From the Guidelines
For a child with nasal congestion, rhinorrhea, sneezing, and cough who tests positive for Respiratory Syncytial Virus (RSV), the appropriate management is supportive care and reassurance to the parents. RSV is a viral infection that typically causes self-limiting symptoms and resolves without specific treatment in most otherwise healthy children 1. The American Academy of Pediatrics advises against using over-the-counter cough and cold medications, including antihistamines, in young children 1. Instead, supportive measures such as:
- Nasal saline
- Gentle suctioning
- Adequate hydration
- Fever control should be recommended alongside reassurance about the typically self-limiting nature of the illness. Antibiotics are not indicated because RSV is a viral infection, not bacterial, and antibiotics would be ineffective and potentially harmful due to side effects and antimicrobial resistance 1. Palivizumab prophylaxis may be considered for high-risk infants, such as those born at 32 weeks of gestation or earlier, or those with certain underlying medical conditions, but this is not typically recommended for otherwise healthy children 1. It is essential to note that the management of RSV infection should focus on alleviating symptoms and supporting the child's overall health, rather than attempting to treat the virus itself. By prioritizing supportive care and reassurance, healthcare providers can help ensure the best possible outcomes for children with RSV infection, while also minimizing the risk of unnecessary treatments and potential harm.
From the Research
Diagnosis and Presentation
- The child's symptoms of nasal congestion, rhinorrhea, sneezing, and cough are consistent with a Respiratory Syncytial Virus (RSV) infection 2, 3, 4.
- Diagnosis of RSV infection is typically clinical, based on patient history and physical examination, and routine use of radiography or viral testing is not recommended 2, 3, 4.
Treatment and Management
- Treatment of RSV infection is mainly supportive, with a focus on maintaining hydration and oxygenation 2, 3, 5, 4.
- Oxygen saturation should be maintained above 90% 2, 4.
- Hydration and nutrition should be maintained by nasogastric or intravenous routes, if needed 2, 4.
- Therapies such as bronchodilators, epinephrine, nebulized hypertonic saline, corticosteroids, antibiotics, and chest physiotherapy are not recommended for routine use in RSV bronchiolitis 2, 3, 5, 4.
Prevention and Prophylaxis
- Palivizumab prophylaxis may be considered for infants at high risk of severe RSV infection, including those born before 29 weeks' gestation, infants with chronic lung disease of prematurity, and infants and children with hemodynamically significant heart disease 2, 3, 4.
- Prevention strategies include washing hands, cleaning environment surfaces, and isolating infants and children with RSV in the emergency care area 5, 4.