CHLA Archives - L.A. Parent

As we headed into the new year, viruses were on the rise — from coronavirus to respiratory syncytial virus, or RSV, a virus that can overwhelmingly impact children. We reached out to Sindhu Mohandas, M.D., infectious diseases specialist at Children’s Hospital Los Angeles, to learn more about the virus and what we can do to protect our families.

What are the symptoms of RSV?

Symptoms of RSV can differ with the age of your child. The most common symptoms include a runny nose, cough, sneezing, decreased appetite and fever. Wheezing and breathing difficulties can also occur in young children.

In very young infants, RSV may present with irritability, decreased activity or breathing difficulties, including apnea (pauses in breathing over 10 seconds), without any of the other cold symptoms.

Are kids of a certain age more at risk? Other risk factors?

Younger children are more at risk for severe symptoms that can require hospitalization. Children younger than 6 months are most likely to have severe illness. Children at particularly high risk for severe RSV-related diseases include premature infants and children younger than 2 years of age with diseases that affect the heart, lungs or immune system.

To prevent serious disease, at-risk infants can be given a monthly injection of a medication consisting of RSV antibodies during the RSV season.

How can we tell the difference between RSV, a cold, the flu and COVID-19?

RSV, cold due to other viruses, flu and COVID are all caused by respiratory viruses and, therefore, there is significant overlap in symptoms, and they can be difficult to tell apart based on the symptoms alone. Some differences do exist, with some symptoms being more common in one than the other. For example, fever is less common in RSV and more common with flu. Wheezing and breathing difficulties are more common with RSV. Loss of taste and smell is unique to COVID. However, testing is the only definitive way to tell these conditions apart.

What are early signs of RSV?

RSV tends to start with a mild cold; however, it can become more severe in a few days (usually 3-4 days after symptoms start). Watch for worsening [conditions], including wheezing and breathing difficulties and seek medical care if they develop. Fever may not always occur with RSV.

Very young infants may not start out with symptoms of a cold, and their only symptoms may be decreased activity or appetite, irritability and apnea.

When should parents call their doctor?

If a child is wheezing, struggling to breathe or not drinking enough fluids, then parents should call the doctor. Be especially vigilant for very young infants if other children in the family have RSV since [babies] can present with more unusual symptoms, such as apnea.

What is the best way to protect our kids?

RSV is highly contagious and is spread through droplets when someone coughs or sneezes. It can live for a few hours on surfaces and on hands. Best way to protect kids is by taking steps to prevent the infection. This can be done by frequent hand washing, keeping hands off your face, avoiding close contact with sick people and cleaning and disinfecting surfaces that people frequently touch, including toys, play surfaces, doorknobs, etc.

What is the most important thing parents should know about RSV?

RSV infections occur every year, but it is particularly worse this year [late 2022]. People of any age can get RSV, but it is more serious in younger children. Be aware of the symptoms of RSV in young children and call your doctor if your child is not improving or is showing signs of worsening.

What health & wellness questions are keeping you up at night? Send your questions to elena.epstein@laparent.comand we’ll ask the experts.

In addition to navigating parenting three children in a pandemic, Jennifer Su, M.D., is pediatric cardiologist and director of heart failure and cardiomyopathies with the Heart Institute at Children’s Hospital Los Angeles. While she and her husband were happy to see their children return to campus after the shutdown, they recently had to take off work to quarantine with their son, whose preschool announced a COVID-19 exposure. “Navigating between the unpredictability of parenting and the busy hospital setting has been quite a challenge,” she says.

In the middle of it all, Su is also working to alleviate misconceptions about the COVID-19 vaccination, including a belief some parents hold that their children will develop myocarditis (an inflammation of the heart muscle) after receiving the vaccine.

How is L.A. County doing with its rate of vaccinated children?

To date [late January], over 80% of adolescents have been vaccinated with at least one dose. In younger children between 5-11 years old, however, the vaccination rate is much lower, with about 30% of these kids having received at least one dose of the COVID vaccine. Particularly in this younger age group, we know that the vaccine has much fewer side effects and is highly effective in preventing COVID complications such as MIS-C, or multisystem inflammatory syndrome in children, a rare but serious condition that is seen a few weeks after COVID infection and includes fever with inflammation of multiple body parts (such as the heart, lungs, kidneys, brain, and intestines).

