[00:00:02] Speaker A: Hello and welcome to a Wonder Care podcast. I'm Sheena Mitchell, a pharmacist and mum of three. I combine healthcare and practical advice to support you on your parenting journey. RSV the respiratory sensational virus. It's one of those viruses that many people have not heard of. Some people may have heard about it, but they don't know what the symptoms are, and a smaller percent will know about it, usually because one of their friends children or their own children have experienced it. RSV infects most children by the age of two. It's the leading cause of hospitalizations in children under four years of age. 70% of children who end up in hospital as a result of RSV are perfectly healthy. So it's not just badly affecting children who have underlying health conditions or those who already struggle with their respiratory health. This can affect any baby in a way which can be mild or severe, and at the moment we don't understand why that is. I'm really glad today to be joined by Sheila Shoaga. Sheila, of course, is host of the amazingly successful podcast ready to be real. I think it's safe to say that she was a household name before her podcasting days, with many appearances on tv and in general just for her and her family's love of the irish language. I'm grateful for Sheila for coming on the podcast today to share her story of RSV, because I think it is only through talking and relating to other families that we learn. So just before I talk to Sheila, I just want to highlight that RSV can be very mild, and in some kids it'll just cause a runny nose and cold like symptoms. But in other children it can cause a condition called bronchiolitis. Bronchiolitis happens when there's an infection within the bronchioles. These are tiny little airways in your baby's lungs that are vital in delivering the right amount of oxygen into your baby's bloodstream to allow healthy bodily function. RSV, the viral infection, causes inflammation and irritation. It can make it difficult for your baby to breathe. This is why this disease is so confusing. In one child they'll have just a bit of a runny nose, and in another they'll have difficulty breathing and end up in hospital. I recently joined the RSV Forum of Ireland and hopefully through that, with a multidisciplinary approach with lots of different healthcare professionals, progress will be made and research will be done to understand why RSV affects some children so differently to others. Mainly, RSV is seasonal and tis the season. I'm afraid most cases occur between November, well, now October and March, but actually it can happen any time of the year. Unlike some other viral infections, you can suffer from it more than once each winter. It spreads in the same way as any other viral infection, through coughs or sneezes of infected people. The incubation period for RSV is about two to seven days, so this means after your child is exposed to it two to seven days later, they'll develop symptoms. The symptoms usually peak three to five days after that, and it does usually resolve itself within two to three weeks. So, as I said, there symptoms can vary from a runny nose to a cough, which is very persistent and dry. They can have a mild fever that will happen in about 30% cases, difficulty breathing, wheezing and poor feeding. It is not an illness that helps with hydration, so signs of dehydration are really, really important to watch out for. I've done a couple of other episodes on this, so I'm not going to linger too long on the signs and symptoms, but if you just go to my website, wondercare ie, and enter RSV in the search bar, you will find the episodes relating to this topic. In those, you'll find lots of more information all about the signs, symptoms and when you need to see the doctor. But for now, I want to explore Sheila's journey with RSV and hopefully we can all learn something from that too. [00:03:55] Speaker B: Thank you so much, Sheila, for joining me today to talk about your own experiences of RSV. Before we dig in, can you tell me a little bit about your children? [00:04:04] Speaker C: So, my little boy is six. His name is Kahal, and my little girl is nearly two, so she'll be two in November. Her name is Kleena, and yes, they've both had RSV now, so I am experienced at this stage, but rewind. Before I became a parent, I didn't. [00:04:23] Speaker B: Know anything about it and I think that's really common. Had you heard of the term RSV pre motherhood, or was it something that was on your radar at all? [00:04:32] Speaker C: It wasn't on my radar. I perhaps heard of the term, but if you were to ask me to describe the symptoms of it, I wouldn't have been able to give you any. I'm pretty sure that's about as far as my knowledge went of RSV, so no is probably the short answer to it. I didn't really know anything about it. And of course then when my kids got it, I certainly had to learn and learn quick about the symptoms. [00:04:54] Speaker B: It's one of those illnesses that people have heard of, they don't fully understand it. And when it comes to the respiratory distress that can come as a result of bronchiolitis induced by RSV and even pneumonia, it can be very, very frightening very quickly and even for the most relaxed mom, a mom of healthy kids, who I always thought I take things in my stride, but this is one of these situations where fear really comes into play. So how did it happen and evolve in your household, and did you get that sense of fear, and how did you manage that? [00:05:29] Speaker