By: Mary Caserta, MD, FAAP & Andrea Jones, MD, FAAP
Almost all children get respiratory syncytial virus (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.
If you are the parent of a baby or young child, you may have questions about RSV and how to prevent it. Read on to learn more.
What is RSV?
RSV is one of the many viruses that cause respiratory illness. It spreads like a cold virus from person to person. It enters the body through the nose or eyes, usually from contact with infected saliva, mucus or nasal discharge.
This virus usually occurs in the late fall through early spring months. The timing can vary in some parts of the country.
RSV is the most common cause of hospitalization in children under age 1 year. Two to three out of every 100
infants with RSV infection may require a
hospital stay. Those babies may need
oxygen to help with breathing or (intravenous) IV fluids if they are not eating or drinking. Most of these children get better and can go home after a few days.
Protecting babies from RSV: nirsevimab & palivizumab
A treatment that works like an immunization called nirsevimab helps prevent serious illness from RSV. Nirsevimab is given as an injection and may be included with your baby's routine immunizations. The shot works a bit different than a vaccine. It provides antibodies that start working to protect babies right away. The protection lasts for the duration of a typical RSV season.
One dose of nirsevimab is recommended to be given during or right before the RSV season to all babies younger than 8 months of age.
One dose is recommended to be given to some children age 8 to 19 months who are entering their second RSV season and are at higher risk of serious illness.
Another product called palivizumab is given as an injection once a month during RSV season and has been used to prevent RSV disease. It is for children under age 24 months with certain conditions that place them at high risk for severe RSV. Children who receive nirsevimab should not get palivizumab. However, if your child did not get all doses of palivizumab, they may be eligible for nirsevimab. Children who received palivizumab in their first season can get nirsevimab in their second season if they are eligible.
RSV symptoms in babies
Typically, RSV causes cold symptoms, which may be followed by
bronchiolitis or pneumonia.
RSV symptoms are typically at their worst on days 3 through 5 of illness. Symptoms generally last an average of 7-14 days.
Cold symptoms may include:
cold symptoms, plus:
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)
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.
Call your pediatrician right away if your child has any:
Symptoms of bronchiolitis
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
fever (with a rectal temperature of 100.4°F or higher) and they are younger than 3 months of age (12 weeks).
fever that rises above 104°F repeatedly for a child of any age.
Poor sleep or fussiness, chest pain, ear tugging or ear drainage
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 specific for RSV, these tests are often not necessary.
How to help your child with mild RSV feel better
There is no specific treatment 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.
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
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.
Other ways to help prevent RSV
Vaccinate. Keep your children up to date on their
immunizations and get the whole family
annual flu and COVID shots. Adults over age 60 years can get the
RSV vaccine. And getting vaccinated with
Tdap―to protect against
whooping cough—is especially important for adults who are around infants.
Limit your baby's exposure to crowds, other children, and anyone with colds. Keep children home from school or
child care when they are sick and teach them to cover their coughs and sneezes.
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.
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.
Medicine is always advancing! Scientists continue to explore new options to prevent and treat RSV. In the meantime, rest assured that most people recover well from RSV.
About Dr. Caserta
Mary T. Caserta, MD, FAAP, is a Professor of Pediatrics in Infectious Diseases at the University of Rochester Medical Center (URMC) in New York. Her early research focused on human herpesvirus research. Recently, her research has focused on viral respiratory disease. For over 10 years, she also has conducted clinical trials, including on the treatment of congenital CMV infection. Dr. Caserta is a fellow of the Infectious Diseases Society of America and member of the Pediatric ID Society. Dr. Caserta is a member of the American Academy of Pediatrics Committee on Infectious Diseases.
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.