Children’s respiratory illnesses can be difficult to pinpoint, especially when they exhibit similar characteristics and symptoms. For help differentiating between a few common conditions, we asked Greshma George, MD, PPG – Pediatrics, to discuss each one while highlighting some treatment options and preventative measures parents can take to keep their children healthy this winter.
Respiratory Syncytial Virus (RSV)
Respiratory Syncytial Virus (RSV) is a viral infection that affects the respiratory tract, upper airways, and lungs, causing acute respiratory illness.
Causes
RSV spreads primarily through the air by way of respiratory droplets when an infected person coughs or sneezes. Direct or close contact with an ill individual is also a common form of transmission.
Symptoms
RSV infections frequently occur in children and young adults, causing upper respiratory tract symptoms, which can include:
- Coughing
- Sneezing
- Fever
- Runny nose
- Discharge and redness of eyes
- Apnea (usually seen in infants)
- Bronchiolitis (seen in both infants and toddlers)
Alternately, RSV in older children and adults can cause various types of lower respiratory tract infections like pneumonia, bronchitis, asthma exacerbation and wheezing. And while RSV can affect anyone at any age, it is more common in younger children, with infants being more at risk for severe complications.
Treatment
Since RSV can cause a broad spectrum of illnesses, parents should provide supportive care, ensuring their child stays hydrated and gets adequate rest. It's also important to monitor a child's temperature, noting any fevers, and administer fever-reducing medication at weight-appropriate doses only after confirming with a physician or pediatrician. Caregivers may also try to relieve their child's discomfort by using cough medicines, but it's unnecessary as the cough usually resolves without treatment.
Additionally, since viral illness can affect a child's appetite, parents should encourage fluid intake and watch urine output. They should seek immediate medical attention if there are any concerns of dehydration, prolonged high fevers for more than two days, worry about their child's breathing or if they have an immunocompromised condition. Children who develop complications due to an RSV infection might need focused treatments based on their situation.
Duration
It can take anywhere from 2-8 days, from the time of exposure, for someone to show symptoms. Those symptoms generally last 3-8 days, with most children recovering in 1-2 weeks. However, children with weakened immune systems can continue to spread the virus for up to four weeks.
Prevention
The best precautions and methods of prevention for an RSV infection include:
- Practicing cough hygiene
- Hand washing in all settings, but especially when high-risk infants are in danger of exposure
- Restricting childcare participation for high-risk infants during RSV season (if possible)
- Avoiding exposure to tobacco and other types of smoke
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Bronchitis
Bronchitis is a general term that means inflammation of the lining of the bronchial tubes or branches of the windpipe, which carry air to and from the lungs. It is also commonly referred to as a chest cold.
Causes
Bronchitis can be acute or chronic and caused by various respiratory viruses and even chemicals, smoke, dust or allergens.
Symptoms
The symptoms of bronchitis are similar to most viral illnesses and can include:
- Cough
- Congestion
- Mucus production
- Chest soreness
- Chills
- Runny nose
- Headaches
- Body aches
- Fever
- Shortness of breath
- Sore throat
- Wheezing
- Discharge or redness of eyes
Treatment
Treatment for bronchitis involves supportive care, staying hydrated and resting. However, it's important to closely monitor and seek immediate medical attention if there are any fears of dehydration, prolonged high fevers, concerns with a child's breathing or if they have an immunocompromised condition.
Duration
With bronchitis, a child's symptoms can last up to two weeks and, in some cases, take up to eight weeks for a cough to resolve.
Prevention
Preventative measures for bronchitis are similar to other respiratory illnesses and should include:
- Hand washing
- Practicing cough hygiene
- Restricting childcare participation (if possible)
- Avoiding exposure to tobacco and different types of smoke
Croup
Croup is an upper airway infection or respiratory illness that obstructs breathing. It causes a characteristic barking cough, resulting from inflammation in the larynx (voice box), windpipe (trachea) and bronchial tubes (bronchi).
Causes
Croup is generally caused by a viral infection, most commonly a parainfluenza virus. However, it can also occur due to other viruses, such as RSV, adenovirus, influenza, rhinovirus, metapneumovirus and coronavirus (COVID-19).
Symptoms
Croup often begins like a cold and typically occurs in children six months to three years. Symptoms that accompany croup are usually worse at night and can include:
- Barking cough
- Hoarseness
- Stridor
- Nasal discharge
- Congestion
- Fever
Also, as airway obstruction progresses, stridor can develop, and there could be difficulty breathing. Respiratory distress will increase as upper airway obstruction becomes more severe. Low oxygen levels (hypoxia) and blue-tinged skin (cyanosis) can develop if airflow to the lungs is restricted. The signs of cyanosis may be evident on the fingers, toenails, ear lobes, tip of the nose, lips, tongue and inside of the cheek.
Treatment
Generally, the treatment of croup depends upon the severity of symptoms and risk of rapid worsening. Children with mild symptoms who have no risk factors for severe croup can be treated at home. Caregivers can utilize mist from a humidifier or sit with their child in a bathroom filled with steam generated by running hot water from the shower. A parent should stay with the child during the mist treatment. A favorite book or lullaby may help decrease the child's anxiety and prevent crying, which can worsen stridor. It's also important to keep the child's head elevated. Try propping the child up in bed with an extra pillow. However, parents should never use pillows with infants younger than 12 months old. Parents may even want to sleep in the same room with their child during an episode of croup, so they are immediately available if the child has difficulty breathing.
Children with moderate to severe symptoms or at risk for rapid worsening should be treated in an emergency department. If a child's symptoms worsen, parents should seek immediate medical care. They may even require additional medications to help reduce the swelling and inflammation of their airways based on the severity of the croup. Secondary bacterial infections could also develop as a complication of croup, necessitating additional treatments.
Duration
Croup is usually a self-limited illness, meaning it will go away on its own. The cough usually resolves within three days, but other symptoms may persist for up to seven, with a gradual return to normal.
Prevention
Preventative measures and precautions for croup are similar to the other respiratory illnesses previously mentioned and should include:
- Hand washing
- Practicing cough hygiene
- Restricting childcare participation (if possible)
Avoiding exposure to tobacco and different types of smoke
