As the weather gets cooler and seasons shift to fall and winter, many parents know it’s cold and flu season. But those aren't the only illnesses parents should be aware of - RSV is just as contagious and can be especially dangerous for babies. This in-depth guide will help you understand the signs and symptoms, treatment, and prevention of RSV so you can protect your family's health.
- RSV is highly contagious and presents symptoms similar to the common cold, and typically goes away in one to two weeks
- Most cases of RSV are mild; however, some cases can be severe in babies up to 12 months and may require intervention from a doctor
What is RSV?
Respiratory syncytial virus is a highly contagious respiratory virus that typically causes mild, cold-like symptoms. It’s a common virus (97% of children contract RSV at least once by age two) and may be mistaken for a cold due to similar symptoms. RSV can affect any part of the respiratory tract:
- Larynx - Voicebox
- Bronchi - Upper Lungs
- Bronchioles - Lower Lungs
While many RSV cases are mild, some cases can be severe - particularly in infants born prematurely, babies up to 12 months of age, especially under six months of age during the season, babies born with heart or lung conditions, children who have difficulty swallowing or can’t clear mucus, and children with weakened immune systems.
Similar to the flu cycle, RSV makes its way around the most in the later part of fall and throughout the winter months, even into the spring in certain states. It is transmitted through infected respiratory droplets, like saliva or nasal congestion from the mouth or nose, which can be spread through sneezing, coughing, or close contact.
It can also be spread through hands and surfaces that have come in contact with respiratory droplets. It lives for about 30 minutes on the hands and several hours on other surfaces.
If your child is exposed to RSV, they’ll likely begin to show symptoms within 4 to 6 days of infection. Symptoms usually appear in stages and don’t occur at once, and are typically worse on days 3-5 of illness.
Common symptoms in infants
While older babies may have symptoms similar to kids (see the immediate next section), in very young infants, RSV symptoms may only include irritability, decreased activity, less eating and drinking, and breathing difficulties.
Common symptoms in older children
Although your child may not experience them all, common mild-case symptoms are nasal congestion and dry cough, mild fever of up to 104°F (40°C), sneezing, headaches, and sore throat. In severe cases, difficulty breathing or wheezing can occur.
The infection can spread to the lower respiratory tract, causing pneumonia (lungs filled with fluid or pus), bronchitis (inflamed bronchial tubes), or croup (swelling in the upper airways) and severe problems breathing (which may require oxygen support in the hospital).
Severe symptoms in infants
Severe RSV manifests distinct symptoms in babies compared to older children. These include short, shallow, and rapid breathing, difficulty breathing (indicated by flared nostrils, grunting sounds, and inward pulling of neck or chest muscles and skin with each breath), coughing, poor feeding, and heightened irritability or even difficulty waking up.
Severe symptoms in older children
Older children whose illness has progressed from mild to severe may experience high fever, severe cough, wheezing (a high-pitched whistling sound that occurs during breathing, often associated with narrowed or constricted airways), rapid or difficulty breathing, chest pain, apnea (pauses in breathing for more than 10 seconds) and cyanosis (skin or nail beds that look pale, gray or blue due to lack of oxygen). They also may prefer to sit up instead of lie down due to their breathing difficulties.
RSV is typically diagnosed through a physical examination. During the exam, a doctor will look for signs of infection, like coughing and difficulty breathing. They may also use a stethoscope to listen for wheezing or other abnormal sounds in the chest and check oxygen saturation or pulse oximetry by a finger or toe test.
In some cases, doctors may order lab tests, such as a viral swab for RSV or other viral infections or a chest X-ray, to confirm the diagnosis.
Diagnosing RSV at Home
Families can use a pediatric telemedicine service, such as Blueberry Pediatrics, when they suspect RSV at home. A typical virtual exam for suspected RSV includes:
- The pediatrician and parent discuss the signs and symptoms of concern
- The child will be asked to breathe and cough for the doctor
- The child's oxygen and heart rates will be checked using the pulse oximeter included in the Blueberry Medical Kit
- Based on the visit, the doctor will determine a treatment plan
Most babies and older children recover without complications and because there is no treatment specific for RSV, further testing is not often necessary. If a more in-depth evaluation is needed, the pediatrician will refer you to get an examination in person with your pediatrician or urgent care/emergency room.
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Mild cases of RSV typically go away on their own in 1 to 2 weeks. Parents can help their sick children by focusing on relieving their symptoms and keeping them comfortable while they recover:
- Encourage getting plenty of rest
- Ensure ample intake of water and other fluids such as Gatorade and Pedialyte if age-appropriate
- Use nasal saline with gentle suctioning
- Place a cool mist humidifier in the room to help clear congestion and facilitate easier breathing
- Administer over-the-counter medications such as acetaminophen or (ibuprofen if 6 months or older) for fever or pain relief
If your child has difficulty breathing, exhibits other severe RSV symptoms, or develops pneumonia or bronchiolitis, take them to the doctor immediately. RSV is the most common cause of hospitalization in children under the age of one. Two to three out of every 100 infants with RSV infection may require a hospital stay. Your child may be treated in one or more ways:
- Oxygen therapy (getting oxygen using a mask, nasal prongs, or a ventilator)
- Fluids through an IV if they are not able to eat or drink
- Mucus removal via suction, which is a thin tube that goes into the upper airway down to the lungs
Only about 3% of children with RSV require a hospital stay, and most of those children can go home from the hospital in a few days.
The best way to protect against RSV is prevention. Washing hands for at least 20 seconds often, limiting exposures by avoiding close contact with people who are sick, and keeping surfaces clean can help reduce the risk of catching RSV. You can also reduce its spread by covering your cough or sneeze with an arm or sleeve and staying home from work, school, and public areas when you or your child is sick.