What is causing hesitancy in parents when it comes to getting their eligible children vaccinated against this virus?

There are three common reasons that come up in terms of vaccine hesitancy. First is the perception that the vaccine doesn’t work. When this comes up, parents often share a story about someone close to them who has gotten vaccinated and subsequently got COVID. I have seen these cases happen as well. We are observing that the COVID vaccine is not completely effective at preventing transmission of this current (Omicron) variant. However, we do see that it is incredibly effective at minimizing the symptoms of COVID. You may have heard that Omicron is a milder variant of COVID-19 – this is in part because many people have now been vaccinated and are experiencing milder symptoms because of their vaccine immunity.

Another reason for vaccine hesitancy that comes up is concern that the mRNA vaccine technology is “too new,” and long-term effects of the vaccine are not fully understood. Even though COVID-19 is the first virus in which the general public has heard of mRNA vaccine technology, mRNA vaccines have actually been around for almost 30 years. This technology was first studied in mice back in 1993. It has been studied and found to be effective in humans since 2013, being used to vaccinate against rabies.

Most commonly, parents are hesitant to get their children vaccinated because of concern for potential vaccine side effects. Specifically, the mRNA COVID vaccine has been linked to myocarditis, most frequently seen after the second vaccine dose in adolescents and young adults.

What is myocarditis? And what is the relationship between it and the vaccine?

The heart is basically one big muscle. Myocarditis is inflammation of the heart muscle as the immune system reacts to the vaccine. Just like how some people might develop soreness in arms or body after receiving a vaccine, occasionally some people will develop inflammation of the heart muscle after the COVID mRNA vaccine.

What is the severity of the risk and what symptoms are usually present?

Myocarditis after the COVID mRNA vaccine is incredibly rare, affecting about 1 in every 10,000 teenagers who receive the vaccine. After observing this side effect for a few months now, we know that in addition to being rare, vaccine-associated myocarditis also tends to be mild. In most cases, symptoms completely resolve after a few days and heart function remains normal. Most common symptoms related to myocarditis are chest pain, difficulty breathing or funny heartbeats that develop within one week after receiving the vaccine.

Jennifer Su, M.D., is pediatric cardiologist and director of heart failure and cardiomyopathies with the Heart Institute at Children’s Hospital Los Angeles. PHOTO COURTESY CHLA

How do these risks compare to risks associated with contracting COVID, especially in kids and teens?

The short answer is that the risk of myocarditis with the vaccine is much smaller than the risk of getting myocarditis from COVID. In fact, in 2020, an estimated 40% of all diagnosed myocarditis in children was related to COVID. The story doesn’t stop here. In addition to myocarditis, COVID can cause many other complications as well, ranging from mild to life-threatening (pneumonia, heart arrhythmias, MIS-C). Although less than in adults, kids and teens may also experience “long COVID” in which symptoms last for months and can lead to mood changes, trouble concentrating and physical difficulties. Compared with side effects of the vaccine, the risk of complications with COVID is much higher, more severe and can potentially last longer.

What should parents do if they suspect myocarditis in their children, and what is the treatment?

If your child complains of symptoms [such as] chest pain, difficulty breathing, abnormal heartbeats within one week of receiving the vaccine, you should go to the doctor to check it out. There are easy and fast ways to check if your child has myocarditis. In most cases that have been reported across the nation, resting and treating the pain with ibuprofen has been the main treatment for mild myocarditis. Myocarditis usually improves completely on its own.

How is CHLA addressing the vaccine hesitancies?

Empowering families with accurate and up-to-date information about COVID and the vaccine is the most important way to begin a conversation about keeping their kids safe during the pandemic. Sharing information through articles such as this one is a valuable way to reach parents and address concerns. We also have an extensive website dedicated to providing families with updated COVID and vaccine related information at chla.org.