Pediatrics provides specialized medical care for infants, children, and adolescents. Learn about routine screenings, vaccinations, and treatments.
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The therapeutic landscape for RSV is predominantly supportive. Despite decades of research, there is no “magic bullet” antiviral cure for established infection in the general population. The primary objective of care is to support respiratory function and hydration until the body’s immune system clears the virus and the airway epithelium regenerates. Treatment intensity is graded: mild cases are managed at home with comfort measures, while severe cases require hospitalization for oxygen therapy, fluid support, and potentially mechanical ventilation. At Liv Hospital, we adhere to strict antibiotic stewardship, avoiding unnecessary medications while providing rigorous supportive care.
Hydration is the first line of defense in RSV management. Respiratory distress creates a high-output state where fluid is lost through rapid breathing, while nasal congestion limits intake.
Suctioning Before Feeds: Clearing the nose immediately before feeding is a critical care step to facilitate coordination.
Oxygen is a drug and is titrated carefully. The goal is to prevent hypoxia-induced organ damage while avoiding oxygen toxicity.
For infants who develop respiratory failure (severe apnea or CO2 retention), intubation is necessary. The ventilation strategy for RSV focuses on avoiding barotrauma (pressure injury) and air trapping.
A primary focus of modern care is stopping the use of ineffective medications. Historical practices of using albuterol (bronchodilators) and systemic steroids have been shown to provide no benefit in typical RSV bronchiolitis.
Cough Medicine: Dangerous and ineffective in infants; contraindicated.
Ribavirin is a nucleoside analog antiviral. Its use is extremely limited due to its high cost, the difficulty of administration (requiring a specialized aerosol generator hood running for 12-18 hours/day), and potential teratogenicity to healthcare staff.
Chest physiotherapy (CPT) involving percussion and vibration was once standard but is now discouraged. In RSV, the airways are floppy and prone to collapse. Percussion can actually increase distress and does not improve the clearance of the specific type of mucus plugs found in bronchiolitis. However, careful positioning and mobilization of older patients are encouraged to prevent atelectasis.
Discharge Criteria and Home Care
The transition to home care is a critical phase. Discharge criteria include stable oxygenation (usually >90% on room air, including during sleep), adequate oral intake to prevent dehydration (at least 75% of normal), and capable caregivers.
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Coughing is the body’s way of clearing the mucus and dead cells from the lungs. Stopping the cough with medicine could trap this debris and lead to pneumonia.
Nebulizers work for asthma by relaxing muscles. In RSV, the problem is swelling and mucus, not tight muscles, so these treatments usually don’t help and can cause side effects like a fast heart rate.
For children over 1 year old, honey can help soothe the throat and cough. However, honey must NEVER be given to babies under 1 year due to the risk of infant bot
Suctioning uses a bulb or tube to suck mucus out of the nose. You should do it before feeding and sleeping, but not too often, as doing it too much can swell the nose and make congestion worse.
The airways take a long time to heal. It is normal for a baby to have a mild wheeze or cough for 2 to 4 weeks after RSV, as long as they are breathing comfortably and eating well.
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