Florida children are getting hit with a slew of viruses that nearly vanished during the pandemic, and some illnesses that normally would be mild are sending kids to the hospital.
“All theses viruses are back, and they are flourishing all at once,” said Dr. Jessica Prince, medical director of the pediatrics emergency department at Palm Beach Children’s Hospital. “We are seeing children getting sick back to back to back, They get over one virus and then they start with another.”
In other parts of the country, respiratory syncytial virus (RSV), is causing overcrowding in children’s hospitals, but in Florida, doctors say a variety of respiratory illnesses are sending them to emergency rooms, with flu picking up steam. COVID-19 infections have yet to start rising in children in Florida, but experts expect an uptick soon.
“I think we’re seeing potentially the same percentage of children getting admitted to the hospital — about 10 to 15% — but a larger number because there are just more children getting sick right now.” Prince said.
Because of COVID precautions during the pandemic, there was little opportunity for children to build immunity. As children return to school and take off their masks, respiratory infections such as adenovirus, parainfluenza and rhinovirus are back in full force.
It is unusual for kids to get more than one at a time, but some young patients admitted to Palm Beach Children’s Hospital have two or even three viruses at the same time. “Children’s immune systems are not what they used to be,” Prince said.
Prince is seeing viruses last longer, too. “Parents are coming in and their kid is not much better at 5, 6, 7 days. In the past we would say in about a week you will start seeing improvement, but we are not seeing that all the time now.”
This whammy is impacting parents, too, notes Dr. Katelyn Jetelina, author of Your Local Epidemiologist newsletter. “The latest Department of Labor data found absences from work due to childcare problems hit a record high last month — higher than during the past two years of the pandemic,” she wrote in her Nov. 10 newsletter. “If you’re home with a sick kid right now, you’re not alone.”
What to look for in a child
Many childhood respiratory infections share similar cold and flu-like symptoms: fever, runny nose, and cough. Pediatricians say parents should make sure their children are well-hydrated, and give them over-the-counter medicines, like ibuprofen, if they have fever. But parents need to keep a close eye on how the virus progresses.
At Nicklaus Children’s Hospital in Miami, children with high fevers, dehydration, difficulty breathing and pneumonia are arriving, needing oxygen or IV fluids. “If they are not responding to initial treatment or need more help breathing, we admit them,” said Dr. Marcos Mestre, vice president and chief medical officer for Nicklaus Children’s Hospital. “Last month we admitted more patients than we had during the entire pandemic.”
Mestre said the circulating viruses are not more severe this fall, they are just here in higher numbers. The one virus that can lead to serious complications in young children is RSV, a common, contagious virus that causes cold-like symptoms in your respiratory tract. For babies it can cause bronchiolitis or inflammation of the lungs,
Broward Health Medical Center in Fort Lauderdale reported they had to open up overflow units for pediatric ICU patients presenting with RSV in early October.
“Young infants haven’t seen respiratory viruses at all in their lifetimes,” Mestre notes. “They haven’t created antibodies.”
You can get RSV at any age, Mestre said, but with young children their small airways could become inflamed and put them at increased risk for difficulty breathing.
Mestre said Florida, overall, doesn’t have the large number of children with RSV at this time that other states do.
“RSV in Florida doesn’t follow the norm of other states,” he said. “We tend to see more year-round.”
Mestre said if his hospital should it see a rise in admissions, it has prepared by designating areas that could become patient rooms.
When to call/visit the pediatrician
Dr. Mona Amin, a pediatrician with Pediatric Associates in Fort Lauderdale, said only the flu has an antiviral treatment if taken within 48 hours of the onset of symptoms. “For all the other respiratory viruses, there is no treatment all, just supportive care,” she said.
She says a parent will want to see the pediatrician if a child’s fever doesn’t go away with fever-reducing medicine.
“Sometimes with inflammation, bacteria can come and colonize, and a virus develops into bacterial pneumonia or an ear infection. That’s when we need to medicate with an antibiotic,” she said.
Amin, who said she herself is recovering from a lingering respiratory infection, said most of the circulating viruses are taking longer. “A lot of parents are telling me their child or they themselves have lingering symptoms. They are able to go about their day, but their cough or their congestion is lingering.”
Prince at Palm Beach Children’s Hospital said with babies, it can be more challenging to know when to go to the pediatrician, or hospital. “If your baby is irritable with a fever, you may want to get a pediatrician to do a more detailed investigation to make sure you are not missing anything.”
Diagnosing different viruses with similar symptoms
“The symptoms for many of the viruses overlap considerably,” said Dr. Mobeen Rathore, a pediatric infectious disease specialist at UF Health Jacksonville.
A pediatrician likely will start with a COVID-19 test and a flu test, which have quick results and can be done in the office.
“COVID is less than 2% of our admissions,” Rathore said. “It’s the lowest of all the viruses at this time, but it may go up.”
There are PCR and antigen tests for RSV, but they require a laboratory to process results. There is no medication specifically to combat RSV. The only treatment is to help alleviate symptoms.
Children and adults can get RSV multiple times, even during a single season, but most likely they will not be as sick from it as children under 3 years old.
How to curb the spread in your home, community
With so many viruses circulating, Florida pediatricians advise parents to wash hands and toys often.
“Keep your kids home if they are sick. It really is common courtesy.” Amin said. “I know it’s inconvenient having a sick kid, but you can’t let your kid go back to school if they are feverish. A kid who is febrile should not be around peers. He should be resting at home.”
Rathore advices teaching your child good cough etiquette to keep droplets from spreading among the family.
“With respiratory illnesses it is hard to predict who will end up in the hospital,” he said. “Use good common parental sense, make sure your child gets sleep, and if he is not improving, call your pediatrician. Only a small number will need to see a healthcare provider, and a minute number will end up admitted.”
Still time to get vaccinated
“Vaccination is really the number one tool that we have,” Rathore said.
In his hospital, he has seen an uptick in children admitted with flu complications in the last few weeks, mostly severe pneumonia. “All had the flu, and then they got sicker.”
While the flu shot is not always a perfect match for the predominant strain in a given year, pediatricians say it could mean the difference between mild and severe illness.
“I strongly advise children to get the vaccine,” Rathore said. “I think it’s going to be a bad flu season.”
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.