By: Andrea Jones, MD, FAAP
Almost all children get RSV at least once before they are 2 years old. For most healthy children, RSV is like a cold. But, some children get very sick with RSV.
What is RSV?
RSV (or respiratory syncytial virus) is one of the many viruses that cause respiratory illness―illnesses of the nose, throat and lungs. This virus usually occurs in the late fall through early spring months, but can vary in different parts of the country.
With mask-wearing and physical distancing for COVID-19, there were fewer cases of RSV in 2020. However, once safety measures relaxed with the arrival of COVID-19 vaccines, a rise in RSV cases began in spring 2021. The spread of RSV and other seasonal respiratory illnesses like influenza (flu) has also started earlier than usual this year.
RSV symptoms in babies
Typically, RSV causes a cold, which may be followed by bronchiolitis or pneumonia. Symptoms generally last an average of 5-7 days.
Cold: Upper Respiratory Tract Infection
| Bronchiolitis: Lower Respiratory Tract Infection
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Cold symptoms may include: | May include cold symptoms, plus:
Fast breathing Flaring of the nostrils & head bobbing with breathing Rhythmic grunting during breathing (see sound clip clip, below)
Belly breathing, tugging between the ribs and/or the lower neck (see video, below)
Wheezing
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How hard is your baby breathing? What to look for. |
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Chest wall retractions happen when a baby must use muscles between the ribs or in the neck to breathe. It is a sign that your baby is having to work harder than normal to breathe. Watch your child's rib cage as they inhale. If you see it "caving in" and forming an upside-down "V" shape under the neck, then they are working too hard.
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Is your baby or young child at a greater risk of this respiratory illness?
Infants with a higher risk for severe RSV infection include:
12 weeks old or younger at the start of RSV season
Premature or low birth weight infants (especially those born before 29 weeks gestation)
Chronic lung disease of prematurity
Babies with certain types of heart defects
Those with weak immune systems due to illness or treatments
Additional risk factors for severe RSV infections include low birth weight, having siblings, a mother's smoking during pregnancy, exposure to secondhand smoke in the home, history of allergies and eczema, not breastfeeding, and being around children in a child care setting or living in crowded living conditions.
When should you call the doctor?
RSV symptoms are typically at their worst on days 3 through 5 of illness. Fortunately, almost all children recover from an RSV infection on their own.
Call your pediatrician right away if your child has any:
Symptoms of bronchiolitis (listed above)
Symptoms of dehydration (fewer than 1 wet diaper every 8 hours)
Pauses or difficulty breathing
Gray or blue color to tongue, lips or skin
Significantly decreased activity and alertness
Some children with RSV may be at increased risk of developing a bacterial infection, such as an ear infection. Call your doctor if your child has:
Symptoms that worsen or do not start to improve after 7 days
A fever (with a rectal temperature of 100.4°F or higher) and they are younger than 3 months of age (12 weeks).
A fever that rises above 104°F repeatedly for a child of any age.
Poor sleep or fussiness, chest pain, ear tugging or ear drainage
How do doctors diagnose RSV?
Pediatricians diagnose children with a cold or bronchiolitis by asking about their symptoms and by doing a physical exam. Your pediatrician may do a nasal swab test to determine if your child has RSV or another virus. A chest x-ray and/or oxygen saturation test may also be done to check for lung congestion. Because most children recover without difficulty and because there is no treatment for RSV, these tests usually are not necessary.
Is RSV contagious?
Yes. RSV spreads just like a common-cold virus―from one person to another. It enters the body through the nose or eyes or, usually from:
Direct person-to-person contact with saliva, mucus, or nasal discharge.
Unclean hands (RSV can survive 30 minutes or more on unwashed hands).
Unclean objects or surfaces (RSV can survive up to 6 hours on surfaces, toys, keyboards, door knobs, etc).
Symptoms can appear 2 to 8 days after contact with RSV. According to the U.S. Centers for Disease Control and Prevention (CDC), people infected with RSV are usually contagious for 3 to 8 days. However, some infants and people with weakened immune systems can be contagious for as long as four weeks―even if they are not showing symptoms.
