WA pediatrician shares tips to battle child respiratory infections and stay out of ER

The key to keeping your child out of the hospital with Respiratory Syncytial Virus Infection or other respiratory ailments could come down to some basic tips.

In a surprise twist, they don’t include reaching for the Robitussin or other over-the-counter medications.

In a presentation Friday, Dr. Michael Alston, a local Kaiser Permanente pediatrician, reviewed what does and doesn’t work best for children struggling with respiratory infections such as RSV or flu.

The presentation was for parents of children attending St. Mark’s Preschool in Tacoma, where Alston’s son also attends.

He put together a summary of tips for parents in hopes of easing local health care pressures.

“There’s just a really high demand at this time,” he said. “We’re going to get through this, but we’re all going to need to work together.”

Earlier in the week, hospital officials across the state noted that pediatric emergency care was experiencing a surge in RSV and flu patients, similar to previous waves of COVID-19 among adult patients in the pandemic.

The rapid viral spread to others is being felt beyond hospitals.

In response to questions, a representative for Tacoma Public Schools said Friday that “data does show a 3 percent decrease in attendance since September.”

“We know from our local health authority that flu season has started and that there has been an increase in RSV and respiratory illnesses,”’ said Tanisha Jumper, chief communications officer for TPS. “In response to this, we encourage families to keep students’ home if they are sick.”

Given the current strain on hospitals and other health care facilities, Alston hoped his information would help parents head off ER visits with children.

“It’s important to note that for infants and toddlers, it is very common to have multiple back-to-back infections from August to April,” he said. “Each is going to last two to three weeks.”

In the course of a typical respiratory illness, he said, “symptoms are going to last 14 to 21 days. ... They usually worsen over those first four to five days. And then around day five, the illness usually peaks and gradually improves.”

He added, “90 percent of kids with these illnesses are going to do totally fine at home.”

Still, looking at current trend lines he shared from the University of Washington virology lab, “we really haven’t seen a peak for RSV yet. You can also see influenza A ... is taking off as well.”

He noted, “Our urgent cares for Kaiser Permanente have seen that childhood illness has surged six times normal levels,” along with ER wait times of more than five hours at times at Mary Bridge Children’s Hospital in Tacoma.

Home care tips

Alston offered some home care tips for families, starting with the importance of nasal suctioning.

“The steps for caring for a child at home with one of these illnesses: It’s suctioning, it’s more suction, it’s even more suctioning, it’s more suctioning still, and then pushing fluids, treating pain and fever, allowing for rest and monitoring,” he said.

“If you do suctioning well at home, you’re going to keep your child out of the scary loud overstimulating emergency room where they’re going to be restrained and suctioned by strangers in masks.”

Suctions can range from simple bulb versions to “Baby Vac” models sold online that attach to your home vacuum cleaner. These models “are better able to replicate the sort of suction that we have in urgent care of the emergency room, so it is powerful.”

The kind you choose depends on what’s easiest for you to use.

“I would rather have a child getting suctioned eight or 10 times a day with a bulb suction rather than not getting suctioned at all,” Alston said.

He said families should plan on suctioning multiple times a day.

“I recommend before meals or before breastfeeding or bottle feeding for an infant,” he said. “And then before and after naps, because that’s when kids tend to get most congested.”

That aspect of treatment is also what can land children in the hospital.

“This is really kind of one of the things that determines if kids get admitted — if they need so much suctioning that the family just can’t keep up at home,” Alston said.

Pushing fluids, Pedialyte and low-sugar versions of Gatorade or Powerade are all options, as are Popsicles for those who don’t want to drink.

“Popsicles are amazing. And there’s a lot of really stubborn toddlers who will refuse to drink. But if you hand them a Popsicle, they’re like, totally happy to eat it,” he said.

His presentation included recommendations for Tylenol and Ibuprofen, which can be used in combination for pain and fever.

“They do not interact,” he said.

One caveat: “Any infant less than 2 months of age with a fever ... really should be connected to the health care team,” he added.

The good news is in most cases, particularly in dealing with viruses, antibiotics are not needed.

In cases where you are “worried about pneumonia, or an ear infection, we may think about antibiotics, but in the vast majority of these cases, they’re not helpful,” he said.

Alston cautioned against turning to over-the-counter cold medicines that show no real proof of working or homeopathic remedies that are largely unregulated.

Honey is a different matter.

“For kids that are over a year of age, honey used a couple times a day — there’s great evidence that honey can help relieve sore throat and cough,” he said.

Parents should avoid exposing babies to honey, as it can lead to infant botulism, according to general medical literature.

Despite all the best intentions and suctioning and rehydrating, RSV and other illnesses can still at times become a serious medical issue. Seeking outside care includes instances where serious dehydration is setting in, such as instances of nonstop vomiting, or serious breathing issues coupled with disorientation.

If your intuition is telling you something serious is happening, he added, don’t hesitate to seek medical attention, starting with your primary care provider or after-hours nurses hotline if available.

Ventilation, masks, socializing outdoors

Alston reminded parents of lessons learned during COVID. Frequent hand washing and good ventilation are still important.

“So when you’re having your your Thanksgiving celebration or your Christmas celebration, open the windows, have air filters, let some fresh air in,” he said. “If you’re getting together with friends on weekends, think about a park rather than going to an indoor place. Is there a way for us to spend more time in the fresh air?”

While no longer state mandated, he reminded his audience that masks still can work to diminish viral airborne spread, from flu to COVID.

“I’d really try and think about this as part of your approach this fall and winter,” he said.

More on RSV and infants/young children: cdc.gov/rsv/high-risk/infants-young-children.html.