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As a parent, you never want to see your kids feeling unwell. Beyond hoping the illness doesn't make its way through your entire household, dragging you down, one by one, you hope they're able to get over it relatively easily and, ideally, without medical intervention.
Like clockwork, flu and RSV seasons seem to run rampant from late fall to early spring, with the worst of it peaking during the winter months. But did you know some respiratory viruses can actually continue circulating as late as May?
But did you know some respiratory viruses can actually continue circulating as late as May?
If your babies were born prematurely (as tends to be the case if you have twins or higher-order multiples), they're at a higher risk of adverse outcomes from respiratory illnesses—and this higher risk of respiratory infections for your preemies can actually extend into adulthood because those who are born preterm can have reduced peak lung function and smaller alveoli, which increases their chances of getting more severe infections when they get sick.
That's why it's incredibly important to understand the difference in symptoms for different illnesses (from your run-of-the-mill cold, to flu, to RSV), so that if your little ones DO catch a nasty virus, you recognize the signs of respiratory distress and know when it's time to take them to the hospital.
What is the flu?
The flu is a seasonal respiratory infection that's caused by either Influenza A or Influenza B viruses. Both A and B viruses are acutely contagious, and the infection from either one can affect the nose, throat and lungs.
Both A and B strains cause similar symptoms, like high fever, body aches, and cough, but they differ in severity and spread.
Flu A tends to be more aggressive and causes more severe symptoms, while Flu B is usually more mild and shows up later in the season.
From November to February, Flu A circulates (in general), and Flu B peaks closer to the end of the season, from February to the end of April.
Flu symptoms
Symptoms of the flu can appear anywhere from one to four days after exposure to the virus, and they tend to come on quickly (whereas your run-of-the-mill cold symptoms tend to take their time settling in).
Flu symptoms can include some, or all, of the following:
- Sudden onset of fever (more than 100.4°F);
- Extreme fatigue;
- Cough;
- Chills;
- Muscle aches;
- Sore throat; and
- Headaches (though, this can be a more difficult symptom to figure out with your babies).
Flu treatment
When one of your babies has the flu, one of the biggest hurdles is trying to prevent their twin or other siblings from catching it.
Children are usually contagious for about 24 hours before symptoms start (not super helpful when you're trying to play interference for your other twin), and they can continue to be contagious for more than a week afterward.
Ensuring your little one is getting lots of rest and staying hydrated can go a long way to helping them feel better. And making sure they're not overdressed can help them from overheating or intensifying chills if they have a fever.
But there are cases where your child could have an adverse outcome from the infection and might require medical care. If you go to the emergency room, a doctor might prescribe an antiviral like Tamiflu (also called oseltamivir), which is an approved drug for treating flu in infants as young as 14 days old (when prescribed by a doctor).
Antivirals are only most effective when they're started early, so if you don't catch on to your baby's symptoms and seek medical care soon enough, they may not prescribe medication.
Antivirals are only most effective when they're started early, so if you don't catch on to your baby's symptoms and seek medical care soon enough, they may not prescribe medication. This is why it's so important to take note of the day and time you first notice symptoms.
Tamiflu works best when it's started within 48 hours of the onset of symptoms. When one of our twins had suspected Flu A (when I say "suspected," I mean the doctors say they suspected it was Flu A and didn't want to wait for labs to come back and confirm it before prescribing us to start him on medication because he was having to work so hard to breathe, plus the stores would have been closed to get the prescription filled by the time the results came back).
When to seek medical care
When we saw how much our little guy was struggling to breathe (he had major retractions), we took him to the emergency room, where we had to wait for a couple of hours, and he was seen by a doctor at about 36-38 hours after the onset of symptoms, and then we were monitored for another couple of hours after that, to ensure his breathing stabilized before we were sent home.
Even having received the flu vaccine at the beginning of the season, one of our twins had this extreme of a respiratory infection from catching the flu. It's because he was born prematurely and, therefore, is at a higher-risk of adverse outcomes. If he hadn't received the vaccine, things could have been even worse.
If you're unsure if you should wait things out at home or take your child to the doctor, err on the side of caution. If you notice they're having difficulty breathing (if their nostrils are flaring every time they breathe or if you see retractions (you can see pulling along the outline of their ribs when they inhale), seem to have chest pain, or a fever that lasts for several days, take them to be examined by a doctor.
What is RSV?
Respiratory syncytial virus (RSV) is a highly contagious respiratory virus that usually causes mild, cold-like symptoms, but it can be very serious for those who are at a higher-risk of adverse outcomes if they contract a respiratory infection—like those who are born prematurely, before their lungs are fully developed.
According to the American Lung Association, RSV is the leading cause of hospitalizations in all infants. It's spread through close contact with others who have the virus or by touching surfaces that are contaminated with the virus.
RSV symptoms
The onset of RSV symptoms typically appear between two and eight days after someone's been exposed to the virus.
