RS virus in toddlers: when it can be dangerous

Pediatric practices and clinics report an increase in respiratory diseases in babies and toddlers, including a noticeable number of RS virus infections, unusually early in the year. We say why the virus can be life-threatening for some children and how parents protect their child.

No, the RS virus is not new. It is a relative of the flu virus, extremely contagious and causes respiratory problems, especially in children. The season starts in November every year. Normally! What is new, however, is the large accumulation ofIllnesses, and that already in late summer and autumn. The Robert Koch Institute (RKI) reports a sharp increase in hospital admissions for infections with RSV in one to four year olds.

There is a kind of catching-up effect behind this: Normally, the children’s immune system could have trained with cold viruses last winter. But because of the lockdown, there was no opportunity to do so. Many parents of small children were happy that their child was not sick all the time for one winter season. The big end is coming now: The RS virus hits untrained immune systems and can therefore spread even faster and earlier in the year than normal.

The problem with this is that infections with the RS virus are often easy, but life-threatening complications can occur in babies, toddlers and previously ill people. Therefore, here are the most important questions and answers for all parents about the RS virus in babies and toddlers.

How common are infections with the RS virus?

Very often! More than half of all children get an RS virus infection at least once during their first year of life. The medical guideline on serious illnesses with the RS virus states: “By the end of the second year of life, almost all children have been through a natural RSV infection. After that, healthy children and adults (…) are mostly able to get through the formation of protective antibodies against RSV itself to protect against serious disease courses. ” But you do not become immune even after an infection.

How at risk are newborn babies?

The Robert Koch Institute emphasizes that there is no complete nest protection. However, newborns and infants can be protected for the first four to six weeks of life. This does not apply to premature babies: They run the risk of developing a serious RSV infection in the first few weeks of life due to a reduced supply of maternal antibodies.

How is the virus transmitted?

When you cough, sneeze or speak, tiny droplets of saliva containing viruses get into the air and are inhaled by other people. For an infection, it is even sufficient that the droplets with the virus hit the mucous membrane of the eyes and from there enter the body. The viruses can also be passed on via a smear infection, for example via toys, spoons or cups.

Are only small children infected with the RS virus?

No, the infection can affect anyone. Small children are most often affected, they are also often more seriously ill and may even have to be hospitalized. In many cases, it is only then that you notice that it is not a simple cold, but an RS virus infection.

How long is the incubation period and how many days are you contagious?

The incubation period, i.e. the time between infection and the outbreak, is two to eight days. The patients are contagious for about three to five days from the day of the outbreak.

How do you recognize an RS infection?

Since an RS infection can have very different degrees of severity, it is also not that easy to recognize:

  • At the symptom-free course notices the: the infected person probably has nothing at all of the disease. This is more common in healthy adults.
  • At the slight course the infection acts like a cold, with sneezing, coughing, sore throat and feeling sick. Even then, it is often not recognized as an RSV infection at all.
  • At the severe course the infection is not limited to the upper respiratory tract, but also affects the bronchi. RSV bronchiolitis can develop, which affects babies and toddlers in particular with risk factors. It is feared because the children are seriously ill and the condition can get so bad within hours that their lives are in danger.

However: Even after mild courses, the mucous membranes of the airways can take weeks to recover. And: Often, in connection with an RS virus infection in toddlers, middle ear infections (otitis media) also occur. If the symptoms are not so obvious, it may be useful to detect the virus with a throat swab.

What is RSV bronchiolitis?

In RSV bronchiolitis, the virus affects the bronchi and lungs. Typically, the child’s condition worsens about three days after the onset of the infection, making them appear seriously ill and weak. Babies may not want to drink anymore. Typical symptoms are

  • fever
  • Difficulty breathing
  • Cough with sputum, rattling noises and “wheezing” (whistling sound) when inhaling
  • Cold pale skin
  • Sinking of the fontanel in children up to about one and a half years of age
  • Breathing stops can occur in premature babies.

How is RSV infection treated?

As is often the case with acute viral infections, there is no special drug to render the RS viruses harmless. Therefore, in consultation with the pediatrician, only the symptoms can be alleviated, with

  • antipyretic agents (leg compresses, paracetamol, ibuprofen)
  • copious drinking
  • Steam baths or inhalations to loosen mucus
  • Nasal rinses with saline solution and nasal drops to reduce swelling

If the child has difficulty breathing that cannot be relieved with such home remedies, they may need to be treated in the clinic. For example, by giving oxygen through a breathing mask or, in the worst case, with ventilation.

Antibiotics can do nothing against viral infections, but they can against complications caused by bacteria, such as otitis media or pneumonia.

Are there certain risk factors for a child to become seriously ill?

Yes. Children with the following risk factors have an increased risk of severe RSV infection in them:

  • Age less than six months
  • Premature birth
  • masculine
  • Multiple
  • chronic lung disease
  • congenital heart defects
  • weakened immune system
  • Trisomy 21 or other chromosome abnormalities
  • Siblings in toddler age
  • Malnutrition
  • Smoking household
  • Family has a tendency to have hay fever, neurodermatitis or asthma

What does the RS virus actually mean?

The abbreviation RS virus or RSV stands for the tongue twister name “Respiratory Syncytial Virus Infections”. It was so named because it affects the respiratory tract (“respiratory tract”) and causes cells there to fuse into so-called “syncytia”.

Is there a vaccination against RSV infections?

Unfortunately, no. For children who are at high risk and very seriously ill, there is a passive vaccination with ready-made antibodies against the RS virus. In the typical RSV season, from November to March, it is injected into the muscle once a month.

Can parents take precautions?

In general, babies and toddlers are better protected from respiratory infections if they are / have been breastfed and if they grow up in a smoke-free household.

The most important specific prevention against an RS virus infection is careful hygiene as with protection against a corona infection. Since RSV is also spread by smear infection, it is important to also regularly clean toys and other items that children touch and put in their mouths.

Sources: “Robert Koch Institute: RKI-Ratgeber” Respiratory Syncytial Virus Infections (RSV) “(Status: 2015)”, “S2k guidelines of the German Society for Pediatric Infectious Diseases (DGPI):” Guideline for the prophylaxis of severe respiratory diseases Syncytial Virus (RSV) in children at risk, 2017/2018 update “

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