As a pediatric emergency physician at Texas Children’s Hospital in Houston, Dr. Kay Leaming-Van Zandt sees sick children come in every day. For the last few weeks, a great many have had colds. Is it normal to see a spike in respiratory viral illnesses in children at this time of year? “Absolutely!” Dr. Leaming-Van Zandt told the Examiner in a telephone interview on Sept. 29.
Have there been more than she would expect? Not really. The doctor has no data but it seems to be business as usual for the time of year. The respiratory illness linked to enterovirus D68 (EV-D68) does not appear to have had an unusual impact in Houston as yet.
Dr. Leaming-Van Zandt points out that there are hundreds of viruses that cause cold or flu-like symptoms. These include rhinoviruses, the respiratory syncytial virus, influenza viruses, parainfluenza viruses or adenoviruses. The family of non-polio enteroviruses that EV-D68 belongs to has over 100 viruses and most can cause a respiratory illness in humans. Children get more colds at this time of year, she said, because they are back in school, around so many other children.
There is no cure for any of viral respiratory illnesses, the doctor stated. Doctors provide support for the patient and treat the symptoms as needed. The name of the virus that caused the illness does not matter when it comes to treating the patient.
Symptoms can very, with children often experiencing the worst and adults have mild or even no symptoms. In children, Dr. Leaming-Van Zandt expects to see fevers up to 103 degrees, with cough and runny nose. In some children, vomiting or diarrhea may also occur.
Children with asthma may have their illness triggered by a viral illness. It could be due to an infection with EV-D68, or with any of the other respiratory illness causing viruses. The illness increases inflammation in the child’s lungs along with swelling and edema, triggering the constriction of the airways that is the sign of an asthma attack, Dr. Leaming-Van Zandt said.
Parents with asthmatic children should be aware that their children may be at risk for a severe asthma attack brought on by a respiratory viral illness. The doctor suggests that parents ensure that their children receive their prescribed medications on time and in the correct dose. Parents should also have an “asthma action plan” created with the child’s physician. The Centers for Disease Control describe the plan as “a written plan that you develop with your doctor to help control your asthma.”
Dr. Leaming-Van Zandt strongly urged parents to feel “empowered to treat their children at home” when they have a respiratory illness. If the child has a fever, it can be relieved with child doses of acetaminophen or ibuprofen. If they are vomiting or have diarrhea, they should receive plenty of liquids to keep them hydrated.
These illnesses last about five to seven days. The doctor stated that the sick child will be sleepy, not acting normal and will continue to have some aches and pains. Until the child is well, the fever may return if the acetaminophen or ibuprofen is stopped.
When should a parent call the doctor? Dr. Leaming-Van Zandt listed three important symptoms that should result in a phone call. Any trouble breathing warrants a pediatrician’s consult, as does a fever lasting over five days. If the child has been vomiting or had diarrhea, has not been able to keep liquids down and is dehydrated, the parent should call the child’s pediatrician.
Dr. Leaming-Van Zandt was asked about reports about cases of acute flaccid paralysis possibly associated with EV-D68. She is not a neurologist but was able to say that children experiencing that symptom are seen in the emergency department of Texas Children’s Hospital. It is rare but not unusual.
As with children with a respiratory viral illness, Leaming-Van Zandt’s focus is on treatment and support for the patient, and not the cause. Once a contagion such as polio has been ruled out, doctors treat the child to support breathing and other bodily functions. A neurologist may suggest a course of medication where necessary.
Dr. Leaming-Van Zandt would like to remind parents that their children should receive a seasonal influenza vaccination every year. The CDC reports that infants and children under age five are at the highest risk of needing to be hospitalized for influenza or its complications. There is also a drug that can be used to protect some infants and toddlers at high risk for complications from an RSV infection.