The illness is generally mild for most people (adults and older healthy children), with mild symptoms akin to the common cold, including:
- Coughing;
- Sneezing;
- Runny nose;
- Wheezing;
- Fever; and
- A decrease in both appetite and energy.
Normally, these milder symptoms will present themselves at different stages and clear up on their own after a few days.
But, again, for those at a higher risk of adverse outcomes from respiratory infections, like older people, those who have heart and lung disease or a weakened immune system / who are immunocompromised, or babies who are 12 months or younger or who were born prematurely, RSV can cause severe symptoms, including:
- Short, shallow, and rapid breathing;
- Struggling to breathe (you can visibly see their chest muscles and skin retracting / pulling tightly inward with every breath they take)
- Cough;
- Poor feeding;
- Unusual tiredness (lethargy); and
- Irritability.
RSV treatment
Children are usually contagious for a day or two before symptoms start (again, not super helpful when you're trying to prevent your other twin from getting sick), and they can continue to be contagious for anywhere from three to eight days (and infants or those with weakened immune systems can be contagious for up to four weeks, even after symptoms subside). Having said that, this virus is most infectious during your child's most symptomatic phase.
For milder cases, getting plenty of rest and hydration will usually do the trick, and your little one will be on the mend in no time. But for those who are at higher risk of infection, you'll need to monitor symptoms closely, as things can change quickly, and they may suddenly require urgent medical care.
Severe RSV cases will require hospitalization, and additional testing may be needed. This can include imaging tests, like chest x-rays or CT scans to check for lung complications, or blood and urine cultures, as RSV-related bronchiolitis can occur with an accompanying urinary tract infection in young babies.
When to seek medical care
According to the American Lung Association, "a barking or wheezing cough can be one of the first signs of a more serious illness. In these instances, the virus has spread to the lower respiratory tract, causing inflammation of the small airways entering the lungs. This can lead to pneumonia or bronchiolitis."
If you notice your infant has short, shallow, and rapid breathing, this can indicate a severe RSV infection.
Signs that your baby is working too hard to breathe can look like:
- A "caving-in" of the chest in between / under the ribs (these are called chest wall retractions, and you'll be able to clearly see the outline of your child's ribs as their body works hard every time they inhale);
- A "spreading-out" of their nostrils every time they breathe (like they're flaring their nostrils with every breath);
- Abnormally fast breathing (this is because they're not taking normal, full breaths; they're taking shorter, shallower breaths that don't last as long); and
- Their mouth, lips, and / or fingernails could appear to be bluish in color (this is due to lack of oxygen from taking shorter, shallower breaths).
Monitoring symptoms across the board
If you suspect your babies or toddlers are feeling under the weather, it's important to monitor their symptoms to see if their condition worsens.
Write things down or keep a note on your phone, and label them separately for each twin, so you can easily track how each of them are doing.
Take their temperature as soon as you notice something might be stirring and track it throughout the day. Fevers tend to spike in the evening and can last a few days.
TwinsyTwins Shop
Medical Digital Thermometer by BIOS
Accurate Temperature Readings
This is a medical digital thermometer by BIOS. It's got memory recall, so you can easily compare a new reading against the most recent one taken (just make sure you're comparing readings from the same twin if you're taking temperatures for both of them throughout the day). It can be used to take temperatures orally, rectally, or axillary (underarm), and it can switch between Celcius and Fahrenheit. It also has an auto-off function, so you don't have to worry about shutting it off when you're focused on your little ones' well-being instead.
When taking an axillary temperature on your baby or toddler, make sure their armpit is dry and that the thermometer is touching skin only and not any part of their clothing. And remember that an axillary temperature isn't as accurate as an oral or rectal reading, so if an underarm reading tells you your child is at 99 degrees Fahrenheit, that means they're in low-grade fever territory.
A temperature that goes down by one or two degrees with medication and then rises again as the medication wears off is normal (still, take note of each temperature reading and be wary of high fevers).
But if you notice your baby's temperature doesn't go down shortly after you've administered acetaminophen or ibuprofen, it's important to seek medical care. When fevers don't go down with medication, they need urgent and immediate care, especially if they're younger than three months old, showing signs of dehydration and / or difficulty breathing, have a severe rash, or are extremely lethargic.
Know when to seek help
Now that spring has sprung, flu and RSV seasons are mostly behind us, but it's important to remember that some respiratory viruses can continue circulating as late as May.
If your babies were born early (as multiples often are), they're at a higher risk of adverse outcomes from respiratory illnesses, so it's crucial to monitor their symptoms if they get sick.
Recognizing the difference between "normal symptoms" from a mild illness and the more severe signs of respiratory distress that can be caused by flu and RSV viruses can help you know when it's time to seek urgent care.
Keeping clear records and taking timely action can help keep your kids safe and, hopefully, prevent adverse outcomes for your little ones who are at a bigger risk if they find themselves fighting one of these infections.
Have your twins ever had retractions from a respiratory virus? How do you monitor symptoms for your preemies? Let us know in the Comments section below or connect with us on Instagram to share your thoughts!
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