Viral infections post-Covid: a GOSH doctor’s advice to parents of disabled children

6 mins read

Monday 7 March 2022

Tags: RSV

Last week we hosted yet another popular Facebook Live with respiratory paediatrician Dr Martin Samuels, who spent an hour answering more than 120 questions and comments from parent carers about how to protect their children from viral infections. Watch it in full here.

This followed on from our first event with Dr Martin in early December, which was described by many families as “the best Facebook Live they had every listened to.”

Though rates of infection from viruses such as respiratory syncytial virus (RSV) are falling as spring draws near, the removal of Covid restrictions in England will see even the most vulnerable children returning to school after shielding. And with masks and weekly testing no longer compulsory, many disabled children will be exposed to new viruses still unknown to their immune system.

As well as questions about shielding and social mixing, parents asked about a range of virus-related issues — including repeated or continuous infections, potential long-term damage, existing home remedies, and the health risk to older children with certain conditions.

You can take a look at some of the questions below, or get immediate advice from our new RSV chatbot if you’re concerned about your child.

My child has Down’s syndrome but no underlying health issues. He’s been going back and forth between the hospital and his GP because of respiratory problems. What can I do?

Most viral infections may produce symptoms for 7-10 days, commonly even up to 2 weeks in children. If the symptoms are over by then, that’s all well and good. But if the symptoms drag on longer for 3-4 weeks, that would certainly be a reason for getting the child reviewed in case they developed a secondary infection. For example, viruses cause some initial inflammation on the nose, throat or air passages, and then bacteria can come down from the nose or throat and get into the lungs to cause a secondary infection of bronchitis. If the symptoms have dragged on but almost settled, and then they get a resurgence of symptoms, that may indicate they have a secondary bacterial infection.

It can also indicate they developed a second viral infection, which is common in young children – they have an average of between 6-8 viral infections a year, usually clustered between October and March.

Prior to Covid, my 9-year-old daughter was ventilated overnight and would be hospitalised with serious chest infections every couple of months. Since shielding, she has had no illness and has stayed out of hospital for 2 years. Will she go back to being unwell now?

It’s very likely that, with her vulnerabilities, a return to normal living may start causing more problems. There are two important things that will help her.

First: if she needs night-time ventilation, that’s because her breathing is inadequate during sleep. Is that being given in a sufficient amount? Does she need changes to her ventilation settings to help keep her lungs better expanded? This is important, because it helps children to tolerate respiratory infections better.

Secondly: Is she getting secondary bacterial infections, or does she have persistent bacterial carriage in her lungs? If that’s the case, she may need preventative antibiotics to keep her chest in good condition. With most vulnerable children I see, the combination of being on prophylactic antibiotic and ventilation (if needed) often helps keep them well and out of hospital. These measures don’t stop them getting viral infections, but it means they’re better able to cope with them and deal with them.

Are there any disabilities that can make viral infections get worse as children age?

Younger children are more vulnerable to infection because their immune system isn’t as experienced. As they age, they build immunity and their respiratory system is improved. Their lungs and air passages are larger (so they don’t get readily blocked up with secretions), their ribcage is usually stronger (helping to keep the lungs better inflated), and their respiratory system is more stable (which improves the strength of their cough).

One situation where breathing problems may become more severe is if a child has a neuromuscular condition that progresses over time. Then some of those susceptibilities become more problematic for them: their lungs don’t stay as well inflated, their muscles are weak, and they can’t cough as well. That’s when respiratory problems might start to become more of a problem in successive years.

Can children develop any long-term damage as a result of RSV infection early in life?

There are cases where RSV causes bronchitis and pneumonia in older children, or lung damage that can be permanent. But it’s not the most common virus to do this: adenovirus is the most common virus to cause lung damage with long-lasting effects.

If the child gets a respiratory infection, they should gradually get better from the effects of this in their lungs and chest over 6-8 weeks. If they have persistent problems lasting longer than that on their breathing and chest, they then may need to be assessed as to whether this has caused longer-term damage or whether they have a secondary bacterial infection. That would certainly be a good indication for a child to be reviewed by a paediatric respiratory specialist.

My child is struggling to sleep because of a cold causing glue ears and mucus accumulation in their nose. How can I help him?

The first thing is paracetamol: Calpol will make them feel more comfortable. The next thing is to try using a saline nasal spray to loosen their mucus. There’s no limit to how often you use saline nasal spray. You can also buy a nasal aspirator at the chemist to remove secretions.

If that doesn’t work, there’s a medicine called Otrivine which constricts the blood vessels in the lining of the nose and could improve the nasal passageway. You can only use it twice a day, and don’t use it longer than 7 days because that can cause a rebound worsening of symptoms when you eventually stop.

Altering the humidity and temperature in the room can also be useful and make their breathing easier. It seems bizarre, but sometimes children miraculously get better on their way to hospital because of exposure to the cold night air!

Can my child’s immune system be exhausted by constant exposure to viruses?

The immune system doesn’t get worn by repeated viral infections. It will keep getting exposed to these viruses and trying to develop immunity to them. The danger is more because of the damage it might cause to the air passages or getting a secondary bacterial infection.

If your child has underlying susceptibilities that make them prone to breathing problems, chronic respiratory difficulties or sleep-related breathing disorders, then those are the things worth getting assessed within a paediatric respiratory service. It’s not the immune system that needs a boost, it’s more about helping those other susceptibilities he has to stop him getting damage from viral infections.