Today on At the Forefront, we're going to discuss RSV, flu, COVID, and other respiratory illnesses that are really impacting children right now. Many parents are struggling with the situation and are rightfully worried. Hear from our experts how you can protect your children and what you need to do if they do get sick. That's coming up right now on At the Forefront.
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And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. We'll start off with having each one of you introduce yourselves and tell us a little bit about what you do here UChicago Medicine. Dr. Fromme, you-- we were joking you drew the short straw. You're actually at the desk.
I am.
So we're going to start with you.
So thanks for asking. I'm a-- my name is Barrett Fromme. I'm a pediatric hospitalist at the University of Chicago. Most people don't know what that means, really, which means I care for children when they've been hospitalized. I don't see kids in clinic. I am there when you are more sick and in the hospital, and that's what my team does.
Interesting, and Dr. Bartlett, you're a veteran of the program. You've been on many times, but go ahead and introduce yourselves just for the folks that may not have seen you in the past.
Sure. Thank you so much for having me back. I'm Dr. Allison Bartlett. I'm a pediatric infectious diseases specialist, and I have a couple other roles here at Comer Children's. I am in charge of our infection prevention and control program, and I'm also in charge of all the quality improvement and patient safety efforts that we have.
Great. So let's just kind of start off with the basics, and I'll open this up to both of you. But we're kind of in the midst of the perfect storm, and I've talked with some of our folks. And you two know this much better than I do, but I know children's hospitals are very, very busy right now. Ours is very busy, and we've got all kinds of things going on that deal with respiratory illnesses. I don't know who wants to start us off, but tell us what's happening and what parents, in particular, need to know.
Sure, I'm happy to start with that.
Sure.
We typically think of winter as-- or late fall and winter as respiratory virus season, and we're used to kids getting colds all the time, or at least we were in the pre-pandemic days. And what's happened this year is that we've had our RSV infections, which usually come later in the year, start early, and it's been a little bit more severe than often.
And we have other viruses as well, causing kids to have anything from colds to needing to be in the hospital or needing to be in the intensive care unit things like parainfluenza virus and adenovirus. And there's just a lot of different viruses circulating making kids sick, and some of those kids will get more sick and need to be hospitalized.
Now, Dr. Fromme, you were talking about your position here, and so you see a lot of kids that are in this situation. What are you seeing?
Yeah, so it's interesting. We are seeing a-- you said perfect storm, and I think that's a great descriptor. We are seeing, and as Dr. Bartlett alluded to, multiple viruses at the same time. And so while a lot of our kids are getting RSV, some are getting multiple viruses. What does that mean, and how does it present?
Well, to be honest, the majority of kids, or I'd say probably at least half of kids who get any of these viruses, it will stay what we call upper airway, meaning it's going to be a head cold. It's going to be runny nose, maybe some cough, maybe a fever, a lot of snot. And those kids do really well. And then about a half it can go down to the lower respiratory tract or what we would call the lungs, and that's where you get the more significant cough.
And these kids then will work to breathe a little bit more. So you'll see them breathing a little bit faster. You'll see them pulling, what we like to call pulling, which means the skin between their ribs will suck in a little bit because they're trying to blow-- pop open some plugging in their lungs. So that snot you're seeing in the nose also plugs up in the lungs a little bit, and they're trying to open that up.
Those are the kids that have a little bit more of the respiratory distress, and honestly, those are the kids we end up admitting to the hospital. And so as a parent, if you have a child who is snotty and congested and miserable, it's probably OK. If you see your child start to have increased rates of breathing, working harder to breathe, that's when you would want to consider coming into at least your primary care physician who can do a quick preliminary look or going into urgent care.
If at any point you see your child not being able to drink because they're breathing so hard or not being able to eat or turning blue, that is something you're definitely going to want to seek emergency services or even call 911. It's a spectrum right now. I see a lot of kids with the full symptoms and have to come to our emergency department and into our hospital, into our intensive care unit. But a lot of kids are doing well with just the suctioning.
I actually heard someone the other day say it's not respiratory syncytial virus. It's repetitive suctioning virus because you-- and you can suction your kids at home to get that snot out. So that's a little piece of it.
This could be pretty serious, then. Some of these kids can get really sick.
Definitely. We-- and I would like to say it's still a minority. It's still a small number of these kids who are getting truly sick and needing an intensive care unit setting. Why we use the intensive care unit setting is just for kids who need more support. So we have higher levels of oxygen, higher pressures of oxygen we can do, and that's where the intensive care unit comes in.
But those kids can't eat while that's happening, and they can be a little bit sicker. Although, I would say I don't think anyone's getting any more sick than they have in past years. It's just more kids getting it. So I'm reassured by the fact that this doesn't seem to be a more dangerous strain. It's just straining our hospital systems because there are so many kids coming.
