Last year, Cook Children’s Medical Center experienced the worst respiratory syncytial virus (RSV) season since before 2017, with the peak hitting in October 2022 when hospital admissions for RSV rose above 300. At the same time, Cook Children’s Emergency Department and Urgent Care Centers were overwhelmed with RSV cases, seeing 500+ patients a day. Nationally, RSV sends anywhere from 58,000 to 80,000 children under 5 years old to the hospital each year, according to the Centers for Disease Control.

But future RSV seasons could look different, thanks to a new tool in fighting the virus.

In July, the U.S. Food and Drug Administration approved Beyfortus™ (nirsevimab-alip), a one-time monoclonal antibody injection for the prevention of severe RSV.

The injection is not technically a vaccine, as it does not provide lifetime immunity, nor is it a treatment. Beyfortus is a temporary antibody boost to a child’s immunity to get them through their highest RSV risk period, according to Nicholas Rister, M.D., an Infectious Diseases physician at Cook Children’s Medical Center. The American Academy of Pediatrics recommends Beyfortus for infants 8 months old and younger entering their first RSV season and children up to 19 months at increased risk for severe RSV and entering their second RSV season. In Texas, the RSV season typically begins in the fall and stretches through the winter months.

Cook Children’s doctors say the new RSV monoclonal antibody shot could be a game-changer when it comes to reducing severe infections and hospitalizations, and it's been a long time coming.

“The last time someone tried to develop an RSV treatment for infants that was preventative, I had not even started medical school,” Dr. Rister said. “So the fact that we now have a treatment option for infants for the first time in like 20 years for one of the most prominent diseases on the planet. That's so huge.”

While this particular use of monoclonal antibodies for the prevention of severe RSV is new, Dr. Rister says monoclonal antibodies have been used for hundreds, if not thousands, of indications for over a decade.

Clinical trials of Beyfortus show it reduces the risk of hospitalization for RSV by 75%, which could take a huge burden off of hospitals during peak respiratory virus season.

“We're talking about a disease that, during some respiratory seasons, is more than half of the admissions to the hospital,” Dr. Rister explained. “If you even drop that by half, which this is claiming to be able to do more than that, we're talking about massive reductions in the number of children getting sick enough to end up in the hospital, and massive reductions in the burden at the hospital during respiratory seasons, which hopefully will lead to even better care for the community at large.”

A welcome relief

It’s a welcome relief for Karen Schultz, M.D., medical director of Pulmonology at Cook Children’s. During peak RSV season, it’s not unusual for her to consult on five to 10 new babies with RSV each day in the Pediatric Intensive Care Unit (PICU). The new antibody shot could drop that number significantly.

“It’s good for our clinicians’ work-life balance during these very busy months, but it’s even better for these babies and families to not have to be in the PICU,” Dr. Schultz said.

As a neonatologist in Cook Children’s Neonatal Intensive Care Unit (NICU), Darryl Miao, M.D., cares for babies at particularly high risk for severe RSV due to their prematurity, underdeveloped lungs and other risk factors like congenital heart disease. He says the new antibody shot gives him more confidence that the babies discharged from the NICU won’t end up back in the hospital with RSV.

“I'm excited that all the data shows that there's less hospitalizations, less morbidity, and makes babies better able to fight off RSV in their first year of life.” Dr. Miao said. “I do expect to see less hospitalizations all across the board, including from our NICU population after discharge. That part is really exciting.”

When Vanessa Charette, M.D., a pediatrician at Cook Children’s Pediatrics Fort Worth – Magnolia, had her first child 17 years ago, RSV was one of her top concerns for her baby. As a physician, she knew all too well how sick the virus can make little ones.

“As much as I had the ability to control things, I tried to have him so he would not be a newborn in the winter during RSV season,” Dr. Charette said. “I was so concerned about him getting the virus in the first month of life that I tried to have a baby that would be delivered in the spring rather than later in the year.”

As both a mom and physician, Dr. Charette is thrilled that the new RSV monoclonal antibody can potentially release parents from this burden.

“We’ve been waiting on something, and I think many families have been waiting on something, like this,” she said. “Maybe they’ve had an older child who had RSV and now they’re having their third baby and maybe they’re worried about their new baby getting RSV. It can be the most severe respiratory illness that babies have in their first year of life, and to finally have a tool to prevent it, that’s exciting.”

What parents need to know

We asked each of these physicians to share with us the most important thing they want parents to know about the RSV monoclonal antibody injection when considering it for their child. Here’s what each of them had to say.

Dr. Miao: “I would say, first of all, that it's not a vaccine. It's actually an antibody, and a similar mode of protection against RSV as one that has been on the market and used for NICU babies for 10+ years. The difference between the two is Beyfortus is one injection that will last about five months, which is usually the entirety of the RSV season, as opposed to a monthly injection of the other throughout RSV season. Beyfortus is also recommended for healthy children, unlike the other which is reserved for our highest risk NICU babies.”

Dr. Schultz: “The safety profile of the new antibody shot, when they have done comparative studies with a similar drug we’ve used for a lot of years and has been very safe, is the same. I know that's a big concern for any parent with a new medicine. What are the side effects? But they were really few and far between. They were mainly really mild things like redness at the injection site. There weren't any significant deterrent symptoms or side effects.”

Dr. Charette: “The main thing we hope to see is that the youngest babies, especially our babies less than six months, won’t be as sick and, therefore, won’t be as at-risk for needing hospitalization should they get RSV. They can still get RSV despite having gotten this injection but with much less severity. That is important, not only for the baby's health, but it also obviously helps alleviate parents' fears when their child is diagnosed with RSV.”