Keep in mind, children and adults can get RSV multiple times–even during a single season. Often, however, repeat infections are less severe than the first one.
What can you do to help your child feel better?
There is no cure for RSV and medications, like steroids and antibiotics, do not help with RSV.
To help your child feel more comfortable, begin by doing what you would for any bad cold:
Nasal saline with gentle suctioning to allow easier breathing and feeding.
Cool-mist humidifier to help break up mucus and allow easier breathing.
Fluids & frequent feedings. Make sure your child is staying hydrated. Infants with a common cold may feed more slowly or not feel like eating because they are having trouble breathing. Try to section baby's nose before trying to breast or bottle-feed. Supplementing with water or formula is unnecessary for breastfed babies. If difficult for the baby to feed at the breast, expressing breastmilk into a cup or bottle may be an option.
Acetaminophen or ibuprofen (if older than 6 months) to help with low-grade fevers. Always avoid aspirin and cough and cold medications.
Do babies with RSV need to be hospitalized?
Only 1% to 2% of children younger than 6 months of age with RSV infection may require a hospital stay. Those babies may need oxygen to help with breathing or an (intravenous) IV line for fluids. Most of these children can go home after 2 or 3 days. Rarely, a child may need care in a pediatric intensive care unit (PICU).
How can you protect your children from RSV?
Wash your hands! Just as you would to prevent germs at any time, use soap and water and scrub for at least 20 seconds. Remind children to practice good hand hygiene all through the year.
Other ways to help prevent RSV
Vaccinate. Keep your children up to date on their immunizations and get the whole family annual flu shots. Getting vaccinated with Tdap―to protect against whooping cough is especially important for adults who are around infant—new parents, grandparents, babysitters, nannies, etc. Your child should also be immunized against COVID-19.
Limit your baby's exposure to crowds, other children, and anyone with colds. Keep them home from school or child care when they are sick and teach them to cover their coughs and sneezes.
Go germ-free. Disinfect objects and surfaces in your home regularly and avoid exposing your child to smoke from tobacco or other substances.
Feed your baby breastmilk. It has unique antibodies to prevent and fight infections.
Monoclonal antibody injections for high-risk infants
There is a monoclonal antibody treatment that may reduce the risk of severe RSV infection in some high-risk infants. Your pediatrician will let you know if your baby is a candidate.
Hope on the horizon for RSV
Medicine is always advancing! Scientists are currently studying vaccines to prevent and medications to treat RSV. We may have more options in the future. In the meantime, rest assured that most children recover well from RSV and grow to be healthy adults.
More information
About Dr. Jones:
Andrea N. Jones, MD, FAAP, is a board-certified general pediatrician. She is an Assistant Professor in the Department of Pediatrics at the University of Wisconsin School of Medicine and Public Health. Dr. Jones is a member of the Wisconsin Chapter of the American Academy of Pediatrics.
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circ*mstances.
FAQs
In adults and older children, RSV is typically a mild illness very similar to the common cold. In infants and the elderly, the symptoms can be more severe.
How do you tell if it's RSV or a cold? ›
You won't be able to tell the difference between a cold and respiratory syncytial virus in your home. You must to go to a healthcare professional to determine whether it's a cold or RSV.
When is RSV at its worse? ›
RSV symptoms are typically at their worst on days 3 through 5 of illness. Fortunately, almost all children recover from an RSV infection on their own.
How do you know if RSV is getting worse? ›
In some cases, RSV can pose significant health threats to young children and older adults.
...
Dangerous Reputation
- Rapid breathing.
- Wheezing.
- Belly breathing or using muscles in the ribs or neck to breathe.
- Flaring nostrils.
- Head bobbing with breathing.
- Rhythmic grunting while breathing.
Children with RSV typically have two to four days of upper respiratory tract symptoms, such as fever and runny nose/congestion. These are then followed by lower respiratory tract symptoms, like increasing wheezing cough that sounds wet and forceful with increased work breathing.