C: Definitely. I definitely got the sense of fear and kind of came out of the blue in a sense that I suppose it was prime time for colds and flus and all the usual things. The most frightening experience of RSV was when Cleana was only four months old. So she starts to present with the normal sniffles, blocked nose, just generally under the weather. But initially, I just assumed it's another cold. It's normal for this time of year. She wasn't improving, and I brought her to the GP and he said very quickly that it looked to be RSV, and he had prescribed a baby inhaler. So it's the inhaler with the spacer, the mask that goes over their mouth, nose, that helps them to breathe. And he said, look, you can use this. It'll help their airways, because I suppose with babies, when they do get bunged up like that, and there's a lot of phlegm, they don't know how to blow their nose, they don't know how to clear it. So between that and the nasal sprays, that was kind of all we could do and keep her comfortable. But, yeah, she wasn't taking her feeds as often as she would have, so it was nothing frightening. Like, she didn't stop feeding altogether, but it just wasn't the same. So she was just know. But anyway, we were reminding her, and that was fine. But there was one day in particular where she just seemed to get worse pretty quick. And it was late, and neither myself or my partner, Damien, wanted to go to bed, I suppose, without getting her seen to. And at that stage, really, the only option was to go into. You know, the four of us piled into the car. We had to get Kahal up out of bed, and Damien and Kahl drove around while I went into Krumlin emergency department to get her seen to. So we were there for hours, and obviously it's a busy department, they're incredibly stretched, they work really hard, but there's a lack of staff and a lot of people that need a lot of care, and there were a lot of babies in there, and we did get seen to, and she was monitored for some time, and they were saying, yes, she has a lot of phlegm on her lungs, on her chest, and they were monitoring her breathing and doing various tests. And that was scary. The weight was very scary. The weight in the waiting room just sitting around that not being seen to your brain will go to scary places because this is your most precious little being. And she was so small. She was only four months. So I remember that being pretty terrifying again, I suppose once she was seen to, there was a level of comfort that came with that, because at least the professionals now are here and they're taking a good look at her. And after a number of hours, they were confident to let us home. They basically said, look, she's actually doing well, considering. There was initially kind of talk about perhaps suctioning the phlegm off, but they didn't feel it was necessary in the end, and they sent us home. And it was basically just the advice to keep her comfortable and keep doing what you're doing. And luckily, within a few days, she turned a corner. But definitely it was frightening, and I think it's the age that she was that was particularly scary. They're so vulnerable when they're so young. I certainly learned a lot about RSV at that point, and it's something that I would be mindful to tell other friends who have young babies to just be aware, just be aware of the symptoms, because it presents as if it's a common cold initially, but it obviously can change quite quickly as well into something more serious. So I suppose, really the most important thing is to follow your own gut instinct, your parental, your maternal instinct. And it was the right call. I mean, luckily, they effectively said what we were doing was what we needed to be doing and that she was okay. But I don't think I would have slept that night had we not gone in for her to be checked. And I didn't want to go into a sleep for fear that something might happen in the middle of the night. So it was the right decision to make. [00:09:02] Speaker B: 100%. And I think you hit the nail on the head there. Gut instinct is always a very powerful tool for parents, and they are so vulnerable and the health service is so overstretched and that you kind of are somewhere torn between the guilt of burdening the health care system and then just the absolute fear of not doing everything you can for your baby. And we know that RSV is the leading cause of hospitalization. In children under four. And we know that 70% of the children who end up hospitalized aren't the at risk kids that you may think they would be. They're perfectly healthy children with no underlying conditions. So it's one of those things where the flu or any cold or even Covid, you can monitor them safely and more easily at home. But with RSV, when people come into the pharmacy, it's the one thing that I'm like, maybe do get up in the middle of the night and even co sleeper, depending on your own personal situation, because the breathing can deteriorate so rapidly. So it is one of those ones that you have no choice but to go into the hospital. So it's 100% the right call. [00:10:06] Speaker C: Yeah, that's the thing with Cahol and Cliana, as you said, we're very fortunate that they don't have any underlying health conditions. So everything seems normal, they seem healthy, but nonetheless, it definitely manifested in such an obvious way in Kleena, especially. Daikahal got it as well, but he know that. Bit older, maybe more robust, but certainly it's not necessarily that she was struggling to