Keeping your child current on routine vaccines is always a good idea, as they help the immune system fight infections faster and more effectively by stimulating the attack against germs.
Babies can also stay strong with your breastmilk, which offers extra antibody protection against infections in general.
Beyfortus (nirsevimab) - passive antibody immunization
In July 2023, the Food and Drug Administration (FDA), a federal government agency responsible for protecting public health by ensuring human drug safety, efficacy, and security, approved Beyfortus, the first preventive drug for RSV in young children.
Beyfortus is a single-dose antibody shot given into the thigh muscle in the month before or during an RSV season (November to March in the US) to babies younger than 8 months born during or entering their first RSV season. It also can be given to children 8 months through 19 months old who are at higher risk of severe RSV disease through their second RSV season.
It provides immediate protection and reduces the risk of RSV-related hospitalizations and doctor visits by 80%, and the protection can last for at least 5 months. The downside of this antibody is that it does not activate the immune system to make memory antibodies; thus, the protection goes away over time. The good thing is that the older the babies get, the less likely they are to get very sick from RSV.
Beyfortus is not recommended for babies with a history of serious allergic reactions to any of the components in the antibody, children with bleeding disorders like hemophilia, or babies who are currently sick with moderate to severe illnesses. Families with babies who are moderately to severely sick should wait until the baby is feeling better before getting Beyfortus.
Synagis (palivizumab) - passive antibody immunization
Synagis (palivizumab) is another passive antibody immunization for children younger than 24 months of age with high-risk health conditions. Unlike Beyfortus, Synagis is administered to your child once a month during the RSV season.
Beyfortus or Synagis can be given with your baby's other routine vaccines, but the two immunizations are not interchangeable.
Abrysvo (RSVpreF vaccine)
The FDA approved an RSV vaccine called Abrysvo for pregnant women to prevent severe RSV in infants from birth through 6 months of age. It is a single-dose shot given in the mother’s upper arm that is administered from 32 weeks through 36 weeks of pregnancy during September through January in the U.S. These protective antibodies pass through the placenta to the baby. It can reduce the risk of severe RSV by 57% in the first 6 months of life. Serious side effects were not commonly reported and are currently still being monitored.
RSV Versus Common Cold
The most significant difference between RSV and the common cold is that RSV can lead to more severe lower respiratory symptoms and a higher risk of hospitalization. Like RSV, the common cold is also highly contagious but usually only results in mild symptoms such as a runny nose, nasal congestion, dry or wet cough, sore throat, and sometimes mild fever. You can get both more than once in a single season. The common cold does not typically result in more extreme symptoms like difficulty breathing or wheezing seen with RSV.
Get Guidance for Your Child’s Symptoms
If you suspect your child has RSV or another infection, you can talk to a pediatrician about your child’s symptoms 24/7 with Blueberry Pediatrics. Blueberry offers on-demand access to board-certified pediatricians via text, phone, or video. Receive a diagnosis and treatment guidance (including prescribed medication, if medically necessary) from the comfort of your home.
The best part? Families get unlimited visits for every child in their household for one low monthly or annual fee. It's like having a doctor's office in your house. Sign up here to chat with a pediatrician right away.
- Wellness, H. &. (n.d.). RSV and Infants: a respiratory disease that can be deadly. Www.lung.org. https://www.lung.org/blog/about-rsv-and-infants
- Respiratory Syncytial Virus (RSV). (n.d.). Www.lung.org. https://www.lung.org/lung-health-diseases/lung-disease-lookup/rsv
- Commissioner, O. of the. (2023, July 18). FDA Approves New Drug to Prevent RSV in Babies and Toddlers. FDA. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-prevent-rsv-babies-and-toddlers
- Respiratory Syncytial Virus (RSV): Symptoms, Treatment, Relief. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/8282-respiratory-syncytial-virus-in-children-and-adults
- Adeyinka, A., & Kondamudi, N. P. (2019). Cyanosis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482247/
- NIH. (2022, December 2). Bronchitis | NHLBI, NIH. Www.nhlbi.nih.gov. https://www.nhlbi.nih.gov/health/bronchitis
- Respiratory Syncytial Virus (RSV). (n.d.). Foundation.chestnet.org. https://foundation.chestnet.org/lung-health-a-z/respiratory-syncytial-virus-rsv/
- Mayo Clinic. (2021, January 9). Respiratory syncytial virus - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/respiratory-syncytial-virus/symptoms-causes/syc-20353098
- Centers for Disease Control and Prevention. (2019). RSV. Centers for Disease Control and Prevention. https://www.cdc.gov/rsv/index.html
- Jones, A. (2020). RSV: When It’s More Than Just a Cold. HealthyChildren.org. https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/RSV-When-Its-More-Than-Just-a-Cold.aspx
- CDC. (2019). RSV in Infants and Young Children. Centers for Disease Control and Prevention. https://www.cdc.gov/rsv/high-risk/infants-young-children.html
- What to Expect if Your Child is Admitted to the Hospital. (n.d.). HealthyChildren.org. https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/What-to-Expect-If-Your-Child-is-Admitted-to-the-Hospital.aspx
Frequently Asked Questions
Is RSV contagious?
Yes, RSV is highly contagious. It is transmitted through respiratory droplets (saliva or nasal congestion) spread by sneezing, coughing, or close contact. It can also spread through contaminated hands and surfaces. The virus remains viable for 30 minutes on hands and several hours on other surfaces.
How long does RSV last?
Mild cases of RSV typically resolve on their own and last one to two weeks. More severe cases may take longer to resolve and require medical intervention to alleviate severe symptoms.
Do antibiotics treat RSV?
No. RSV is a viral infection, and antibiotics don’t work on viral infections.