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RSV: When It's More Than Just a Cold

RSV: When it's more than just a cold RSV: When it's more than just a cold

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.

New ways to protect babies from RSV

Two new tools protect babies from severe illness during RSV season. You can choose RSV immunization during pregnancy, or your baby can be immunized after they are born. Most infants will likely only need protection from either the maternal RSV vaccine or infant immunization, but not both.

RSV vaccine during pregnancy

Pregnant people can receive the maternal RSV vaccine at 32 through 36 weeks pregnancy if their baby will be born during RSV season. The vaccine reduces the risk of RSV hospitalization for babies by 57% in their first six months after birth.

RSV immunization for babies

For infants and some toddlers, an RSV immunization called nirsevimab can be given as an injection and may be included with or between your baby's routine immunizations. Nirsevimab has been shown to reduce the risk of both RSV-related hospitalizations and health care visits in infants by about 80%.

The shot works a little differently than a vaccine. It provides antibodies that start working to protect babies right away. The protection lasts throughout a typical RSV season.

Watch this video about new immunization options to prevent RSV:

What about palivizumab?

For some children, there is another product called palivizumab that is given as an injection once a month during RSV season. 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: Upper Respiratory Tract Infection

Bronchiolitis: Lower Respiratory Tract Infection

Cold symptoms may include:

  • Fever (temperature of 100.4 or higher)

  • Cough (dry or wet sounding)

  • Congestion

  • Runny nose

  • Sneezing

  • Fussiness

  • Poor feeding

May include cold symptoms, plus:

  • Fast breathing

  • 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)

  • Wheezing

How hard is your baby breathing? What to look for.

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 (listed above)

  • Symptoms of dehydration (fewer than 1 wet diaper every 8 hours)

  • Pauses or difficulty breathing

  • Pale, gray or blue-colored skin, lips or nail beds, depending on skin tone

  • 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

  • A fever (with a rectal temperature of 100.4°F or higher) and they are younger than 3 months of age (12 weeks).

  • A 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.

  • Cool-mist 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 medications.

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

  • Stay up to date on vaccines. 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.

More information

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 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.

Last Updated
American Academy of Pediatrics Committee on Infectious Diseases (Copyright © 2023)
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.
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