Dr. Mary Katherine Maroney

Parents need to be alert to kids' respiratory infections

Winter and spring bring not only snow and changing weather but an increase in respiratory infections in children. These infections can range from the familiar colds, coughs and runny noses to more serious lower respiratory tract diseases, such as pneumonia and bronchiolitis.

Most upper respiratory tract infections, such as colds, are mild, and the child gets better in about one week. But in some cases, respiratory diseases can become serious quickly because infants and young children have much smaller airways for breathing. It is important that parents know what to look for and when to call the doctor or nurse practitioner.

The most common cause of lower respiratory tract infections in infants and children younger than 4 is a virus called respiratory syncytial virus (RSV).
This is such a common virus that it is believed most children have been exposed to or infected by RSV by the time they are 3. It is the leading cause of pneumonia and bronchiolitis in children, with the incidence greatest from birth to age 3. A person becomes infected by coming in contact with an infected person. Generally, this results in a mild respiratory infection similar to a cold with symptoms of nasal congestion, runny nose, cough and sometimes ear infection. The symptoms may last for up to two weeks; the cough may last longer.

Because RSV is so common and relatively easy to spread, family members often pass it on to one another. It is almost impossible to prevent the normal child's exposure. However, a simple, effective means of preventing the spread of infection is good hand washing.

ä When is RSV serious, and how will I know?
Typically, the infant or child will have one to three days of cold-like symptoms and then develop more frequent coughing, wheezing, more rapid or difficult breathing and generally look sicker. The child may become more restless, irritable, less playful and less interested in food.

- When should I call the doctor?

As in other cases of illness, you should call your doctor whenever you are worried about your child. In general, doctors or nurse practitioners prefer to examine sick babies directly rather than rely on phone descriptions to determine the severity of an illness. It is recommended that you call the doctor if the infant has any of these symptoms:

- Fever higher than 101 degrees, particularly in infants younger than 3 months old
- Thick nasal discharge that is yellow, green or gray
- Cough that is "wheezy" or "croupy" and lasts four days or more
- Rapid or difficult breathing
- Decreased alertness
- Bluish or gray skin or lip color
- Since RSV is a virus, how |is it treated?

In most cases, respiratory symptoms are mild and the infant or child will get better without specific treatment. These recommendations usually help make the child more comfortable:

- Keep the room air temperature between 70 and 72 degrees.
- Be sure the child drinks enough fluids to prevent dehydration.
- Use a bulb syringe to suction nasal secretions. (Place tip of the syringe at the entrance to the nostril. Do not insert the tip deep into nostril.)
- Saline (salt water) nose drops may be recommended by the doctor or nurse practitioner.
- Do not smoke in the house or around the child; smoke irritates the respiratory problem.
- If the child has a fever, the doctor may prescribe some medication to control it. If the child has an ear infection, antibiotics may be prescribed.

In cases when the RSV infection becomes serious, it may be necessary to hospitalize the infant and treat with specific antiviral therapy. There are many factors that the physician considers when making treatment decisions. The first step is for parents to be alert to serious symptoms and contact their doctor. Together they can determine the best treatment.

Dr. Mary Katharine Maroney is director and professor of nursing at Utica College. Maroney can be reached via e-mail at: mmaroney@utica.edu.