Rhinovirus In Babies

Overview

Rhinoviruses are also known as the common cold viruses. They cause several of the cold-like illnesses babies experience. Usually, rhinoviruses cause acute respiratory tract infections, which is usually an upper respiratory tract infection but can be an infection of the lower respiratory tract in some cases. ¹ These viruses were discovered sometime in the 1950s and have a very significant impact on the economy because they are responsible for most of the hospital visits annually and missed work by parents of infected babies. ¹

Rhinovirus infection can occur throughout the year, but it peaks during early autumn and in the spring. There seems to be a relationship between having rhinoviruses and bacterial infections, as most babies with rhinovirus infection also have sinusitis or otitis media of bacterial origin. Your baby could also develop other respiratory diseases like asthma or bronchitis as rhinoviruses have also been linked with these. ⁶

Risks and sources of rhinovirus infections in babies

Rhinoviruses can infect anyone, including babies. However, the following are risk factors for your baby contracting this virus easily:

• Spread via respiratory droplets from coughing and sneezing in an infected person.¹
• When your baby touches infected surfaces/objects (sometimes called fomites) and then touches the eyes, nose and mouth
• Close personal contact
• Daycares are also another point of spread.⁴
• Babies who are not properly breastfed are more at risk of being infected.³
• Smoking close to your baby.  The cloud of toxins and particulates from smoking can reach surprisingly far, up to 25-30 feet.²
• The fact that babies generally have weaker immunity and can easily get infected by organisms, especially viruses
• Hospitalised babies are also at risk.^1,5

Signs and symptoms of rhinovirus in babies

It takes between 12-72 hours for your baby to begin showing symptoms of rhinovirus infection. After this, symptoms generally last 7-11 days or longer. Symptoms in babies include:

• Nasal congestion/even a runny nose
• Colourless nasal discharge, which may subsequently become yellowish or greenish (this colour change signifies a coexisting bacterial infection)
• A red/inflamed nose
• Nasal dryness
• Sneezing
• Cough
• Sleeping difficulty
• Refusal of feeds
• Enlarged lumps (lymph nodes) around the neck

However, you should seek urgent medical help if your baby is less than 3 months old and any of the following symptoms appear:

• Fever greater than 100.4^oF/38^oC
• Reduced urine output (predominantly dry nappies)
• Ear pain
• Unusual irritability
• Red eyes, or the development of yellow or greenish discharge from the eyes
• Trouble breathing/wheezing/bluish lips or skin (cyanosis)
• Persistent cough
• Vomiting after coughing
• Coughing up blood
• Thick green or yellow nasal discharge for several days
• Unusually low energy or sleepiness

Diagnosis of rhinovirus infection

Mostly, diagnosis takes the form of physical examination and discussion of the symptoms. When you bring your baby to your healthcare provider, you'll be asked about the symptoms you notice, which are mostly respiratory symptoms, including runny nose/nasal congestion, fever, restlessness and so on. These symptoms give away a viral infection hence, performing some laboratory tests may not be necessary. However, blood tests and a PCR (polymerase chain reaction) test may be done to identify the virus involved.¹

Management and treatment for rhinovirus in babies

Rhinovirus infection typically goes on its own within 5-14 days, meaning it is self-limiting. Your baby just needs some supportive care to alleviate the symptoms. The major principles of management involve:

• Rest
• Taking enough water
• Use of antihistamines and/or NSAIDs (not for babies less than 3 months old or less than 5 kg in weight)
• Use of nasal decongestants
• Disinfecting the environment
• Ensuring proper hand hygiene before nursing your baby
• Elevating your baby's mattress to an angle of 45°
• Use of nasal saline drops and bulb-syringing the nostrils
• Adequate humidity to soothe nasal dryness

FAQs

How is rhinovirus in babies diagnosed?

Doctors ask you questions about the symptoms your baby is experiencing. These symptoms could be cough, nasal congestion or runny nose, loss of appetite and even fever. Explain these symptoms to your doctor. Tests are not typically done when there's a suspicion of rhinovirus infection as it is plainly a viral infection but in unusual cases, some special tests such as a PCR could be conducted.

How can I prevent rhinovirus in babies?

It is important to take note of preventive measures against rhinovirus infection. There are, however, no vaccines for rhinovirus infection. Preventive measures include the following:

• Wash your hands regularly. Do this, especially after contact with surfaces or objects, sneezing, coughing and blowing your nose. In the absence of water, use an alcohol-based rub to sanitize your hands before touching your baby.  
• Keep your baby away from ill people. This is important because babies have an immature immunity, which can predispose them to getting easily infected.
• Keep your baby's toys and pacifiers clean. This is important because babies regularly touch their face, nose and mouth with their hands. Also, keep clean surfaces that your baby often comes in contact with
• Review the care centre you intend to enrol your baby into.  Check out their hygiene policies as well as policies guiding keeping sick babies at home to prevent infection of other healthy babies.
• Encourage proper sneezing and coughing practices. Members of your household should be encouraged to cough and sneeze into a tissue or their elbow while covering their nose and mouth to prevent the spread of infection to your baby.

What are the risk factors for rhinovirus in babies?

The risk factors for rhinovirus in babies include:

• Immature immunity. Your baby's immunity isn't as strong as yours. They can get infected easily once in contact with the offending organism.
• Cold season. Rhinovirus infection (common cold) is very common during the cold seasons.  Your baby can get a cold at another time, but spring and early autumn are peak seasons for this viral infection.
• Smoking. Smoking close to your baby can predispose your baby to a rhinovirus infection ²
• Exposure to infected individuals. If your baby comes in close contact with a coughing or sneezing individual who is also infected with rhinovirus, your baby could get infected as well.
• Crowded settings. Babies in crowded places like daycare are more easily infected. 

What are the complications of rhinovirus in babies?

These conditions can complicate the common cold:

• Acute ear infections. Otitis media is an infection of the middle ear and is the most common complication common cold 
• Asthma. Common colds either cause or worsen asthma in a baby
• Sinusitis. Common colds can lead to infection of the sinuses
• Other complications. Bronchiolitis, pneumonia and croup are other complications of the common cold.

How common is rhinovirus in babies?

Common colds are very common in babies. It is normal for a child to have up to 6 -8 episodes of colds per year. In fact, at certain times of the year especially when the temperature gets cooler, cold episodes become more frequent.

When should I see a doctor?

Normally, when babies develop a common cold, it resolves on its own within 5-7 days (possibly 10-14 days in younger children), especially in the absence of complications. But you should be vigilant and monitor your baby's symptoms closely. If you notice that the symptoms aren't resolving, you should consult your healthcare provider. However, in babies less than 3 months, any symptom should be taken seriously. Your doctor should be told about these symptoms to decide whether medications should be given. Generally, you should seek medical attention in the presence of the following symptoms:

• Refusal of feeds
• Bluish discolouration of your baby's lip or skin
• Breathing difficulty
• Distressing cough that leads to vomiting
• Temperature higher than 38°C
• Weakness and inability to sleep
• Red eyes with greenish/yellowish discharge
• Thick nasal discharge that is greenish and persistent for several days
• Ear pain and irritability

Summary

Common colds are usually caused by rhinoviruses. This infection peaks during the cold seasons of the year, and babies are the most affected. You can protect your baby by observing necessary hygiene measures. However, note that it is pretty normal for your baby to have colds several times in a year, but make sure you watch out for complications and a protracted disease course. Once any of these is discovered, you should inform your health provider.