RSV Overview

Respiratory Syncytial Virus (RSV), is one of the most common viruses that cause respiratory tract infections, especially in children under the age of 4 years. In infants and young children, RSV is the most important cause of bronchiolitis and pneumonia. Most children will have been exposed to the virus by the time they are 3 years old, but will only have mild symptoms. Sometimes, you cannot tell these symptoms from the common cold.

RSV is a seasonal virus. It usually only occurs in the winter and spring months. The time between when a child is infected and when symptoms first appear (incubation period) ranges from 2 to 8 days.

RSV causes a stuffy nose, runny nose, and cough. Wheezing may also be present. Wheezing is usually a high-pitched sound that can be heard when the infant breathes out. There can be a low-grade fever linked with RSV, as well as ear infections. The low-grade fever may last for several days, and the cough will at times persist for 2 weeks.

There are some children who do develop a lower respiratory infection as a result of the RSV virus. Each year, there are about 80,000 children with RSV who need to be hospitalized. Most of these children were born prematurely or have an underlying cardiac or respiratory problem.

Any child who develops the following signs and symptoms should be checked by his or her physician:

• Signs of stressful breathing
• More frequent cough
• Decrease in activity level
• Decreased appetite

The physician or nurse will need to do a nasal (nose) swab for a culture. The swab is sent to the lab and the final results will be available within 24 hours. Usually, your physician will keep your child on the same treatment, even after the test results come back.

Most RSV infections run their course (self-limiting) and need no specific treatment. If your child has a fever, you can give him or her acetaminophen or ibuprofen as directed by your physician. There are some children who will develop an ear infection with RSV and may need to be treated with antibiotics. Using normal saline nasal drops and suctioning nasal passages with a bulb syringe may be all that is needed. If your infant or child is wheezing, your physician may order albuterol, a medication that opens the airways in the lungs. Albuterol is best given as an inhaled form. There are a small number of children who are admitted to the hospital for additional treatment.

Humans are the only source of the infection. The virus spreads when a person comes into direct contact with an infected person's body fluids (such as mucus from the nose). The virus can live on environmental surfaces for hours and on hands for more than one and a half hours.Good hand washing is very important in preventing the virus from spreading. During the RSV season, infants, young children, and children with cardiac or respiratory illnesses should be kept from having close contact with people who are sick. Your child should not be around tobacco smoke; the smoke will further irritate his or her lungs.

Dealing with RLS

Restless legs syndrome (RLS) is a movement disorder in which the child or adolescent reports an uncomfortable and irresistible urge to move his or her legs. This urge usually happens at bedtime but can occur at other times when the legs have been inactive, such as when sitting still for a long period of time (eg, during long car rides or while watching a movie).

Treatment options for RLS can include any of the following:

• Adopt appropriate bedtime habits. The child or adolescent is only to get into bed and lay in bed when it is time to go to bed. Do not get into bed and spend time reading, watching television, or playing any games.
• Say "No" to caffeine. Caffeine can make RLS worse, so avoid caffeinated products (eg, coffees, teas, colas, chocolates, and some medications).
• Using local comfort aids for legs. Apply a heating pad, cold compress, or consider rubbing your legs to provide temporary relief to the discomfort in your legs. Also consider massage, acupressure, walking, stretching, or other relaxation techniques.
• Supplement micronutrients. Have your physician check your child’s iron stores and if necessary, folic acid levels. Low levels of these substances can contribute to restless legs syndrome symptoms.
• Consider medication options. Your child’s doctor may discuss several different types of drugs as options. The simplest is iron or folate supplementation as mentioned above. Other categories of drugs include dopaminergic agents (eg, carbidopa-levodopa), dopamine agonists (eg, ropinirole, pramipexole), benzodiazepines (eg, clonazepam), anticonvulsants (eg, gabapentin), and others including clonidine.
• Reduce avoidable medications. Talk with your doctor about other medications (both prescription and over-the-counter) and herbal products your child may be taking. They may be making RLS worse.

Some of the types of products to discuss with your doctor include drugs to treat nausea, colds, allergies, and depression. Conduct a dietary review. Make sure your child is eating a healthy and well-balanced diet. You may wish to review this with the physician.

Overview RLS

Restless legs syndrome (RLS) is a movement disorder in which the child or adolescent reports an uncomfortable and irresistible urge to move his or her legs. This urge usually happens at bedtime but can occur at other times when the legs have been inactive, such as when sitting still for a long period of time.

To relieve the discomfort, the child or adolescent moves his or her legs, stretches his or her legs, tosses and turns, or gets up and walks or runs around. The relief experienced is usually immediate.

The exact cause of this disorder is not known. RLS can be related to a low iron level or sometimes associated with diabetes, kidney or some neurological diseases. RLS sometimes runs in families and there is thought to be a genetic link in these cases. Many types of drugs used in the treatment of other disorders may cause RLS as a side effect.

Symptoms of restless legs syndrome include:

• Leg discomfort— uncomfortable leg sensations described as creeping, itching, pulling, crawling, cramping, tugging, tingling, burning, gnawing, or pain. Feeling of "Coca Cola in the veins" has been described. These sensations usually occur at bedtime but can occur at other times of leg inactivity.
• Urge to move legs — to relieve leg discomfort, children and adolescents have an uncontrollable urge to move their legs.
• Sleep disruption — additional time is often needed to fall asleep because of the urge to move the legs to relieve the discomfort. Sometimes staying asleep may also be difficult.
• Bedtime behavior problems — because children have a hard time falling asleep, they may not always stay in bed and sometimes need to get out of bed to stretch their legs to relieve discomfort.
• Daytime sleepiness — problems with falling asleep and staying asleep may result in problems with daytime sleepiness.
• Behavior and school performance problems — again, due to sleep disruption, problems may emerge in the child’s academic performance or in daytime behavior (irritability, mood swings, difficulty concentrating, hyperactivity, etc)

Unfortunately, there is no specific test for restless legs syndrome. Diagnosis is made based on symptoms. A medical history and complete physical exam is conducted to rule out any other potential health problems. An overnight sleep study may be recommended to evaluate for other sleep disorders, particularly periodic limb movement disorder.

The individual must have nearly an intense urge to move his or her legs. The urge is often accompanied by uncomfortable sensations described above. The symptoms start or become worse at rest.

Symptoms are provisionally relieved when legs are moved. Relief can be complete or partial but only persists as long as legs continue to be moved. The restless legs symptoms are worse in the evening and especially when lying down. Adapted criteria are in place for children younger than 12 year where the diagnosis may be more uncertain.