breathe, but it was definitely strained. Her breathing was strained, and that's a frightening thing to see in your baby and the helplessness you feel. I'm glad we didn't take any risks, and I'm glad we got in the car and we drove in. We were all extremely tired getting home, but it was a relief. It was fantastic. And I felt very lucky that we were able to come home because I have a friend who found herself in a similar situation whose baby is very similar in age. There's only a few weeks between them. Her baby ended up being kept in Crumlin for four nights. And they did have to suction the phlegm off baby's. You know, that was an ordeal for them, though. I think awareness is huge, and I think having these conversations with each other and normalizing on a platform like yours is really helpful. I would have loved to have heard a conversation like this. Not even when Cleana was a small baby, when Kahla was a small baby, because I wasn't as aware of it while he got it. I don't remember him getting it as a small baby now. He did get it from whoever picked it up. It could have been me. I mean, I don't know, like all these things. Who picks up the virus? Nobody knows, but he possibly had it as a baby. But maybe I didn't recognize that's what it was. [00:11:30] Speaker B: And this is the whole thing because the majority of children will have it by the age of two. And for some children, and there's no. Right, this is why there's a lot of research going to be done in this area, because there's no reason why one child will just suffer from mild cold like symptoms and the second will develop into severe bronchiolitis, potentially with breathing difficulties, which will end up requiring a three day hospital stay. There is no difference between the two children that that will happen to and none that we can see at the moment. So there's a lot more work to be done there. And again, just like you said there you had two healthy babies. So for the people who have maybe high risk babies, they're already on alert, and a very small group of them will already be on treatment to help them cope with severe respiratory disease. And so in a way, they get the education forced upon them. Whereas as a mom of healthy kids, I don't remember seeing it in any like, obviously, I'm a community pharmacist, so I was aware of RSV, but I certainly don't recall seeing it in any of the pregnancy literature or being told about it significantly in postnatal care. It's only through conversations like this that awareness spreads. And I think more work could be done on that, on patient education. Just so that you can know that it's one of those conditions that can whirl out of control rather quickly. [00:12:46] Speaker C: Yeah. [00:12:48] Speaker A: I am delighted to partner with one of my all time favorite products, salon plus. This is the world's 1st 100% natural dry salt therapy device. It's clinically proven to relieve a wide variety of allergens and respiratory conditions. This salt therapy method has been trusted for generations and has become hugely popular worldwide. As more and more people recognize the superb results achieved from a natural and noninvasive method, this device will help you breathe easier and sleep better. [00:13:19] Speaker B: One of the big problems with RSV is like with COVID or with any other viral illness, it spreads through contact. And as you said, it doesn't matter who brings it into the house or how it comes in. But a big thing that I spent a lot of time talking about earlier this year and the end of last year was vigilance, especially for the under three month age group in, I suppose, protecting them because their immune systems are so underdeveloped and they don't have antibodies. They are the age group who are most likely to be hospitalized for Morris C. And it's that whole piece of hand hygiene, obviously, all of that. And then there's the other slightly more controversial piece of not letting people touch and cuddle and kiss your baby, which is so hard. Like, I had three children and I was like the Lion King, like, holding them up, delighted with myself, wanting everyone to see them. But at this time of year in particular, with so many viral illnesses circulating, it is important to try and protect them to a certain extent. Was that whole cocooning situation? [00:14:20] Speaker A: Yeah. [00:14:20] Speaker B: Did you find that hard? I'm trying to think of the timeline. So obviously cleaner would have been a problem. [00:14:25] Speaker C: She was born in baby. Yeah, she was born November 2021. So smack bang in the middle of the season for all of these viral illnesses. And I actually did find it hard. I did find it hard, but I also feel like if you are somebody, I mean, I'm not exactly shy, I suppose, but in saying that, I wouldn't be the most forceful of people either. And I think it's an opportunity when you become a parent, to actually step up and speak up if you feel you need to. Because a lot of us, and I think it's ingrained in the society that we live in, that we're quite people pleasing by nature and we don't want to put people out and we don't want to come across as rude or whatever, but when it comes to your most precious little beings, you do want to protect them. So it's your opportunity to kind of step up and be the mama bear who will say, you know what, I'm just not comfortable with this. I think there's a way of delivering the information that is as gentle as it can be, but is also as firm as it can be. So for us, did I stop everyone from cuddling