A sniff, a sneeze or a cough can set off alarm bells in families with young children these days.
Mother-of-two Vickie Leon said her kids, ages 4 and 2, can sometimes go a month or two without bringing anything back from daycare. Then there are times when it seems like the family in Aurora, Colorado, sniffs out a virus every other week.
“Once that hits, we’re just in it for a while,” she said.
Many children have spent years social distancing to protect themselves from Covid-19, and now healthcare systems are overloaded with cases of the respiratory virus RSV – which can cause a runny nose, loss of appetite, coughing, sneezing, fever and wheezing.
The viral infection has always been common. Nearly all children get RSV at some point before they turn 2, the U.S. Centers for Disease Control and Prevention says. And the immunity that develops after an infection often declines over time, causing people to get multiple infections in their lifetime, said Dr. William Schaffner, a professor in the Department of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, Tennessee.
The public health challenge this year is that while many children were kept at home to protect themselves from Covid-19, they were also isolated of RSV, meaning more people now have their first — and therefore most serious — infection, said CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health.
An RSV infection is often mild but can be a cause for concern for young infants, children with underlying conditions and older adults, said Schaffner, who is also medical director of the National Foundation for Infectious Diseases.
That doesn’t mean it’s time to panic, added Wen, who is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.” Contracting RSV and other viral and bacterial infections is part of children growing up and developing their immune systems.
Here’s how to judge, according to experts, when to keep your child home from school and when to visit the pediatrician.
Between the common cold, the flu, strep throat, RSV and persistent Covid-19, there are a lot of infections this winter — and they can often be very similar in symptoms, Schaffner said. Even astute doctors can have trouble telling them apart when a patient is in the office, he added.
However, pediatricians are well-trained and equipped to treat upper respiratory infections, even when it’s not possible to distinguish exactly which virus or bacteria is causing it, Wen said.
Whatever virus or bacteria is causing a headache or sore throat in your household, your child’s age, symptoms and health status will likely make a difference in how you move on, she said.
Ideally, public health professionals would like it if no child with symptoms was sent to school or daycare, where they could potentially spread infection, Schaffner said. But – especially for single parents or carers who have to be at work — that’s not always the most practical advice, he added.
Home tests can indicate whether a child has a Covid-19 infection, he added. But for other viruses, like the common cold, there may be no good way to know for sure.
Some symptoms that could really indicate it’s time to keep your child home from school or daycare include a high fever, vomiting, diarrhea, difficulty eating, poor sleep or difficulty breathing, Wen said.
Donna Mazyck, a registered nurse and executive director of the National Association of School Nurses, breaks it down into two primary considerations: Does the child have a fever and is it too sick to fully learn?
Families should also check their school’s guidelines, some of which may be detailed about when a child should be kept home from school, while others will rely more on parental judgment, she said.
“When in doubt, consult the school policy and make a plan with a pediatrician,” Wen said.
And for kids at higher risk due to other medical conditions, see your pediatrician before your child gets sick so you know what to watch for.
Again, here schools may have different policies and it becomes important to check written information, a school administrator or school nurse, Wen said.
“In general, the schools will ask that the child be fever-free without the use of fever-reducing drugs” before returning to the class, she said.
For children with asthma or allergies, it may not be reasonable to keep them out of school when they show symptoms of coughing or sniffling, Wen said. That could very well keep them out for half a year.
And some symptoms, such as a persistent cough, may linger as an infection clears and a child recovers. In those cases, it may be appropriate to send a child back to school, Mazyck said, reiterating the importance of checking the school’s guidelines.
Families are often good at taking their kids to the pediatrician if they seem unwell, Schaffner said. Still, with so many things happening, it’s important to remind families that doctors prefer to see children who aren’t feeling well sooner rather than later, he added.
If they seem lethargic, stop eating or have trouble breathing, parents and caregivers would also be justified in taking their children to the pediatrician and seeking medical attention, especially if symptoms worsen, Schaffner said.
“This is not something they should hesitate about,” he said.
For younger babies and infants, it may be time to go to the emergency room if they are having trouble taking in fluids or if they have dry diapers, flared nostrils, trouble breathing, and a chest that contracts when it should be expanding, added Wen.
Families should seek emergency treatment for school-age children who have trouble breathing and speaking in full sentences, Wen said. Fortunately, most don’t need emergency treatment — and those that do are usually back home within a few days and doing well, Schaffner said.
“Parents need to know that treating RSV and other respiratory infections is the bread and butter of pediatricians and emergency room physicians,” Wen said. “This is what we do.”
To prevent these respiratory diseases, teach your children to adopt the hygiene practices that health professionals promoted long before the pandemic, such as washing hands, using hand sanitizer when a sink is not available, coughing and sneezing into an elbow or tissue, and not sharing food or utensils with friends, Wen said.
No vaccine for RSV has yet been approved by the U.S. Food and Drug Administration, but effective vaccines are available for the flu and Covid-19, Schaffner said.
If your child hasn’t already been vaccinated, talk to their doctor about protection against these viruses, he added.