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Forum Name: Pediatric Topics

Question: Urgent RSV question!


 mrbeansmom - Sun Mar 13, 2005 4:11 pm

I am a foster parent with a one year old boy who was diagnosed and hospitalized with RSV last week. In the morning of the day he was diagnosed with it he had a clear runny nose and a small cough. I called his caseworker and told her that I felt he was getting a cold and that maybe he shouldn't go on the visit he was supposed to go on with his parents that afternoon. It was to be his first unsupervised visit. She told me that as long as he wasn't "knocking on death's door", he needed to go as they needed to know how to handle a sick baby. This is their 5th child and one of the children, not him, has asthma and special needs.

Anyway, he was gone a total of 4 hours. When he returned, I could audibly hear that he was in trouble when the aide opened the car door. He was whistling with each exhale and his tummy looking like it was struggling for him to get air. I commented that he didn't sound so good and the aide just said he slept all the way home, as though that meant he was comfortable. I put him immediately into my car and took him to urgent care where he was given 3 bretahing treatments with oxygen in between before they sent us to the hospital as they could not get his oxygen up out of the low 80's.

The social worker called me the next morning and I expresed my frustration that his condition was so bad when he got home. She blamed me for sending a sick child on a visit! Next, she told indicated that he probably didn't develop the more serious symptoms until he got home and they probably never saw any.

I realize that you are probably limited in what you can say and you don't know me or my situation, but I just want to know, in your opinion, if his breathing distress could have developed on the 20 minute ride home or if he had to be showing some signs of distress during those 4 hours? Also, he is still on breathing treatments at home and I'm wondering if this is asthma that he will have long term or if it's just related to the RSV and will go away when he gets over the virus?

Thank you so much for the opportunity to ask these questions!
 Dr. Heba Ismail - Mon Mar 14, 2005 2:37 pm

Dear mrbeansmom,
RSV usually begins by affection of the nose and throat, as you've described, then moves on rapidly over 1-2 days to cause inflammation of the small airways of the lungs. So it's very unlikely he would be short of breath and whistling within 20 minutes. He must have been showing signs of distress earlier that day, even mild signs.
RSV infection has a tendency for recurrence and children hospitalized for RSV disease during infancy have been shown to have abnormal pulmonary function tests and/or increased episodes of wheezing up to 10 years later. Whether RSV itself plays an active role in this or is just a marker for children at risk for asthma remains controversial.
.
 mrbeansmom - Mon Mar 14, 2005 4:10 pm

Thank you so much for your quick reply! I actually had to take the little fellow to the doctor this a.m. and she said, almost word for word, what you just said here. She recommended watching him for a time and, that if he continued to have coughing and such, she would probably start him on Singulair or some preventative type inhaler. You can't begin to imagine how fearful I am about this little one being sent back to these parents. It is a very scary situation...........

Thank you again so much. :)

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