Dr. Lara’s Guide for RSV

What is RSV?

RSV stands for Respiratory Syncytial Virus (RSV). It is one of the many viruses that causes respiratory tract infections. It can affect people of all ages, but symptoms are usually more severe in infants. There are two subtypes of RSV circulating simultaneously during any given RSV season.

When is RSV season?

In the United States, RSV season occurs anytime from September to May, with a peak in January or February.

What’s the big deal about RSV?

RSV is one of the most common illnesses of early childhood. Nearly all children get RSV at least one time before the age of 2 years. Interestingly, previous infection with RSV does not prevent reinfection, thus children can get infected multiple times, even during the same season.

RSV is more than just a simple cold; it can cause inflammation in the lower respiratory tract (lung pipes). It is the most common cause of wheezing (bronchiolitis) and pneumonia in children younger than 1 year of age. It is also a common reason for outpatient and ER visits, and hospitalizations in infants.

Who is at risk for severe RSV infection?

  • Babies born prematurely, particularly those born before 29 weeks gestation
  • Infants with cardiac or lung disease, and other chronic conditions like immune deficiency
  • History of low birth weight
  • Babies younger than six months of age, especially those who are born during the first half of the RSV season
  • Infants who attend daycare
  • Infants with older siblings
  • Maternal smoking during pregnancy
  • Infants exposed to secondhand smoke
  • Crowded living conditions
  • Not breastfeeding
  • History of allergies and eczema

What’s the incubation period for RSV?  

The incubation period is 4 to 6 days.

How is RSV transmitted?

By direct or close contact to air droplets after an infected person coughs or sneezes near you. RSV can survive for several hours on hands and objects, so it can be transmitted after touching contaminated surfaces and then touching your eyes, nose, or mouth.

How long is my child contagious when infected with RSV?

Three to eight days. Young infants and those with a weak immune system can shed the virus for a longer time.

When can my baby or toddler return to daycare?

Approximately one week after diagnosis.

What are the RSV symptoms?

Infants and young children symptoms – Illness usually starts as a common cold but after a few days’ symptoms can worsen if the child develops bronchiolitis. Overall the illness lasts about 5 to 7 days, but the cough could last about 7 to 14 days.

Cold symptoms:

Initially symptoms involve just the upper airway (nose and throat). Typical symptoms include stuffy nose, sneezing, runny nose, wet-sounding cough, and fussiness. Fever is common but not always present. Due to nasal congestion, most infants have difficulty feeding and are at risk for dehydration.

Bronchiolitis symptoms:

RSV symptoms typically worsen on day 3 to 5 of illness when the lower airway (lung pipes) gets infected.   

Bronchiolitis symptoms include rapid and labored breathing, difficulty breathing, and wheezing. When a baby has bronchiolitis, they can develop chest retractions as they start using their chest and neck muscles to aid in their breathing. Chest retractions look like skin pulling in between the ribs. The presence of chest retractions means that the baby is working harder than usual to breath. This is known as respiratory distress. If you notice chest retractions, please seek medical attention for your baby immediately.

Older children symptoms:

RSV infection in this age group looks like a regular cold. Symptoms include stuffy nose, runny nose, red eyes, and cough. When compared with other viruses, RSV is more likely to cause sinusitis, ear infections, and asthma flareups.  

When should I take my child to the pediatrician?

Thankfully most infants and young children recover from RSV on their own and without medical intervention.

Seek medical attention if:

  • Your baby has developed symptoms of bronchiolitis and/ or chest retractions
  • Your baby is not feeding as usual
  • Your baby has fewer wet diapers than usual
  • Your baby is pausing when breathing, also known as apnea
  • Significant decreased activity, or excessive fussiness
  • Persistent fever, especially if your baby is younger than 3-month-old
  • Symptoms do not improve or worsen after 7 days of illness

How is RSV diagnosed?

In order to determine if your child has RSV, the pediatrician may order a nasal swab test. If there are concerns of lower airway involvement/bronchiolitis, the pediatrician may order a chest x-ray. Since most children recover from RSV on their own, these tests are usually not indicated.

What is the treatment for RSV?

RSV is a viral illness; therefore, antibiotics are not necessary for its treatment, unless the child has a secondary bacterial infection like ear infection, sinusitis or pneumonia.

Other medications like oral steroids and bronchodilators (breathing treatments) are usually not indicated because research shows that they do not help with symptoms or length of illness. Your pediatrician will determine if they are necessary for your child.

Cough and cold medications are not acceptable for young children, especially those younger than 6 months old. Always ask your pediatrician before administering any over the counter cough and cold medication.

Supportive measures to treat RSV include:

  • Nasal saline and suctioning 
  • Cool-mist humidifier
  • Frequent feedings to prevent dehydration
  • Fever reducers like Acetaminophen or Ibuprofen (only for babies older than 6 months old)

How can I prevent my baby from getting RSV?

Minimize exposure to contagious settings like childcare and crowded places, especially if your baby is at high risk for severe infection.

Limit exposure to secondhand smoke. 

Frequent hand washing.

Use alcohol-based hand sanitizers if water and soap are not available.

Cover your mouth when coughing or sneezing.