When should I be worried about RSV? ›
Call your child's health care provider if your child: seems sick, shows signs of RSV and is less than 6 months of age or at high risk.
What color snot do you have with RSV? ›
Strained breathing, high fever, thick nasal discharge, and a worsening cough that produces yellow, green, or gray mucus are all signs of a worsening or severe illness. “RSV symptoms can lead to more serious illnesses, such as pneumonia and bronchiolitis.
What does a mild case of RSV look like? ›
Initial signs of RSV are similar to mild cold symptoms, including congestion, runny nose, fever, cough and sore throat. Very young infants may be irritable, fatigued and have breathing difficulties. Normally these symptoms will clear up on their own in a few days.
How do doctors confirm RSV? ›
Both rRT-PCR and antigen detection tests are effective methods for diagnosing RSV infection in infants and young children. The RSV sensitivity of antigen detection tests generally ranges from 80% to 90% in this age group.
How do you make RSV go away faster? ›
Lifestyle and home remedies
- Create moist air to breathe. Keep the room warm but not overheated. ...
- Drink fluids. Continue breastfeeding or bottle-feeding your infant as you would normally. ...
- Try saline nasal drops. ...
- Use over-the-counter pain relievers. ...
- Stay away from cigarette smoke.
Most RSV infections go away on their own in a week or two. There is no specific treatment for RSV infection, though researchers are working to develop vaccines and antivirals (medicines that fight viruses).
What are the last stages of RSV? ›
What are possible complications of RSV in a child? In high-risk babies, RSV can lead to severe breathing illness and pneumonia. This may become life-threatening. RSV as a baby may be linked to asthma later in childhood.
What happens when RSV gets worse? ›
Premature infants, babies younger than 6 months old, people above age 65 and people who have a compromised immune system, chronic lung disease or congenital heart condition can get a more severe case of RSV. A severe RSV infection can lead to pneumonia and bronchiolitis, which may require hospital care.
Do you sleep a lot with RSV? ›
Children with bronchiolitis don't sleep well due to stuffy nose and cough causing frequent nighttime wake ups. Your child's snot can feel like a constant faucet. Unfortunately, there isn't much we can do as parents or doctors to make it better.
When should I take my toddler to the ER for RSV? ›
Immediately head to the ER if your baby exhibits any of the following symptoms:
- Dehydration (decrease in wet diapers)
- Difficult, labored, shallow or rapid breathing.
- High fever.
- Lethargy.
- Skin turning blue (especially lips and fingernails)
- Unresponsiveness.
In adults and older children, RSV usually causes mild cold-like signs and symptoms. These may include: Congested or runny nose. Dry cough.
Is RSV contagious if still coughing? ›
2. RSV is highly contagious. RSV can be spread through droplets containing the virus when someone coughs or sneezes. It also can live for a few hours on surfaces (such as countertops, doorknobs or toys) and on hands, so it can be easily spread when a person touches something contaminated.
Do you cough up phlegm with RSV? ›
Rapid breathing at a rate of over 40 breaths per minute. Tight breathing (having to work hard to push air out). Coughing (may cough up very sticky mucus). Fever and a runny nose often start before the breathing problems.
Should I take my child to the ER for RSV? ›
When do I need to see a doctor for RSV? If your child with RSV is not having labored breathing, is not vomiting frequently due to hard coughing and is drinking plenty of fluids, there's usually no need for emergency treatment.
Is cold air good for RSV? ›
A significant number of patients have recurrent episodes of bronchiolitis and wheezing, and may develop asthma later in life. Avoidance of exposure to tobacco smoke, cold air and air pollutants is also beneficial to long-term recovery from RSV bronchiolitis.
Some may be sick for only a few days, others for one to two weeks. But we typically see cases of RSV get worse before they get better (just like the common cold). If a child is diagnosed on Day 2, mostly likely the virus will get worse before it gets better.
