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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 may have? 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.

What Is RSV?

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 inhale droplets that stay in the air after someone with RSV coughs or sneezes close 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. 

Symptoms of Colds and RSV

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

Bronchiolitis (inflammation in the tiny lung 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


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.” “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.”