her? I didn't, if I'm perfectly honest. But what I did do is everyone that came into the house had to wash their hands really well. And if anyone had any sign of any sort of a sniffle, no, it's not cool. But nobody had a problem with it either. I wasn't a big fan of lots of visitors in the early days. I just wanted to do skin on skin and cuddle my baba. And actually, I just didn't want people around me anyway. So we didn't have a huge amount of visitors because people kind of knew that's what I wanted. I actually loved the simplicity of the baby bubble. But, yeah, I mean, obviously when the likes of my mom would come, like she's a grandmother, I would find it very hard to say, no, you can't hold your own grandchild, your only granddaughter. I would find that really hard. But she wouldn't dream of holding her ar Kahal if she had a cold either. But I know the thing is, with a lot of these things, sometimes we don't know that we have them. So it's a really hard one to navigate. It's very, very hard. I will say that I think maybe. [00:16:20] Speaker B: The easiest thing of all is to. [00:16:21] Speaker C: Try and keep visitors away for those early weeks as much as you can, because then if they're not coming to the house, then you don't have to have that awkward conversation. And sometimes people just assume it's fine and go straight to the baby and lift them up and they think that's okay. So I think maybe just keeping people away altogether, but if they are coming, wash your hands really well or admire them from afar. But look, I'm not going to lie, it's not an easy chat to have. But if you can have it, do, and people should understand, and if you verbalize it clearly, the reason I'm doing this is nothing to do with you. I would love you to hold him or her, but there are so many viruses circulating at the moment. None of us know if we have them at the moment, we could have something we don't even realize. So just to keep babies safe, and anyone you'd explain that to, any reasonable person will agree with that and say, oh God, absolutely, no problem. [00:17:10] Speaker B: Yeah. And it's 100% like you said, how you deliver it. So I'm always like, yeah, to my husband, maybe you deal with your in laws and just fling them, text and be like, but you're right, of course you're going to let the grandparents hold their grandchildren. There's no question at that. I suppose it's more your friend coming over who maybe has a few toddlers or whatever that are going to crash. And it's just navigating that. And it is delicate and it is difficult, but as you say, anyone reasonable will understand. And I actually recorded a podcast on this last year about this. And unfortunately, it's not just seasonal because we have things like neonatal herpes that comes from the cold sore virus. And unfortunately, I had a lovely chat with a woman on the podcast who lost her baby to neonatal herpes. Okay, I know that's the worst of the worst case. That's the absolute. [00:18:02] Speaker C: But it can happen. [00:18:03] Speaker B: It can happen. [00:18:05] Speaker C: And that's probably just from kissing, baby. [00:18:08] Speaker B: Kissing, or maybe touching, even the blister and then touching. So easy. But I think ultimately, just respecting that, that kind of three month period, you can't wrap them in bubble wrap but you can do kind of close to it. And what you said is a great way of just making sure that there isn't a constant flow of people through the house. And like you said, easier for moms as well, to just be in their pjs, cuddling babies and enjoying that little time where you do get to relax and bond and work on feeding or whatever, you're. [00:18:37] Speaker C: Exactly, exactly. I think I was lucky because in the sense that with Cleanda being a winter baby born in November, there was an element of that kind of just, we're going to camp in, we're going to light the fire, it's going to be cozy, and we're just going to do our own thing. There was a feeling of that coming into the Christmas. Well, Christmas we were with families. We wanted to go visiting both sides of our families, because we were living in Dublin at the time. My partner is a corkman, I'm from Galway. So we were interacting with more people. So I remember feeling a bit nervy at the time. But look, we did it as carefully as we could and we were okay. We got through the Christmas. But, yeah, it wasn't until then, as I said, she was four months old, so you're talking like March, and, I mean, RSV season is now. It's October to the end of February. But I know, and you know, obviously far more about this that it can actually present sooner and later than those dates as well. And particularly after the summer we've had, the weather has been shocking. A lot of these viruses then can linger for longer. [00:19:36] Speaker B: And we found that looking at the figures over the last two years. So, obviously, there was the COVID year where there was no RSV. The only way to get rid of RSV is bring in a lockdown, which obviously is not anything any of us want to talk about ever again. However, since the lockdown, the subsequent years have had really high, really early rsv seasons and levels three to four times what existed pre Covid. So it's become much more of a problem. And that could be down to the fact that a lot of children don't have immunity because they didn't have a chance to be exposed to the virus when they were, I suppose, stuck at home even when they were one, too. So it could be an element of all of that. Plus, just