What pediatricians should know for the upcoming respiratory virus season

Pediatricians preparing for the fall respiratory virus season should focus on vaccine access, practical prevention strategies, and helping families recognize when a sick child needs medical evaluation, according to Lori Handy, MD, MSCE, associate director of the Vaccine Education Center at Children’s Hospital of Philadelphia and a pediatric infectious disease physician.

Handy noted that clinicians enter each fall with uncertainty about the severity of respiratory syncytial virus (RSV), influenza, and COVID-19 activity. This year, measles also remains a concern. Regardless of which infections predominate, practices can take steps to prepare families before illness occurs.

How can pediatric practices improve vaccine access?

One priority is ensuring that families who want vaccination can receive it without unnecessary delays. Handy said limited appointment availability can undermine confidence among parents who are actively trying to protect their children.

“The worst thing is a family who says, “Gosh, I actually do really want to get vaccinated for flu this year,” and calling up and finding out the next availability is December 4th at 10:00 a.m.,” Handy said. “And that really makes that family less confident in the health care system, lose some trust, feel like, “I'm trying to do the right thing, help me do the right thing,’.”

Practices can also set realistic expectations about vaccination. Respiratory vaccines do not necessarily prevent every infection, Handy explained, but can reduce the likelihood of severe outcomes.

“We are not trying to eliminate respiratory infections with vaccines. We are trying to make them less bad,” she said. “So we might vaccinate a child for flu and COVID and RSV, and they could get any one of those, but ideally we are keeping them out of the emergency room, out of the hospital, out of the intensive care unit, and that's really the goal.”

Does identifying the specific respiratory virus always matter?

Although circulating-virus trends can help clinicians interpret symptoms, Handy said identifying the specific pathogen is often less important than determining what care a child needs.

Influenza can be an exception when testing could influence antiviral treatment, particularly for very young children, hospitalized patients, children with high-risk conditions, and immunocompromised patients. For many other children, management centers on supportive care and clinical assessment.

Preventive counseling should also include basic infection-control measures. Handy recommended good hand hygiene and keeping children and adults home when they are ill, regardless of whether COVID-19 testing is negative.

“The name of the virus doesn't matter, the fact that you have a respiratory infection that you can spread to other people with all of this coughing and germs that are on your hands and you're touching everything, that's the thing we want to avoid,” Handy said.

Which warning signs should prompt medical assessment?

Pediatricians can also use anticipatory guidance to help caregivers recognize symptoms that warrant evaluation. Handy identified increased work of breathing, low oxygen levels, dehydration, altered mental status, reduced urination, and unusual sleepiness as warning signs.

She emphasized that clinicians should encourage caregivers to seek assessment when they are uncertain about a child’s condition rather than worry that a visit may prove unnecessary.

“Bring that kid in. See them. Look at them. Help that parent learn because it's really, really scary to be at home as the parent and think, I don't know if my child's sick or okay,” Handy said.

Even when examination provides reassurance, and the child can return home, Handy said the visit can still help families understand what to watch for as the illness progresses.

“That's still a worthwhile visit, and we want those to happen,” she said.