So Dr. Bartlett, I've got to ask-- COVID. We've-- I know we're probably tired of talking about that, but it's been in our lives now for two and a half years, roughly. What are we seeing as far as children with COVID, and how does that exasperate the situation?
I was really looking forward to not talking about COVID, but we--
Sorry.
We've got to talk about Bruno and COVID. So at the moment, COVID levels are pretty low in many places. So we are seeing an occasional child that tests positive for COVID, but that really isn't fueling what we're seeing now. However, if COVID numbers continue to climb, and it looks like they're starting to, that could be yet another burden on the health care system if we see more kids getting COVID.
Again, like for all of these viruses, like Dr. Fromme just mentioned, very few children who get COVID need hospitalization because of it. But that can start to add up as there are more and more cases. So I think in the context of all of these respiratory viral infections, influenza as well is starting to climb. We need to work together to prevent the ones that we can prevent with vaccines.
So, obviously, the message, and this is the message we've been preaching for, well, longer than two and a half years, but in particular for COVID for two and a half years. But in general, vaccinate your kids. That's just so critical, and before the show started, Dr. Fromme, you said something that was really interesting.
And if the two of you can talk about this a little bit, just the potential vaccine for-- was it for RSV? Yeah, tell us what you were talking about before the show. I just thought that was so interesting.
Yeah, and I'll let Dr. Bartlett say most of it.
Sure.
But I think the preliminary is that, as we know, the COVID vaccine, Moderna and Pfizer, are mRNA vaccines. And the reason we were able to jump start those so quickly or part of the reason is that they're already doing research on this type of vaccine, this method, mRNA, with RSV. And so that had already been being explored. Dr. Bartlett, you probably can comment more on this than I can.
I can a little bit more. I'm happy to. It's really an exciting development. So we have struggled to develop vaccines for our youngest infants. You may remember that our flu vaccine and our COVID vaccines, we start giving it to children when they are six months old, which is great. But RSV causes the most serious problems in kids who are less than six months old.
So we had to figure out a way to get a vaccine to children that would work for them. It turns out the way to do that is actually to vaccinate the moms. So just like it's important to get a flu vaccine during pregnancy and a COVID vaccine during pregnancy to pass those protective antibodies onto the baby, that's how this technology can work for preventing RSV infection in babies.
So I'm really excited that there's both a much greater comfort of giving vaccines to women when they're pregnant because it is safe and effective. And then we can target this sort of specific window where RSV is really a problem for young children.
That's very interesting, and so what exactly does RSV do to the child? How does-- what does RSV-- how does it attack the child? What is it-- how does that work?
So I'm happy to start with that.
Sure.
So RSV, like many other viruses, can infect cells in the lungs. Dr. Fromme talked before about upper airway and lower airway diseases. The virus can infect both upper airway cells and can spread down to your lungs. And when these RSV viral particles infect the cells of your lungs, a couple of things happen.
One is the cells can get swollen and inflamed. Another is the cells can actually die. Mucus can come into your lungs, and your airways actually get blocked. And your immune system tries to come in and help with that and can actually be a little bit counterproductive. And so what you see is the little tiny airways are getting blocked with mucus and cell debris. And that's one of the reasons that the disease is more severe in younger kids than in older kids because their airways are smaller. So it takes less gunk to block their airways.
Dr. Fromme, anything to add to that?
No, I think it's a great explanation. I always tell families exactly that. It is that the inflammation of the airway is one thing and then this plugging. And if you've ever had RSV, and I think most adults have had some variation of it, what you'll feel is you've got a rattle in your chest. There's some phlegm, but if you take my or your chest, it's pretty big. We've got a lot. Our lungs are pretty huge.
You plug up a little, it's not a big deal. When you take those little-- I mean, we're talking chests this big. Lungs are really small, and you plug up even the smallest part of that airway, you lose capacity pretty quickly. And so when we see that distress, it's kids trying to pull to almost open up that airway. So that's the manifestation of this plugging.
And we'll actually see kids breathe really fast and then on their own at some point start breathing a lot slower because they've accomplished that. And then they'll breathe a little bit fast, and then they'll breathe a little bit slower. That's a normal variation within RSV. It's when we start seeing the breathing fast consistently that we know their lungs are getting a little overwhelmed and need our help.
Yeah, so there's a couple of, I think, pretty important messages that we probably need to share with folks out there. And one of them is what-- first of all, what do parents need to look for? What are some of the preliminary signs?
We've talked a little bit about some of the things that can happen, but what are some of the preliminary signs that you need to look for and then be concerned about as they progress? And then what do parents need to do because I know hospitals are full right now. So there are other things potentially to do to get care for your children, and I'll open that up to whoever wants to take that.
Yeah, I think this is always the question. So we start, and you might-- the first things you may see are just a cold. Runny nose, congestion, and this honestly could be RSV. It could be, we mentioned, parainfluenza, adenovirus. It can be anything. It could be a virus we don't test for.
