Respiratory syncytial virus (RSV) is such a common condition that about 97% of children have caught it by the time they are 2 years old. Many people may not even realize their child has RSV because the symptoms are so similar to a cold. For the most part, it acts just like a cold. But in some children, RSV can be serious. Up to 3 out of every 100 children in the United States who are younger than 1 year need to be hospitalized with RSV. So new parents should know what to watch for.
RSV Is Easy to Catch
RSV spreads through infected droplets. When someone with the virus coughs or sneezes, the droplets get into the air. Your child can inhale them if they’re close enough. RSV can also live on hard surfaces like toys for more than 6 hours and on soft surfaces like clothing for up to an hour. Babies can easily get the virus when they put their hands and other things in their mouths.
Someone with RSV is contagious for about a week after they become infected, but infants can spread it for longer.
RSV Symptoms to Watch for
Babies and toddlers who catch the common cold usually have a cough and runny nose. But if your baby’s nose is runnier than usual and starts getting slimy, this can be a sign of RSV. Babies usually get sick with a cold about 1 to 3 days after they’re exposed to the virus. RSV symptoms often begin 4 to 6 days after contact.
Other RSV symptoms include:
- Red eyes
- Not eating as much
- Sore or scratchy throat, although this may be hard to tell with young children
Other RSV symptoms can mean your baby needs medical care right away, including:
- Wheezing (a high-pitched whistle or rattling when breathing)
- A hard time breathing
- Decreased activity
- Pauses in breathing for more than 10 seconds, called apnea, in babies younger than 6 months
- Nostrils flaring
- Bluish lips and fingernails
- Fast breathing
- “Caving in” of the chest when the baby breathes
Keep in mind, though, that not all babies show these symptoms. Some may only be cranky, be less active, and have trouble breathing. If in doubt, contact your doctor.
Which Babies Might Get Very Sick?
It’s important to remember that most babies and toddlers who get RSV don’t get sicker than they might with a cold. But some children are at higher risk of serious illness and RSV complications, so they should be watched closely if they get cold symptoms. They include:
- Premature infants
- Infants younger than 6 months
- Children younger than 2 years old with chronic lung disease or heart disease from birth
- Children with weakened immune systems who are prone to catching infections
- Children who have neuromuscular disorders that can make it hard to swallow or clear mucus
RSV can lead to a condition called bronchiolitis, which happens when the tiny airways in the lung get inflamed or swollen. RSV can also cause pneumonia, a lung infection.
Diagnosing RSV can be tricky because it is so similar to a cold. It may not even be necessary for most children because the virus passes within a week or two. But diagnosis is important if your child is at high risk for serious illness or is showing signs that the infection is getting worse. One clue is what time of year it is. RSV is much more common during “RSV season,” which runs from the fall to the end of spring. But RSV can appear at any time of the year. After doing a medical exam and asking you questions about your baby’s medical history, recent changes, and symptoms, your doctor might call for:
- Blood tests to look for other infections
- Swabs of the mouth and nose to do an RSV test
- Oxygen level monitor – usually put on a finger for older children and on the wrist, hand, thumb, foot, or toe for infants – to check how much oxygen is in the blood
- Chest X-rays
There is no medication to treat RSV, so the goal of RSV treatment is to keep your baby as comfortable as possible. Symptoms usually go away within 1 week, 2 at the most. It’s best to speak with your child’s doctor about steps to take before they become sick so you’ll know what to do. Here are some steps you can take to ease the symptoms:
- Fever: Several over-the-counter (OTC) medications, such as ibuprofen or acetaminophen, lower fevers and help ease body aches. Keep in mind that you should not give your baby aspirin because of the risk of a severe complication called Reye’s syndrome.
- Dehydration: Give your child fluids so they can stay hydrated. Signs of dehydration include little or no urine output (fewer wet diapers), eyes that look sunken in, no tears, crankiness, and sleepiness.
- Trouble breathing: A cool-mist humidifier can put more moisture in your baby’s room to help break up the mucus and make breathing easier. Avoid using a vaporizer because they can be burn hazards.
- Stuffy nose: Small suction bulbs can help you remove mucus. Be gentle so it won’t irritate your baby’s nose. Saline nose drops might be helpful, too.
If your baby has to go to the hospital with RSV, they may be treated with:
- Oxygen, given through a small tube just below the nose or a mask
- Suctioning to remove mucus from the nose and airway
- Intravenous (IV) fluids to rehydrate them
- Mechanical ventilation, a machine that helps them breathe
- Tube feeding, to make sure they have proper nutrients
Lowering the Risk of Getting RSV or Serious Illness
To prevent RSV, you should take the usual steps of washing your hands often and well and avoiding sick people as much as possible. Your baby can get RSV again, just as they can get another cold.
In July 2023, the FDA approved a new drug, nirsevimab-alip (Beyfortus), for newborns and infants entering their first RSV season. Children at risk for serious RSV can get the shot through their second RSV season. If you are concerned, speak with your doctor to see if this is an option for your baby.
If your child is at high risk for serious RSV disease (is very premature or has certain heart and lung conditions), your doctor may suggest a medication called palivizumab. Your baby would get it before the beginning of RSV season and then about once a month until the end of spring. The timing may be different depending on where you live.
Photo Credit: gpointstudio / Getty Images
American Lung Association: “RSV and Infants: a Respiratory Disease That Can Be Deadly,” “RSV Symptoms and Diagnosis,” “RSV Treatment and Prevention.”
CDC: “RSV in Infants and Young Children,” “Respiratory Syncytial Virus (RSV).”
Children’s Hospital of Philadelphia: “How to Treat RSV at Home and When to Go to the Doctor.”
Children’s Minnesota: “Newborn Pulse Oximetry Screening.”
Cleveland Clinic: “Wheezing.”
Mayo Clinic: “Common Cold,” “Respiratory Syncytial Virus (RSV).”
MedlinePlus: “Respiratory Syncytial Virus Infections,” “Respiratory Syncytial Virus (RSV) Tests.”
National Institute of Neurological Disorders and Stroke: “Reye’s Syndrome.”
Nationwide Children’s: “RSV Infection (Respiratory Syncytial Virus).”
SickKids: “Respiratory Syncytial Virus (RSV).”
University of Utah: “Signs and Symptoms of RSV.”
FDA: “FDA Approves New Drug to Prevent RSV in Babies and Toddlers.”