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If your child has been diagnosed with RSV (respiratory synctial virus), clinical indications to take the child to the ER are: 1. was a former premie 2. is displaying a respiratory rate of > 50 breaths a minute 3. is manifesting great effort in breathing by having the chest/neck muscles cave in with each inspiration 4. is grunting or, 5. the baby looks sicker than you are comfortable with.

For our 3 month old born full term diagnosed with RSV, there were a few additional indicators he was in respiratory distress that we wish our dr had told us to look for. Firstly, he got lethargic and a bit limp - a sure sign that he was not getting enough oxygen. We mistook this for him just being tired because he did shortly thereafter fall asleep. But in hindsight we now know his O2Sat rate was probably dangerously low. Though we didn't know it, puting our baby to bed put him at further at risk because O2 naturally drops even further when you sleep anyway.

In addition to having more than 50 breaths a minute (which you can assess by putting your hand on his belly to count - hard to do if, as in our case, baby is coughing a lot) our baby's entire belly was caving in with each breath. Watch baby's belly button and see if it goes up and down sharply with each breath to know if he is having to work too hard to get air. You may also see his ribs with each inhalation.

If you have any doubt, don't be scared to go to the ER, preferably a children's hospital if you have one nearby, as an adult hospital is not as equiped to handle infants. They should check his O2 and pulse rate, and put him on O2 if it's low. If they don't admit him but his o2 is dropping and staying in the 80's. either go somewhere else or get them to write an RX for O2 at home.

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Q: Your baby has RSV when should you Take them to the hospital?
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Respiratory syncytial virus (RSV)?

DefinitionRespiratory syncytial virus (RSV) is a very common virus that leads to mild, cold-like symptoms in adults and older healthy children. It can be more serious in young babies, especially to those in certain high-risk groups.Alternative NamesRSV; Palivizumab; Respiratory Syncytial Virus Immune GlobulinCauses, incidence, and risk factorsRSV is the most common germ that causes lung and airway infections in infants and young children. Most infants have had this infection by age 2. Outbreaks of RSV infections most often begin in the fall and run into the spring.RSV is spread easily by physical contact. Touching, kissing, and shaking hands with an infected person can spread RSV. The disease spreads from person to person through contact with contaminated tiny droplets or objects that the droplets have touched.RSV can live for a half an hour or more on hands. The virus can also live for up to 5 hours on countertops and for several hours on used tissues. RSV often spreads very rapidly in crowded households and day care centers.The infection can occur in people of all ages.Risks include:Attending day careBeing exposed to tobacco smokeHaving school-aged siblingsLiving in crowded conditionsSymptomsBluish skin color due to a lack of oxygen (cyanosis)Breathing difficulty or labored breathingCoughCroupy cough (often described as a "seal bark" cough)FeverNasal flaringRapid breathing(tachypnea)Shortness of breathStuffy noseWheezingNote: Symptoms vary and differ with age. Infants under age 1 are most severely affected and often have the most trouble breathing. Older children usually have only mild, cold-like symptoms. Symptoms usually appear 4 - 6 days after coming in contact with the virus.Signs and testsRapid tests for this virus can be done on a fluid sample taken from the nose at many hospitals and clinics.TreatmentAntibiotics do not treat RSV. Mild infections go away without treatment. Infants and children with a severe RSV infection may be admitted to the hospital so they can receive oxygen, humidified air, and fluids by IV.A breathing machine (ventilator) may be needed.Expectations (prognosis)RSV infection can, in rare cases, cause death in infants. However, this is unlikely if the child is seen by a health care provider early in the course of the illness.More severe RSV disease may be seen in:Premature infantsInfants with chronic lung diseaseInfants whose immune system does not work wellInfants with certain forms of heart diseaseIn older children and adults, the disease will usually be mild.Some evidence suggests that children who have had RSV bronchiolitis are at increased risk for asthma.ComplicationsIn young children, RSV can cause:BronchiolitisCroupEar infectionsLung failurePneumoniaCalling your health care providerCall your health care provider if breathing difficulties or other symptoms of this disorder appear. Any breathing difficulties in an infant are an emergency. Seek medical attention right away.PreventionA simple way to help prevent RSV infection is to wash your hands often, especially before touching your baby. It is important to make certain that other people, especially caregivers, take precautions to avoid giving RSV to your baby. The following simple steps can help protect your baby:Insist that others wash their hands with warm water and soap before touching your baby.Have others avoid contact with the baby if they have a cold or fever. If necessary, have them wear a mask.Be aware that kissing the baby can spread RSV infection.Try to keep young children away from your baby. RSV is very common among young children and easily spreads from child to child.Do not smoke inside your house, car, or anywhere near your baby. Exposure to tobacco smoke increases the risk of RSV illness.Parents of high-risk young infants should avoid crowds during outbreaks of RSV. Moderate-to-large outbreaks are often reported in the local news and newspapers to provide parents with an opportunity to avoid exposure.The drug Synagis (palivizumab) is approved for the prevention of RSV disease in children younger than 24 months who are at high risk for serious RSV disease. Ask your doctor if your child is at high risk for RSV and whether this medicine should be given.ReferencesCommittee on Infectious Diseases. Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. Pediatrics. 2009;124:1694-1701.Simoes E, Groothuis JR, Carbonell-Estrany X, Rieger C, Mitchell I, Fredrick LM, Kimpen J, et al. Palivizumab prophylaxis, respiratory syncytial virus, and subsequent recurrent wheezing. J Pediatr. 2007;151:34-42.Cincinnati Children's Hospital Medical Center. Evidence based clinical practice guideline for medical management of bronchiolitis in infants less than 1 year of age presenting with a first time episode. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2006 May. 13 p.Mcintosh K. Respiratory syncytial virus. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 257.


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