and two weeks; however, other complications can develop. An ear or sinus infection could result from the flu, and other more serious complications, such as pneumonia can become life threatening and require hospitalization.

• Fever or chills*
• Coughing
• Sore throat
• Runny or stuffy nose
• Muscle or body aches
• Headaches
• Fatigue
• Vomiting or diarrhea (more common for children)

* Not everyone with the flu will have a fever.

Prevention Priorities

• Wash your hands; stay vigilant about good hygiene.
• Stay home when you’re sick.
• Cover your nose and mouth when you sneeze or cough.
• Wipe down hard surfaces where the virus can survive for hours.
• Be conscientious about being around vulnerable people, including infants, elderly people and those with compromised immune systems.

More Healthy Steps

Dr. Chilton recommends families focus on their overall health and well-being year-round.

• Eat nourishing food.
• Make sleep a priority every night.
• Exercise and move your body throughout the day.
• Get outside for fresh air.
• Keep kids on track with their vaccinations.
• Get your flu and booster shots.

Monitoring Conditions

With multiple viruses floating around, it can be tough to know what you’re facing when someone in your family starts to show symptoms. It’s important to monitor what’s going on, and parents should also trust their instincts to call for medical advice or seek help when they are concerned. Below are four big things to keep an eye on while caring for loved ones at home.

Breathing

Be alert to any signs of breathing difficulty, such as wheezing or visible sucking in under the ribs or above the collarbones.

Feeding

Babies and older children, alike, might need to eat smaller amounts more frequently. Offer fluids and food more frequently.

Hydration

Dehydration is a big concern for all ages, but young children and babies are typically at greater risk when they are sick. Make sure children continue to eat well and go to the bathroom. For babies, this means making sure they have a normal amount of wet diapers. Call for medical help if you believe they are dehydrated, and they will not drink fluids.

Fever

It’s important to monitor and manage a fever with the age-appropriate dosage and frequency of fever-reducing medication. Talk to your pediatrician if you have any questions or uncertainty about what your child should be given to reduce a fever. Remember, a fever is a sign that the immune system is doing its job, but if you’re unable to reduce your child’s fever, seek medical care.

Know Where to Get Care

“Widespread RSV and flu are putting a significant strain on emergency departments this winter,” explained Andy Jakubowicz, MD, medical director, WakeMed Children’s Emergency Department. “We are fortunate to have a broad network of urgent cares and emergency departments at WakeMed. I encourage families to know their options and seek care early if they or their child have concerning symptoms. Many times, symptoms can be managed by your pediatrician or an urgent care.”

---

This article is adapted from our Families First Magazine. Interested in getting future issues of Families First delivered to your home? Subscribe here.