By Kate Marino

Pediatric pneumonia cases requiring hospitalization are up 30% in Central Virginia.

While not a cause for panic, it does call for caution.

Christopher Doern, M.D., director of microbiology at VCU Health, said the initial investigations suggest that this rise in hospitalizations may be because of an increase in rhinovirus and enterovirus.

“The last time we saw this phenomenon was in 2014 during the EVD68 outbreak,” Doern said. “I don't have any speculation as to why this is only being observed in Central Virginia and would be surprised if it doesn't soon disseminate to the rest of the region and beyond.”

David Marcello, M.D., chief of pediatric hospital medicine, answers some key questions about the spike in pneumonia cases and the type of care being provided at Children’s Hospital of Richmond at VCU.

What might be causing this current rise in pediatric pneumonia?

In addition to increased Mycoplasma infections (atypical bacterial pneumonia), community acquired bacterial infections, we’re also seeing a spike in rhinovirus/enterovirus infections. These are two types of the many respiratory viral infections that typically rise this time of year with back to school, weather changes and increased pollen counts. It may be that there’s a new strain of rhinovirus or enterovirus that is more virulent than in the past, something that occurs every 6-10 years. We know viral infections can also lead to bacterial pneumonias (typical or atypical).

What care is your team providing for children in the hospital with pneumonia?

These children are provided supportive care in the hospital, which varies depending on their specific symptoms and needs. It may include hydration via IV or by mouth, or oral hydration via nasogastric tube (tube from nose to stomach) for children who can’t take liquids by mouth. Oral is always preferred, especially now with the shortage of IV fluids due to Hurricane Helene storm damage. They may also receive oxygen through a nasal cannula, mask or in very severe cases a ventilator (with a tube from the mouth into the breathing passages).

Antibiotics are an important component of care if a bacterial infection is suspected. We’ll also give steroids and albuterol to patients who experience an asthma attack in addition to their pneumonia.

Do you expect that this will improve or get worse in the coming weeks?

It’s likely to worsen with pollen and mold counts rising, colder weather keeping everyone inside and the holidays bringing people together. Asthma is triggered by infection and cold weather, so we often see patients with asthma needing extra care this time of year as well.

When should families seek medical care for children’s respiratory symptoms?

Not all cases of respiratory illness require care in a medical setting. That said, if you notice any of the following symptoms, we urge you to check with the pediatrician if possible or bring your child to the emergency room:

• High fever (higher than 100.4˚F for infants younger than 3 months, or higher than 102.2˚F in children older than 3 months) that lasts more than 2-3 days despite Tylenol and/or Motrin
• Inability to drink liquids or vomiting so much that they’re not urinating regularly (fewer than three wet diapers per day in an infant, using the bathroom less than once per day in older children)
• Dry lips or mouth
• Working hard to breathe/catch their breath (seeing their ribs with each breath, belly breathing more than usual, gasping for air, inability to speak if they’re typically verbal)

If your child has asthma, cough with wheezing, needing more than four breathing treatments per day, and working hard to breathe with no response to breathing treatments would all warrant medical assessment and care.

Should families try any care at home for respiratory symptoms before seeking medical treatment?

For mild symptoms, we encourage lots of liquids and Tylenol or Motrin for pain relief. Honey can help decrease cough but should only be given to children over 1 year of age (there’s a risk of botulism in little ones with immature digestive tracts). Children with asthma should follow their asthma action plan instructions.

If symptoms begin to cause concern, seek medical care right away.

What are the best ways to protect ourselves and our kids from getting sick?

Infection prevention measures are essential, including:

• Washing your and your child's hands
• Staying home and away from others until symptoms are improving and there is no fever for 24 hours without the assistance of fever-reducing medication
• Getting the flu vaccine (now is the time to get the vaccine and start building immunity)
• Staying up to date on COVID-19 vaccines
• Getting all childhood vaccines on schedule
• Wearing a mask if tolerated, especially if you have a weakened immune system or are recovering from illness