Respiratory Syncytial Virus (RSV) in Children

What is respiratory syncytial virus (RSV) in children?

RSV is a viral illness that causes symptoms such as trouble breathing. It’s the most common cause of inflammation of the small airways in the lungs (bronchiolitis) and pneumonia in babies.

What causes RSV in a child?

RSV is spread when a child comes into contact with fluid from an infected person’s nose or mouth. This can happen if a child touches a contaminated surface and touches his or her eyes, mouth, or nose. It may also happen when inhaling droplets from an infected person’s sneeze or cough.

Which children are at risk for RSV?

A child is more at risk for RSV if he or she is around other people with the virus. RSV often occurs in yearly outbreaks in communities, classrooms, and childcare centers. RSV is more common in winter and early spring months.

RSV can affect a person of any age but causes the most problems for the very young and very old. Most babies have been infected at least once by the time they are 2 years old. Babies can also be reinfected with the virus. Infection can happen again anytime throughout life. RSV infection in older children and adults may seem like an episode of severe asthma. Babies born prematurely or with heart, lung, or immune system diseases are at increased risk for more severe illness.

What are the symptoms of RSV in a child?

Symptoms start about 2 to 5 days after contact with the virus.

The early phase of RSV in babies and young children is often mild, like a cold. In children younger than age 3, the illness may move into the lungs and cause coughing and wheezing. In some children, the infection turns to a severe respiratory disease. Your child may need to be treated in the hospital to help with breathing.

The most common symptoms of RSV include:

  • Runny nose

  • Fever  

  • Cough, which can sometimes last for 10 days or more

  • Short periods without breathing (apnea)

  • Trouble eating, drinking, or swallowing

  • Wheezing

  • Flaring of the nostrils or straining of the chest or stomach while breathing

  • Breathing faster than usual, or trouble breathing

  • Turning blue around the lips and fingertips 

The symptoms of RSV can seem like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is RSV diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. He or she may also ask about any recent illness in your family or other children in childcare or school. He or she will give your child a physical exam. Your child may also have tests, such as a nasal swab or wash. This is a painless test to look for the virus in fluid from the nose. However, because RSV is not treated any differently from other common upper respiratory viruses, this testing is not usually needed.

How is RSV treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Antibiotics are not used to treat RSV. Treatment for RSV is done to help ease symptoms. Treatment may include:

  • More fluids. It's very important to make sure your child drinks plenty of fluids. If needed, your child will get an intravenous (IV) line to give fluids and electrolytes.

  • Oxygen. This is extra oxygen given through a mask, nasal prongs, or an oxygen tent.

  • Suctioning of mucus. A bulb syringe can help suction mucus from the nose. In the hospital, this is sometimes done through a small catheter.

  • Tube feeding. This may be done if a baby has trouble sucking. A thin tube is put through the baby’s nose and down into the stomach. Liquid nutrition is sent through the tube.

  • Mechanical ventilation. A child who is very ill may need to be put on a breathing machine (ventilator) to help with breathing.

  • Antivirals. Antivirals are rarely needed, though are sometimes considered in children who are severely immunocompromised.

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.

What are possible complications of RSV in a child?

In high-risk babies, RSV can lead to severe breathing illness and pneumonia. This may become life-threatening. RSV as a baby may be linked to asthma later in childhood.

How can I help prevent RSV in my child?

The American Academy of Pediatrics (AAP) recommends that babies at high risk for RSV get a medicine called palivizumab. Ask your child's healthcare provider if your child is at high risk for RSV. If so, ask about monthly injections during RSV season to help prevent infection.

To reduce the risk for RSV, the AAP recommends all babies, especially preterm infants:

  • Be breastfed

  • Be protected from contact with smoke

  • Not go to childcare with lots of children during their first winter season

  • Not have contact with sick people

Also make sure that household members wash their hands or use an alcohol-based hand cleaner before and after touching a baby with RSV.

When should I call my child's healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that don't get better, or get worse

  • New symptoms

Key points about RSV in children

  • RSV is a viral illness that causes trouble breathing. It is more common in winter and early spring months.

  • Most babies have been infected at least once by the time they are 2 years old. Babies can also be re-infected with the virus. Infection can happen again anytime throughout life.

  • Treatment for RSV may include extra oxygen. This is extra oxygen given through a mask, nasal prongs, or an oxygen tent. A child who is very ill may need to be put on a breathing machine (ventilator) to help with breathing

  • In high-risk babies, RSV can lead to severe respiratory illness and pneumonia. This may become life-threatening. RSV as a baby may be linked to asthma later in childhood.

  • Babies at high risk for RSV receive a medicine called palivizumab. Ask your child's healthcare provider if your child is at high risk for RSV.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

  • Ask if your child’s condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if your child does not take the medicine or have the test or procedure.

  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.