How to keep your child at a safe distance from winter viruses
A cute baby boy with a doctor's hand holding a stethoscope to his chest
Broadcaster Síle Seoige is urging parents of young babies not to be “people-pleasers” — and to be upfront about asking visitors not to kiss their infants.
The Connemara native’s advice comes just as RSV (respiratory syncytial virus) season kicks off.
A common virus that can cause lower respiratory tract infection (LRTI), it is highly contagious, with approximately 90% of children infected by two years of age — RSV is the lead cause of LRTI in babies.
“Obviously, people coming to your house will want to pick up, kiss and cuddle your baby, but you need to be able to say: ‘There are so many things going around, we don’t know what people are picking up, do you mind not kissing him?’. People are hopefully used to that now from covid,” says Seoige.
Until Seoige became mum to Cathal, six, and Cliodhna, two next month, RSV wasn’t on her radar.
But she and partner Damien O’Farrell got a scare when Cliodhna caught RSV as a four-month-old.
“It began like any cold — runny nose, slightly raised temperature — you could cut and paste with lots of different infections.
Covid was still rife at the time, so we did a test but it wasn’t that.
“Then her breathing became a bit strained, she was completely bunged up, a lot of phlegm – babies don’t know how to blow their nose or clear their airways.
She wasn’t taking as much food, she wasn’t herself.
“Parental instinct is very powerful. We weren’t willing to sleep through the night in case this was anything risky. We decided our best bet was to bring her to Crumlin.”
Admitting it was scary, Síle says: “You’re sitting around. Staff are stretched, it’s not their fault, but you’re looking at your watch and your baby’s so tiny – your heart’s in your mouth — and at this stage, you haven’t been given that sense of comfort that she’s going to be OK.”
Describing staff as “really brilliant”, Síle says Cliodhna’s breathing was monitored and medics were happy to let her go home after a few hours.
“I’ve a friend whose baby was a similar age to Cliodhna, who got a similar infection. They got an awful fright — she had to have phlegm suctioned off her lungs and was kept in hospital.
“We didn’t have that. We were advised to keep Cliodhna’s airways clear. Using a nasal spray and a baby inhaler definitely helped. Within a few days she’d turned a corner,” says Seoige, adding that Cathal also got RSV but was “far more able to manage it”.
A major cause of severe respiratory illness among the under twos, RSV is also the most common cause of hospital admissions in young children.
LRTIs like pneumonia or pneumonitis are most likely to occur during a child's first infection with RSV and may develop in 30-70% of first infections. And babies are at risk of more severe RSV illnesses such as croup, bronchiolitis and pneumonia.
Findings from a recent survey, commissioned by biopharmaceutical company Sanofi of more than 500 parents in Ireland, show almost two-thirds (63%) are concerned their child may contract RSV this winter — and 74% said they would ask family members/friends/acquaintances not to touch their child’s face or hands as a preventative measure.
Almost four out of five (79%) parents had heard of RSV, but overall understanding of the disease was low, with just one in five reporting good knowledge.
This contrasts with their greater knowledge of other childhood illnesses, for example, common cold (74%), influenza (52%) and pneumonia (38%).
The HSE defines the Irish RSV season as starting at the beginning of October and ending in late February. But in 2022, RSV infections surged outside of the normal winter season — potentially as a consequence of covid social distancing measures and lockdown periods, meaning babies had experienced less exposure to typical childhood viruses.
Prof Roy Philip, consultant neonatologist and paediatrician at University Hospital Limerick, says: “For almost two years during covid we contained the spread of infection. Yet 90% of children get RSV by the age of two, so [post-Covid] there was a natural viral resurgence, which got those who hadn’t been affected up to then.”
This year RSV season began earlier and there has been a rise in hospital admissions.
Prof Philip says figures show one in five children under two years “require some form of medical input” (GP, PHN, A&E) for acute respiratory infections — of these, one in 50 need hospital admission which could include paediatric high-dependency care or intensive care.
Describing the trajectory of RSV, Prof Philip says it initially presents with symptoms similar to a common cold.
“It's not uncommon for infants or young children to have runny nose, sniffles, fever, reduced feeding, irritability, or even ear infections.”
But while RSV “behaves like a head cold in the vast majority of children”, the worry is that in a proportion of infants, RSV can lead to LRTIs such as bronchiolitis or pneumonia. “If parents notice rapid breathing, significantly reduced feeding, prolonged periods without wet nappies, or persistent high fever despite medication, they should consult their GP immediately.
“Moreover, in instances of obvious breathing difficulties, significant pauses in breathing or unexplained lethargy/sleepiness, it's imperative to seek urgent medical attention from emergency services,” says Prof Philip.
Very premature infants and those with certain underlying medical conditions – congenital heart disease, cystic fibrosis, Down syndrome, chronic lung disease – are more vulnerable to severe RSV infections, at times warranting critical care. But Prof Philip says it is still true that the “vast majority of babies with RSV seeking help from GP or A&E are typical healthy babies”.
While there is no specific treatment for RSV, certain factors – cigarette smoke, overcrowding, lack of breastfeeding — have been suggested to increase the frequency and severity of RSV infections. “If a baby is in a cigarette-smoking environment their chances of getting severe RSV is higher.
“And in crowded situations like crèches — and crèches are wonderful and do their best — if one child develops RSV it’s very easy for it to spread. Sibling affection is important, but if an older sibling in crèche/playschool comes home with a viral infection and kisses the face of the three-month-old, the chances of RSV spread is higher.”
Professor Philip is one of the authors of a recent study published in (exa.mn/Breastfeeding-RSV) that found “breastfeeding associated with lower frequency and severity of RSV-associated acute LRI”.
To prevent RSV spread, Dr Maire Finn, GP at Ennis Family Medical Centre, advises frequent, careful handwashing with soap and water as an important preventative action. “Always follow good cough etiquette — cough into your sleeve or a tissue. Encourage children to do the same. If a sibling or other family member is symptomatic you should keep them away where possible.”
Prof Philip recommends good hydration if your child has RSV. “As long as they’re alert, having no significant breathing difficulties and have wet nappies, it means your baby is coping well. They usually take a few days to a week to recover. What’s important is to keep them feeding, keep them warm — and keep a close eye for any warning signs.”
For Síle Seoige, who moved back to her home village in Connemara a year or so ago, having the support of family and friends nearby is important during these child-rearing years. “I’m in my mid-40s. It took time for me to realise I’m from a lovely place and community. My parents are out the road. My closest friends from my schooldays still live in the village.”
She and Damien are building a home here: “Our goal is to be in before Christmas.”
The couple moved from Dublin ahead of Cathal starting primary school. “We said 'let’s just make the move, we’ll rent, we’ll make it work'.
Cathal’s in his second year of primary now. He has transitioned so well into life in the Gaeltacht – he’s a real little Connemara man.”
And when it comes to childhood illnesses, Síle is following in her mum, Phil’s footsteps.
“She believes in nourishing a child to have a robust immune system, so they’re well able to fight whatever comes along. She’d always reach for natural remedies and did a lot of concoctions for us growing up. Like her, I really believe in supporting the body.”
Also like her mum, Síle believes in listening to her instincts – as well as in the importance of keeping informed. “Because knowledge is power.”
