RSV: Should I be concerned?

What is RSV?

Respiratory syncytial virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. If you have ever had a cold, you may have had RSV!  Most people with RSV have symptoms like runny nose and cough and recover in a week or two. RSV can cause breathing problems for some infants. However, most babies who have RSV experience a cold with no complications. Testing for RSV is not helpful because there rarely isn’t any treatment needed other than supportive care.

As with any respiratory illness, we advise monitoring breathing and keeping kids hydrated. Watching for changes in behavior, sleepiness or breathing with their belly in and out would be concerning signs.

Why are there so many cases of RSV?

We have always had RSV cases this time of year.  However, with mask-wearing and physical distancing for COVID-19, there were fewer cases of RSV in 2020.  Once safety measures relaxed with the arrival of COVID-19 vaccines, a rise in RSV cases began in spring 2021. The spread of RSV and other seasonal respiratory illnesses like influenza (flu) has also started earlier than usual this year. Therefore, it is important to get your flu vaccine if you haven’t already!

What are the symptoms of RSV?

• Fever
• Cough, congestion
• Fussiness with poor feeding
• Fast breathing
• Flaring of the nostrils
• Head bobbing breathing
• Rhythmic grunting during breathing
• Belly breathing, tugging between the ribs and/or lower neck
• Wheezing

How do I know if my child is having “uncomfortable breathing”?

• Chest wall retractions happen when a child must use muscles between the ribs or in the neck to breathe. It is a sign that your child 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.
• In older kids, they may have trouble speaking, coughing nonstop or wheezing that you can hear.
• [Signs of RSV in babies YouTube Video]

Is testing for RSV helpful?

• No. Testing for RSV is not helpful because there isn’t any treatment needed other than supportive care.
• There are no medications to treat RSV or shorten the course of illness.
• As with any respiratory illness, we advise monitoring breathing and keeping kids hydrated.  Concerning signs to monitor in any child with cold symptoms regardless of RSV or not would be monitoring for changes in behavior, sleepiness, not eating well, wheezing or breathing with their belly in and out.
• RSV symptoms are typically at their worst on days 3 through 5 of illness. Fortunately, almost all children recover from an RSV infection on their own. Only 3% of children with RSV will require a hospital stay.

Call your pediatrician right away if your child has any:

• Symptoms of dehydration
• Pauses or difficulty breathing
• Gray or blue color to tongue, lips or skin
• Significantly decreased activity and alertness
• Symptoms that worsen or do not start to improve after 7 days
• A fever (100.4°F or higher) if they are younger than 3 months of age (12 weeks).
• Poor sleep or fussiness, chest pain, ear tugging or ear drainage

Is RSV contagious?  When can my child go back to school or daycare?

• RSV spreads just like a common-cold virus―from one person to another. Symptoms can appear with a few days of encountering someone who is sick.
• If they have RSV or even if a health care provider suspects it is RSV even with no testing done, children can go back to school or daycare once they are starting to feel better and they have no fever for 24 hours.
• There is no test needed for RSV for patients to return to daycare.
• 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.

What can you do to help your child feel better?

There is no cure for RSV and medications, like steroids and antibiotics, do not help with RSV because it is a virus. 

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.
• Giving a bath a couple times a day to clear out all the mucus
• Cool-mist humidifier to help break up mucus and allow easier breathing.
• Fluids and 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 suction baby's nose before attempting to breast or bottle-feed. DO NOT supplement water for babies under 6 months old, but may use Pedialyte instead. 
• Acetaminophen or ibuprofen (if older than 6 months) to help with fevers. Always avoid aspirin and cough and cold medications in younger children.

How can you protect your child from RSV?

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.

Stay well and wash your hands often!

Read more from the American Academy of Pediatrics

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.