Do you cough a lot with RSV? ›
Serious cases of RSV can lead to more dangerous conditions, including bronchiolitis (inflammation of the small airways in the lungs) and pneumonia (infection of the lungs). Symptoms of severe RSV include: Severe cough.
Do you have a sore throat with RSV? ›
In adults and older children, typical RSV symptoms include a low-grade fever, congested or runny nose, cough, sore throat, headache, fatigue, and occasionally wheezing.
How many days is RSV contagious for? ›
People infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks.
Can it be RSV without fever? ›
Fever may not always occur with RSV infections.
How long will you test positive for RSV? ›
By using a rapid test for respiratory syncytial virus (RSV) detection (Abbott TestPack RSV), a number of patients were observed, showing repeatedly positive results over a period of up to 10 weeks.
What to do if you test positive for RSV? ›
A positive result means that you likely have an RSV infection. Infants, young children and older adults may need treatment in the hospital if they are having trouble breathing or have lost too much fluid and become dehydrated. Treatment may include oxygen and intravenous (IV) fluids.
What do doctors prescribe for RSV? ›
Medications to treat respiratory syncytial virus (RSV) infection include the antiviral drug ribavirin, which can be used in severe high-risk cases, and bronchodilators. The efficacy of bronchodilators or racemic epinephrine in treating RSV disease remains unproved.
Should I get tested for RSV? ›
So do children really need to be tested for RSV? The American Academy of Pediatrics came out with recommendations for testing your child for RSV. They do not recommend routine testing for RSV in children older that 6 weeks of age.
Can a common cold turn into RSV? ›
Most cases are mild, but for some children, an ordinary cold or flu can quickly turn into respiratory syncytial virus (RSV), asthma or pneumonia that requires ER treatment or hospitalization.
Most RSV infections go away on their own in a week or two. There is no specific treatment for RSV infection, though researchers are working to develop vaccines and antivirals (medicines that fight viruses).
Is RSV a critical illness? ›
Respiratory syncytial virus, commonly known as RSV, is a common respiratory infection that affects children and adults. Most children contract RSV before the age of 2. RSV is not usually a serious condition; however, high risk groups — especially infants — can develop serious cases and require a hospital visit.
Is RSV serious? ›
Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States.
Does RSV start with a sore throat? ›
The onset of RSV can look much like that of an average cold or flu—early symptoms include a congested or runny nose, coughing, sneezing, sore throat and a fever.
Is a runny nose a symptom of RSV? ›
What are the symptoms of RSV? In mild cases of RSV, inflammation is limited to the upper respiratory tract (the nose and throat), most significantly causing a runny nose and nasal congestion. “The hallmark of RSV is that it causes a lot of mucus production that causes you to blow your nose more frequently,” Dr.
What happens if you don't treat RSV? ›
Serious cases of RSV can lead to more dangerous conditions, including bronchiolitis (inflammation of the small airways in the lungs) and pneumonia (infection of the lungs). Symptoms of severe RSV include: Severe cough. Difficulty breathing.
Can adults get RSV from kids? ›
Overview. Respiratory syncytial virus (RSV) causes infections of the lungs and respiratory tract. It's so common that most children have been infected with the virus by age 2. Respiratory syncytial (sin-SISH-ul) virus can also infect adults.
What are the first signs of RSV? ›
Initial signs of RSV are similar to mild cold symptoms, including congestion, runny nose, fever, cough and sore throat. Very young infants may be irritable, fatigued and have breathing difficulties. Normally these symptoms will clear up on their own in a few days.
How contagious is RSV to adults? ›
How Do Adults Get RSV? Like other respiratory infections, RSV is highly contagious and spreads via sneezing, coughing — even kissing. The airborne virus can enter the body through the eyes, nose, or mouth, says the Cleveland Clinic.
Andrea N. Jones, MD, FAAP, is a board-certified general pediatrician. She is an Assistant Professor in the Department of Pediatrics at the University of Wisconsin School of Medicine and Public Health. Dr. Jones is a member of the Wisconsin Chapter of the American Academy of Pediatrics. 