as you said, even conditions. And everyone's so joyous to be back out in the world and visiting people, that these things circulate more freely. But it is something that's being looked at, the possible causes for why it's peaking so early. So I think anytime from now on is just a time to remember, okay, RSV, my child has a cold. That's fine. No one should stress about health. Health anxiety is not what we're trying to do here, but just to have it in your mind that if your child is starting to get very mucusy or if their breathing is getting shallow or quick, that do seek help, you're not overreacting. And as you said, sheila, gut instinct is everything. [00:21:01] Speaker A: Really? [00:21:01] Speaker C: Yeah, for sure. I found it interesting as well, to learn that with RSV, while, because I suppose I would have made the assumption that, okay, baby gets it once, the next time they get it, it'll probably be milder because they'll have built up a certain immunity. But what one of the experts was informing me was, while one child might get it and might get it, the symptoms very strong first time and then milder the second time, it can be completely the opposite for another child, where they get it mild the first time and then have really strong symptoms the next time they get it. So that's also something I think that's important for us to be aware of, that you're not necessarily out of the woods if you get it that one time or your baby gets it that one time. But luckily, I suppose the key timeline is from newborns to the age of two, and after that, the symptoms seem to lessen. Isn't that right? [00:21:48] Speaker B: It is, but there's a kind of caveat to that, because, again, you raised a really important point, so you can get repeat infections, and there is actually another group who are really vulnerable to the effects of RSV, and that's the elderly. So we always tend to think about RSV as a disease that impacts babies. And the reality is that no anyone with a vulnerable respiratory system or anyone with a vulnerable immune system and even healthy people. But it does present, and we've seen that in the data over the last several years, that the two groups who end up in hospital from RSV are both babies and the very elderly. So both spectrums. That's a good thing for people to be aware of, because if your baby is sick at home, and obviously, it depends on your situation, but I'm married to a scottish fella, so his parents are no good to us, unfortunately, when the baby is sick. But you might call on your mom or whoever to come and mind them. And if you have an elderly parent minding a baby with RSD, you do have to consider that the elderly parent is also potentially at risk of RSV. [00:22:57] Speaker C: I didn't think of that. I'll be honest. Every day is a school day. And thank you for that. Of course. And it makes sense. It's very easy to get RSV confused with COVID because the symptoms can be quite similar, can't they? [00:23:09] Speaker B: Yes, very much so. And Covid, the fact that Covid keeps evolving and the symptoms keep changing in presentation is frustrating. I suppose there's pros and cons to this, but you can actually do a home test, just like you can for Covid. You can do that for RSV as well. This comes down to the point of, are you going to act any differently whether you have a positive screening test or not, realistically, it doesn't impact the actions that you can take, because you should still be watching the symptoms. Like, just because you get a positive Boris v test does not mean that you need to go to the hospital. Your child might just have the runny nose and that's absolutely fine. Whereas if they have any difficulty breathings or, as you said, feeding dry nappies for more than 12 hours, any signs of dehydration, anything like that? Drowsiness, lethargy? These are all signs that regardless of what illness it is, you need to go and be seen by a healthcare professional. So there is merit in them, in that it can increase your vigilance. And if you're someone like me, who is a complete information hungry nerd, I swab everyone for everything, all the time, because curiosity just gets too much for me. I was the same when I was trying for babies. If there was a stick I could pee on, I'd be peeing on it. I love testing things. So there is pros and cons, and you do have to balance being caught up in obsessing about these things and just actually stepping away and just responding to your baby's cues as if. Same thing as when you're trying to. [00:24:49] Speaker C: Get them to go to sleep, you. [00:24:51] Speaker B: Have to lean into it and just respond to their symptoms. And gut instinct is more powerful than any test in that situation. [00:24:58] Speaker C: That's across the board, really, isn't it? [00:25:00] Speaker B: 100%, yeah. [00:25:01] Speaker C: And it's worth mentioning that Sanofi recently launched a brilliant website as part of their campaign together against RSV. And it's full of information for parents, for mums to be and caregivers about the signs and symptoms, the risk groups and the ways to prevent infection. So that's a brilliant thing to know about as well. [00:25:18] Speaker B: Thank you so much, Sheila, for sharing your story, because increasing awareness of RSV improved patient outcomes by empowering parents to know how to respond and what to expect from the symptoms of RSB. So I really, really appreciate you coming in to chat today, all about it, and sharing your story. [00:25:37] Speaker C: Thanks for having me.