Clinic Watches out for Respiratory Trouble After Prior RSV Care

Editor’s Note: The Respiratory Clinic is limited only to patients who were recently treated at the Cook Children's Emergency Department, Medical Center or Urgent Care Clinics and received a referral for respiratory therapy.

Story by Jean Yaeger. Video by Tom Riehm.

Babies and toddlers treated for viral respiratory infections at certain Cook Children’s locations can get their breathing checked at a special clinic that provides free follow-up visits. 

The clinic serves children ages 2 months to 2 years old who were previously admitted to these Cook Children’s facilities: Medical Center, Emergency Department (ED) or Urgent Care centers. What’s the benefit? For up to a week after these patients go home, their caregivers can bring them to be seen by therapists who specialize in caring for the lungs. 

No appointment is necessary at the Cook Children’s Respiratory Outpatient Clinic. But patients must have a referral from a provider at the Medical Center, ED or Urgent Care centers.   

The clinic is designed to give guidance and reassurance to parents whose little ones are continuing to recover from severe bronchiolitis. If a child has trouble breathing or other complications within seven days of being discharged, the experts at the clinic can do an evaluation. 

Janie Galindo found out about the clinic at the Cook Children’s Urgent Care center where her twins, Dallas and Dionne, tested positive for the respiratory syncytial virus (RSV) in October. Thanks to a referral from their Urgent Care provider, Janie had access to the clinic when her babies got sicker overnight. As soon as the clinic opened the next morning, they were there.   

Just as their mom suspected, Dallas’s and Dionne’s symptoms had gotten worse. A respiratory therapist met them at their vehicle and took them inside for evaluation. In their case, the clinic checkup ended with admission to the hospital.   

Janie is grateful for this resource. And she urges other parents to take advantage of the clinic, which Cook Children’s has offered every year since 2019 during peak season for respiratory illnesses. The clinic saw 119 patients from September through December 2022.

A surge in RSV and flu cases has hit hard in North Texas and nationwide in recent months, contributing to long wait times in health care settings. But the convenience of the Respiratory Outpatient Clinic at Cook Children’s can allow families to avoid returning to the crowded ED or Urgent Care locations where their child was recently treated. 

Families come to the clinic seeking peace of mind. Many children are doing OK and can go back home. Others might need additional treatment as Dallas and Dionne did. 

“It was so helpful,” Janie said. “If your babies aren’t better, just to ease your nerves, just take them in. It doesn’t hurt.” 

The clinic, located at the Medical Center in Fort Worth, is open through March. Hours are from 11 am-7 pm daily. Here’s how it works: 

• Get a referral and instructions when your child is discharged from Cook Children’s Medical Center, ED or Urgent Care with a bronchiolitis/RSV diagnosis.  You can come to the clinic as often as twice a day over the next week. 
• Park in the designated area, call the clinic when you arrive, and wait in your vehicle.
• In the meantime, registration personnel verifies that your referral is on record.     
• A respiratory therapist from the ED walks you to the clinic. The therapist checks your child for labored breathing, low oxygen, dehydration and other concerns. The therapist also determines if your child needs further medical attention.  
• There’s no charge, and insurance isn’t required. 

Cathy Carroll, respiratory director at Cook Children’s, said the clinic is structured to serve children with RSV or bronchiolitis who are otherwise healthy after they leave the Medical Center, ED or Urgent Care. If concerns arise while their children recover at home, parents can bring them to the clinic for a quick outpatient visit. “It’s very helpful, reassuring and a great experience for parents,” she said.

Carroll said the clinic is staffed by respiratory therapists who reinforce the educational tools that were provided when the patients were discharged earlier. The therapists take the opportunity to explain signs of low oxygen -- teaching parents to look for fast or shallow breaths, flared nostrils and bluish lips. It’s a model that aims to prevent unnecessary return trips to the ED or Urgent Care. 

The clinic was there when Dallas and Dionne needed help to fight RSV. This is their story. 

Two Too Sick  

Dionne and Dallas were born 15 weeks early, in August 2021. They each weighed less than 2 pounds, and their lungs weren’t fully developed. Dallas was intubated to help him breathe while in the neonatal intensive care unit (NICU). After several months in the NICU, the preemies were strong enough to join their parents and three older siblings at home in Fort Worth. 

The U.S. Centers for Disease Control and Prevention puts children like Dionne and Dallas in a category for higher risk from RSV, due to their impaired lungs at birth. Other higher-risk groups include infants younger than 6 months old, and children with heart disease or weakened immune systems. 

One day in October, Dallas started running a fever, coughing and throwing up. Dionne soon came down with similar symptoms. The 14-month-old siblings were too sleepy to play or eat. Dionne, who is normally feisty, wanted to be held constantly. Dallas, who is normally cuddly, wanted to be left alone. Then he started breathing rapidly. 

“I don’t think this is a cold,” Janie thought at the time. She took both twins to Cook Children’s Urgent Care, where they were tested for flu, COVID-19 and RSV. The RSV tests came back positive, but their vital signs weren’t alarming. 

Urgent Care staff gave Janie a referral to the Respiratory Outpatient Clinic and encouraged her to take the twins for a follow-up visit if their illness changed for the worse anytime in the next week. Back at home, Janie grew concerned when the babies had more trouble keeping food down. And she thought Dallas’s lips began to look gray.  

“They were really groggy. They weren’t crying because they didn’t have energy. They were just blah. Dallas had a really bad cough. Dionne wasn’t doing good at coughing it out.” Janie wanted a medical professional’s opinion. 

So she took the twins to the clinic’s designated parking area when it opened at 11 am. Within the hour, therapists were evaluating their condition. Dallas and Dionne then were admitted to the Medical Center, receiving oxygen and IV fluids for dehydration. A high-flow oxygen device was used on Dallas because his oxygen level kept dropping when he slept, Janie said. 

The twins perked up quickly. They wanted to eat and play with toys in their hospital room. But their airflows still needed monitoring, and they needed rest. Dionne stayed in the hospital for six days; Dallas for nine.  

Janie said she appreciates that because of the referral from Urgent Care, the clinic already had the background on Dionne’s and Dallas’s diagnoses. That made it easier and faster to get checked out by respiratory experts the next day without having to go back to Urgent Care. “It was nice to already know what was going on. We were just following up on that.”   

More info on RSV 

Most of the time, an RSV infection causes a mild illness like a cold. But it can also lead to bronchiolitis or pneumonia in young children. Early symptoms are runny nose, decrease in appetite and cough. Get medical help right away for more serious symptoms:

• Fast, shallow breathing, indicated by the belly moving up and down quickly and the area around the ribs sinking in. 
• Extreme fussiness, can’t be comforted.   
• Sleepiness, won’t wake up for feedings. 
• Poor appetite and fewer wet diapers.  
• Blue color to the lips, tongue or fingernails. 

Help prevent the spread of RSV by washing your hands often, avoiding close contact with sick people, covering your coughs and sneezes, and staying home when you’re sick.