Children, visits to the emergency room tripled. How to distinguish flu, Covid, RSV and what to do

Access to the emergency room for children tripled due to respiratory viruses. In these days “we are at the center of the peak of the epidemic of respiratory diseases also for children, not just for adults. We have many cases of bronchiolitis, we have children who have acute episodes of asthmatic bronchitis, pneumonia. But basically bronchiolitis is the most frequent disease and one that particularly clogs up emergency rooms. The three viruses that are circulating are: the Respiratory Syncytial Virus (RSV) in first place, followed by influenza and Coronavirus Sars-CoV-2 in more or less the same measure”, he says. Fabio Midulla, president of Simri (Italian Society of Childhood Respiratory Diseases), head of the emergency pediatrics department of the Policlinico Umberto I in Rome.

This year, access to the emergency room is also increasingly congested due to the numerous parainfluenza viruses and the increase in multiple infections, i.e. those caused by multiple viral infections. «What we find this year is the tendency to see different types of viruses present at the same time, especially Covid and flu together (the so-called Flurona
, ed) condition that makes the diagnosis more complex even if the classic indications for the flu apply for treatment: antipyretics, rest and hydration – he explains Davide Libreri pediatrician and neonatologist in the Neonatal Intensive Care Unit at the Papa Giovanni XXIII hospital in Bergamo — . Distinguish classic flu from Covid and Respiratory Syncytial Virus in children (ed. Vrs) is quite difficult, even in the large ones. This year's flu is characterized by very high fever peaks, over 39
and strong resistance to antipyretics. This condition understandably causes great alarm in parents who, not seeing the fever regress quickly, choose to take their children to the emergency room, while they would have to wait a few days because most of the time it is “simple” flu.”

When to go to the emergency room

“Self after 48/72 hours of high fever the conditions do not improve, if the patient is unable to hydrate, if he is breathing badly it is important to have the child evaluated – Libreri specifies –. The recommendation is not to go to the emergency room first, especially if by giving an antipyretic the fever goes down and the child remains quite active, because the risk is that while waiting in the emergency room – certainly a long one – the child could be infected by something else.”

What to do in case of cough

In younger children, the Respiratory Syncytial Virus
(Vrs) is the one that must be kept under greatest observation because it is the antechamber of bronchiolitis
«which initially manifests itself only with a runny nose and cough which, as a rule, last three days. However, the symptoms do not always regress, especially if the child is very young. In bronchiolitis, the viruses reach the bronchioles, the thinnest branches of the bronchi, creating an inflammation that causes accumulation of exudate and reduction in caliber with consequent difficulty in the process of oxygenation and removal of carbon dioxide”, explains Libreri.

How to understand if a child has contracted bronchiolitis? «Bronchiolitis cough is a irritating and often incessant cough, with abundant secretions. In the little ones, under the age of one, it must be kept under strict control, while above the age of one, it can be irritable at first, then catarrhal and tends to resolve on its own. In the little ones, the signs that should alert are a more increased respiratory rate, labored breathing, activation of the accessory respiratory muscles with consequent subcostal and intercostal indentations, slowed sucking and difficulty in feeding, which is one of the clearest symptoms that something is wrong – explains Libreri -. If a baby has difficulty latching on to the breast or finishing the bottle there is probably a respiratory problem.”

«The category of newborns most at risk are children under 3 months, premature babies and small children with lung malformations or heart disease, small children with immunodeficiencies or neuromuscular pathologies which are the children who are subjected to monoclonal antibodies which give temporary protection against RSV. The only way to reduce the circulation of the virus is to act on prevention. If there is an older sibling or a relative with a cough and, above all, a fever (in this case the viral load is higher), it is recommended the use of a mask, careful hand washing, airing rooms often and avoiding crowded places, which are also the prevention rules recommended for Covid and flu. Normally if a child over the age of one has a cough, is fever-free, has no difficulty breathing and plays regularly, the cough should not worry».

What to do in case of fever

This year's flu has, as a characteristic, very high fever which particularly alarms parents. «It is counterproductive to go to the emergency room immediately, with the risk of giving the child other infections – explains Libreri -. If at the first treatment the fever shows signs of decreasing and the general conditions are good there is no need to worrynot even if peaks of high fever then return. With this year's flu, peaks above 39 degrees in the first 48 hours should not cause alarm, especially if the child is sometimes active and drinks regularly».

Is there a better antipyretic for this year's flu? «The first recommendation is not to mix drugs, but preferably choose immediately whether to treat the child with ibuprofen or paracetamol, in order to avoid repercussions on the liver – continues Libreri -. As a rule, paracetamol can be given every six hours, ibuprofen every 8, the latter usually guaranteeing a greater antipyretic effect and a more prolonged defervescence. If the fever is resistant to one of the two drugs, you can switch to the other but then it is preferable to continue with the one chosen. However, it must be remembered that the antipyretic only serves to provide relief, not to treat fever which represents an important defense mechanism. If the child is lively, you can wait to give him the drug, which in any case should be avoided if the fever does not exceed 38.5 degrees and the child is not particularly depressed.”

In case of fever it is essential to keep the child's hydration level under control which, especially in case of high fever and sweating, loses many mineral salts. «If he is an infant, it is advisable to breastfeed him often, but if he is older, and even more so if he has no appetite, oral rehydrators may be indicated which contain sugars and mineral salts, potassium, sodium and other precious substances. Among other things, giving these products to feverish children helps prevent acetone. If the child has a high fever and is particularly depressed, without signs of recovery, then in that case it is always better to have him seen.”

What to do in case of diarrhea

Other viral forms that are particularly widespread this season can generate diarrhea. «In this case, probiotics and oral rehydrators are useful – explains the pediatrician – which serve to recover lost fluids and mineral salts. If the child continues to eat and hydrate, it is a good sign and you can support him in his choices, not necessarily with a blank diet, but by avoiding only fatty and fried foods or the intake of foods rich in simple sugars such as fruit juices or carbonated drinks which could increase diarrheal discharges”.

When to worry?

«In children over one year old, two-three days of fever are normal and they don't have to worry. This year we are seeing many respiratory forms that present complications with ear infections, caused by the presence of a large amount of phlegm that accumulates behind the eardrum – explains the pediatrician -. This condition, in younger children, is particularly impactful, due to the fact that they cannot blow their nose. To remove the phlegm it is therefore necessary to have the child undergo frequent procedures nasal washes with physiological solution and, in the case of ear pain, it is important to promptly resort to an anti-inflammatory. If the child complains of severe pain, instead of carrying out nasal washes using the classic syringe, which creates pressure on the tympanic membrane, it is preferable to use isotonic or hypertonic sprays or give the child nasal showers using common aerosol machines” .

Complications: otitis, asthmatic bronchitis and bronchopneumonia

If ear pain, often manifested by inconsolable crying, is associated with fever, it is likely that it is otitis. «In this case ibuprofen is indicated. If the pain and fever resolve or regress within one to two days, it means that the child is on the road to recovery. If, however, the fever continues or rises, a visit to the pediatrician is needed who could prescribe antibiotic therapy – explains Libreri -. Another particularly popular trend this year are the asthmatic bronchitis, which mainly concern children aged two and over. These are viral forms that can be complicated with breathing difficulties associated with a wheezing or whistling sound. Also in this case, a visit to the pediatrician is recommended, who may prescribe a bronchodilator and possibly cortisone. In more serious, but less common, cases, bronchitis can degenerate into bronchopneumonia which has very evident symptoms.”

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