So the congestion is fine, and if your child is just having congestion, just watch it. We know that there is about a five day, roughly, in RSV from when you first notice symptoms to like the peak of symptoms. So you're going to watch it for those first couple of days. It may just be that upper airway, that congestion.
They may have a little bit of cough, but as long as they're breathing fine with that cough, stay at home. Just take care of them. Keep them drinking. That's a big thing. We want kids to stay hydrated. So keep-- they're going to be so congested they may not take eight ounces at a time. They may take four ounces more frequently.
So break up those feeds because you put a bottle or you put something in their mouth, and their nose is congested. They can't breathe. Take breaks. Keep them drinking. If you start to notice that it's more in their lungs, that they're having more of a cough, more of a rattle, but they're breathing comfortably, you're still good. If you're concerned, you can go to a regular pediatrician's appointment.
But most of the time, you don't even need that. When you start noticing maybe they're having these periods of increased work of breathing and then settling, I would go see your primary care physician. I would go to an urgent care. That's going to save you from going into where these other viruses are and getting exposed.
However, if your child starts having rapid breathing that does not abate. It does not slow down. They're not drinking anything. That's one of my greatest indicators that kids are struggling is if they stop drinking. I have kids who are breathing a little fast, but they've got their pacifier. They're trading it out with a bottle of milk. They're giggling. They're doing OK.
But when they stop drinking, seek care. If they start changing any colors, if they get blue or dusky, then you definitely want to go to the emergency department as quickly as you can.
Dr. Bartlett.
I think the other thing that comes up a lot is fever. And fever is a distressing sign for all parents, and I know that we are concerned with our children have fever. And there's times when we need to be very proactive. So any newborn infant in the first two or three months of life, we say that a fever is 100.4 degrees. And any child in the first couple of months of life really needs to be seen by a physician when they have a temperature.
Once you're out of that very young window, it is less about the fever and the height of the fever, and it is about all of the other symptoms that Dr. Fromme was talking about. I think she was really right to focus on the drinking. So some of the older kids who are two or three and may not want to have any of the solid foods that they usually like, that's fine.
Kids aren't going to waste away in a day or two. You know that when you're sick with the flu or some illness, you don't feel particularly well and don't have a normal appetite. But, really, it's making sure that kids are hydrated and are making the same number of wet diapers that they've had are helpful clues for us.
So Dr. Bartlett, I want to also talk about preventative measures, and I know the big one that you always stress is hand hygiene. But what else? Well, talk about that, and what else can folks do?
Absolutely. So I think that it's important to know when, if your child is sick, they should seek care. But our plea to the community is let's keep kids from getting sick and relieve the burden on the health care system. And so that's where the prevention piece comes in.
So absolutely, washing hands and keeping surfaces clean, vaccines for COVID and influenza where we have them. There's a population of children who are at very high risk for RSV like we discussed. Former premature infants and children with chronic lung disease and chronic heart disease can actually get a monthly preventative injection that can help keep them safe from RSV.
One of the reasons we're in the position that we are in is the two years of COVID-related precautions, masking and distancing and school closures, kept kids from getting RSV, which was fantastic. But now we have kids who are getting their first RSV infection at the age of two or three instead of in that first year of life. So all of the same COVID-related prevention of wearing a mask and staying home when you're sick and trying to keep distance from people works for all the respiratory viruses.
So I think we're going to wrap it up here pretty soon, but I do want to ask both of you is there anything we've left out that you think is good information, important information, that parents need to know?
I think I would like parents to know that, yes, our hospital and all of the local hospitals and children's hospitals across the country are straining because of all the children that need us. But our teams are amazing and dedicated, and we are committed to providing care for all the children that we need to provide care for. But we ask your partnership in helping keeping your children safe.
Dr. Fromme, any final words from you?
Yeah, I would just say, to Dr. Bartlett's point, is we do this well. And by we, I mean all hospitals. RSV and respiratory viruses like this, I don't want to simplify them, but we know how to manage them. This isn't a confusing-- this isn't COVID at the beginning where we didn't know what to do. We know exactly how to treat and manage these kids, and we have the resources to do it.
The key for us is making sure if you're not too sick, stay home. Take care of yourself at home, and when you need us, come in. And I do want people to know, again, we're not seeing a more severe course of RSV than we have in the past. It's oxygen. It's hydration, IV fluids. That's what we do for you here, and we are wholly capable of doing that.
So I don't want anyone to be nervous that we are out of a medication, that we don't have the resources, we don't know what to do. This is in some ways unprecedented, but also it's the same RSV, same adenovirus, same parainfluenza. And we will be your partners through this.
Fantastic. Well, thank you both. You were fantastic. That was great information for our viewers, and we want to thank our viewers for being with us today. If you want to keep a check out for our Facebook page for our schedule of programs, we'll tell you what shows are coming up in the future. Make an appointment. You can go online at uchicagomedicine.org or give us a call at 888-824-0200. Thanks again for being with us today, and I hope everyone has a great week.
