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It’s a fact of life: Children get colds. Parents and other adults can pass viruses to their infants.  And babies who go to day care or have school-age siblings are at higher risk of getting sick. But when is a cold more than a cold, like the respiratory syncytial virus (RSV)? And does it matter which your infant has? For most children, no, it doesn’t make a difference. But for a few, an RSV infection can lead to serious illness, so it’s good for you to know the difference.

How Is RSV Different From a Cold?

Like the common cold, RSV is a contagious respiratory illness. Almost all children in the United States get RSV by their second birthday. Most parents may not realize it because of how similar the two conditions are. 

RSV is spread the same way as colds: through infected droplets. Your child can breathe in droplets that stay in the air after someone with RSV coughs or sneezes nearby. The virus can also be spread through direct contact. If the droplets land on a surface, your child can touch that surface. If your baby then touches their mouth or nose, the virus can enter the body. The virus stays on hard surfaces, like tabletops or toys, for about 6 hours. It can stay on soft surfaces, like clothing or soft toys, for about an hour. The best way to stop RSV infection is washing your hands well and often and trying to avoid people who are sick.

RSV and colds have another thing in common: Children can get them more than once. 

RSV vs. cold in newborns

While your newborn's cold or RSV symptoms may be similar, RSV can lead to other issues that aren't as common with a cold. The CDC says that RSV is the top reason for pneumonia and bronchiolitis in babies under 1 year old. Up to 3% of infants end up in the hospital from RSV.

RSV vs. cold in toddlers

For toddlers under the age of 2 who get RSV for the first time, about 40% of them have complicationslike bronchiolitis or pneumonia. These both require medical attention right away.

Cold Symptoms vs. RSV Symptoms

It’s hard to tell the difference between a regular cold and RSV because they start out in much the same way. Cold symptoms include: 

  • Coughing, which can be dry or rattling
  • Stuffy nose
  • Runny nose
  • Sneezing
  • Fever (100.4 F or higher)
  • Not eating or drinking as much

Your baby may have only those “cold-like” RSV symptoms if their case is mild. And most cases are. But they could have more symptoms, including: 

  • A very bad cough
  • A hard time breathing
  • Wheezing, which is a whistling noise when your baby breathes 

RSV Can Be Much More Serious Than Colds

Every year in the U.S., about 58,000 to 80,000 children under 5 years old must be admitted to the hospital for RSV complications. Those at the highest risk for these complications include children who:

  • Are premature 
  • Are 6 months old or younger
  • Are younger than 2 years old and have heart disease they were born with or lung disease they’ve had a long time
  • Have a weakened immune system
  • Have a neuromuscular disorder, especially if the condition makes it hard for them to swallow or clear mucus from their throat

All kids are at risk for the common cold. But there are a few things that put your child at a higher risk:

Winter season. During fall and winter, your child tends to be inside more often. This causes them to be around more germs. The humidity also is usually lower around this time, which makes the passages in their noses dry and raises the risk for infection.

Weaker immune systems. Your child's immune system isn't as strong as most adults'. This makes it harder for them to fight off germs.

Spreading germs through touch. Kids are more likely to touch their nose, eyes, and mouth before washing their hands. This can easily spread germs that lead to a cold.

School and day care. When your child comes in contact with other kids, cold germs spread easily.

Bronchiolitis (inflammation in the lungs' tiny airways) and a lung infection called pneumonia are serious complications RSV can cause in vulnerable children. 

Wheezing and trouble breathing are signs your child may have bronchiolitis. Watch how your baby is breathing. Call your doctor if your baby’s ribcage seems to be “caving in” when they breathe.

Pneumonia in infants can be caused by RSV. It happens when the virus moves into the lower respiratory tract.  Signs of pneumonia include:

  • Mucus from the mouth when the baby coughs
  • Vomiting or diarrhea
  • Loss of appetite
  • Tiredness
  • Fever
  • Chills (baby seems cold even though it is warm around them)
  • Fast breathing
  • Hard breathing (like baby is having difficulty getting air in and out)
  • Fussiness

If your baby is showing signs of pneumonia, contact your doctor as soon as possible. 

When It’s an Emergency

If the baby is having difficulty breathing, don’t wait. Get emergency medical help. Other serious symptoms mean you should take your child to the closest emergency department or call 911. They include:

  • Bluish or gray color to the skin, lips, or fingernails
  • Struggling to breathe (very fast breathing, chest sinking inward when inhaling, wheezing, grunting, nasal flaring)
  • Cannot cry
  • Signs of dehydration, including sunken eyes and fewer than one wet diaper every 8 hours
  • Refuses to nurse or take the bottle
  • Not as active, seems weak

Complications from RSV are not common, but you can be prepared if you know what to watch for. Speak with your doctor if your child is at higher risk of RSV complications to see if you should take more steps to protect your baby.

Show Sources

Photo Credit: Science Photo Library / Getty Images

SOURCES:

American Lung Association: “RSV Treatment and Prevention.”

CDC: “RSV in Infants and Young Children,” “Respiratory Syncytial Virus (RSV); Symptoms and Care.”

Children’s Hospital of Philadelphia: “How to Treat RSV at Home and When to Go to the Doctor.”

HealthyChildren.org: “RSV: When It’s More Than Just a Cold.”

JAMA Pediatrics: “Shifting Epidemiology and Severity of Respiratory Syncytial Virus in Children During the COVID-19 Pandemic.”

Mayo Clinic: “Respiratory Syncytial Virus (RSV),” “Bronchiolitis.”

National Institute of Allergy and Infectious Diseases: “Respiratory Syncytial Virus (RSV).”

National Institute of Neurological Disorders and Stroke: “Reye’s Syndrome.”

Nationwide Children’s: “RSV Infection (Respiratory Syncytial Virus).”

SickKids: “Respiratory Syncytial Virus (RSV).”

Stanford Medicine, Children’s Health: “Pneumonia in Children," "Common Cold in Children."

Children's Hospital of The King's Daughters: "RSV Acts Like a Cold but Can Be Much Worse."

Cleveland Clinic: "RSV in Babies & Children."