Dr. Rister: “I think the most important thing parents need to know is that they need to talk to their pediatrician about it. There is some nuance with this, even though it's generally being recommended for all children, so everyone needs to talk to their pediatrician about their child specifically. Does their child have extra risks? I would just hate to think someone's not having this conversation because it has such a big role in the safety and health of children going forward, especially those young infants, for the first time in decades.”

RELATED STORIES:

• CDC Recommends RSV Shot for Infants. Infectious Diseases Doctor Shares What Parents Need to Know 
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The CDC says more public health research is urgently needed to find out why the dramatic increase in what the CDC describes as a "serious birth defect of the abdominal wall."

Patrick Thomas, M.D., FACS, a pediatric surgeon at Cook Children’s says gastroschisis results from a defect in the abdominal wall with herniation of the abdominal contents (such as intestines, stomach and often the gonads). The hernia is always to the right of the bellybutton.

Treatment includes starting immediate IV fluids and placing the infant in an organ bag below the chest to prevent heat loss and to protect the bowel. Surgical options can include immediate repair by placing the organs back in the abdomen and closing the abdominal wall defect. For cases not responsive to immediate closure, a protective bandage (called a silo) is placed and the bowel gradually reduced until closure of the defect can be performed about a week later.

Dr. Thomas said ongoing studies are needed to identify the causes of gastroschisis, but the current treatment through surgery has produced “great outcomes.”

Candace Gamble, M.D., a medical geneticist at Cook Children’s, calls the report from the CDC on the increasing prevalence of gastroschisis, significant.

“It is particularly important for health care providers in the prenatal and neonatal setting as we care for these babies,” Dr. Gamble said. “While expecting parents have cause for concern, the occurrence is still relatively rare considering there are well over 3 million babies born in the U.S. each year. However, it’s a reminder that every pregnancy has a 3-5 percent risk of some type of congenital birth defect. Thus good prenatal care is essential in detecting these defects early so that these babies can receive the proper management.”

Both Dr. Thomas and Dr. Gamble state that researchers and clinicians do not fully understand why this is happening. There is no known genetic mutation that causes gastroschisis. It is likely due to a number of genetic and environmental factors, which lead to an error in fetal development. Doctors do know that there are certain factors that increase the risk for having a baby with gastroschisis, including being a pregnant mother under the age of 20, smoking, and taking vasoconstrictive medications.

“Prenatal care is very important,” Dr. Gamble said. “A screening test where we measure the maternal serum alpha fetoprotein around 16 weeks gestation can be used to detect some babies with gastroschisis, other abdominal wall defects, and more specific defects. In addition, the anatomy ultrasound at 20 weeks gestation can also be useful to detect this and other congenital abnormalities. However, neither measure can completely rule out all birth defects. It is important for parents to discuss these risk and screening options with their health care provider.”

*Illustration courtesy of CDC.

The first line of treatment for children with ADHD are behavioral options. I never ask (or let) a family jump first to medication if they haven't first tried some of the techniques I’m going to describe below.

What are the goals of treatment?

1. Improved interaction with parents, teacher, classmates and siblings

2. Improved grades

In my opinion, the goals are simple and should be taken in that order. It is important to consider these goals and re-evaluate them frequently during the treatment course. Perfection should not be the goal.

I recommend these behavioral techniques before medication for all children, especially those who are young or who have milder ADHD:

1. Make a schedule daily. All kids have difficulty and waste time with transitions. Children with ADHD do this to the 1000th degree. If these transitions are scheduled and the child knows what comes next it might speed up the transition. Things that should be included on the schedule are homework time, daily chores and self-care items (shower, brushing teeth, etc).

2. Make separate areas in the house for necessary tasks. Keep toys and video games out of the space where homework needs to be completed. This helps limit the child’s distractions so that they can finish the task at hand.

3. Set small goals that are attainable. Don’t ask the child who is failing to make the A honor roll in the next six weeks. Start with turning all assignments in and that they are complete, then slight increases in grades, etc.

4. Use charts and checklists. Children with ADHD are often very visual and concrete. If you can put a list in front of them that can be checked off, they are much more likely to complete what needs to be done. I find this to be helpful for me as well ...

5. Keep choices to a minimum. Don’t tell them to go to the closet in the morning and pick out something to wear. This is a sure way to start a huge fight as they stand in front of the closet for hours while you are trying to wrestle them out the door. Pick out two options ahead of time for them to choose from.

6. Don’t discipline them impulsively. Remember that one of their biggest problems is that they don’t stop to think about consequences before they act. If your discipline follows the same pattern, how can we expect them to learn to act differently? Plan out your discipline plan in advance and be consistent. As tempting as it may be, corporal punishment is rarely effective. I’m not going to get into a spank your child or not debate here, but timeouts and restriction of privileges seem to be more effective for children with ADHD.

7. Help your child with organizational skills. Developing a system that helps them keep track of all the papers is a way to keep them from getting thrown away, having them sit in the floorboard of the car or (more infamously) avoiding having the dog eat them. If you need some help establishing this system, check out this amazing book called That Crumpled Paper Was Due Last Week.

8. Get help. Raising a child with ADHD can be very frustrating and quite exhausting. There will be lots of times when you will feel like there is nothing left to do to help. If your child continues to struggle, talk with your pediatrician about options for treatment, including medication options. Find a family counselor that can work with your child but, maybe even more importantly, that can help you develop a plan for your child and help you cope with the struggles you will face.

I hope that you find these tips helpful as you begin to think about how you can help your child with ADHD.

As you walk through the process keep in mind that your goal should be function, not perfection.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

What are the most common causes of a runny nose? How do you treat one? When should you call a pediatrician?

Doc Smitty is back with the latest My Kid Minute. Watch the video to find out all the answers.