Respiratory Syncytial Virus (RSV): What You Need to Know

What is respiratory syncytial virus (RSV)?

Respiratory syncytial virus (RSV) is a common illness that affects the airways (nose, throat and lungs). In older children and teenagers, RSV can be mild and causes cold-like symptoms. In babies and children under age 5, though RSV can be mild, it can also be very serious. RSV can cause bronchiolitis (inflammation of the lower airways and lungs). RSV is typically most common in the fall and winter months, but doctors have seen cases during other times of the year.

Who is more likely to develop severe RSV?

The following are more likely to develop severe cases of RSV:

• Premature babies
• Very young babies, especially those age 6 months or younger
• Children under age 2 years with chronic (long-term) lung conditions or congenital heart disease (heart disease that is present at birth)
• Children with weakened immune systems (system in the body that helps fight germs and illness)
• Children with neuromuscular disorders (disorders that affect how the nervous system and muscles work together), including children who have trouble swallowing or clearing mucus (thick, sticky liquid that lines the lungs, throat, mouth and nose) on their own

How is RSV spread?

RSV is spread in the following ways:

• If a person with RSV coughs, sneezes or blows their nose near you
• Touching, kissing or shaking hands with someone who has RSV
• Touching shared surfaces or objects also touched by someone with RSV, such as a doorknob or toys

RSV can spread quickly through enclosed, shared spaces, such as day care centers, schools or crowded households.

What are the symptoms of RSV in children?

In most children with RSV, RSV typically causes cold-like symptoms, such as cough, congestion, runny nose or fever higher than 100.4°F/39°C. Additional symptoms may vary and are listed below by age group.

Symptoms usually appear 2-8 days after being exposed to RSV. Symptoms last about 5-7 days and the cough may linger.

Birth – 6 months

• Wheezing (a whistling sound when breathing in)
• Nasal flaring (when the edges of the nostrils flare outward when your baby breathes out)
• Shortness of breath, trouble breathing, breathing fast or working harder to breath
• Visible chest retractions (when the chest appears to sink in just below the neck or breastbone with each breath)
• Decreased appetite or poor feeding, leading to fewer wet diapers and dehydration
• Decreased activity levels (not as active as usual)
• Fussiness or irritability
• In severe cases, cyanosis (bluish color in the skin caused by lack of oxygen) or apnea (pauses in breathing)

6 months – 5 years

• Wheezing (a whistling sound when breathing)
• Nasal flaring (when the edges of the nostrils flare outward when your baby breathes out)
• Shortness of breath, trouble breathing, breathing fast or working harder to breathe
• Visible chest retractions (when the chest appears to sink in just below the neck or breastbone with each breath)
• Low-grade fever (fever between 100.4°F-102.2°F/38°C-39°C)
• In severe cases, cyanosis (bluish color in the skin caused by lack of oxygen) or apnea (pauses in breathing)

Age 5 years and older

• Cold-like symptoms, such as cough, stuffy nose or fever (often between 100.4°F-102.2°F/38°C-39°C).
• Sometimes, the cough sounds tight or like a seal barking

How do doctors diagnose RSV in children?

Doctors can diagnose RSV by taking a swab of fluid from your baby/child’s nose or through a blood test. Testing for RSV is usually only necessary when considering hospitalization. Doctors will usually treat the symptoms without having to test for RSV. This is because treatment for RSV is similar to treatment for other respiratory (airway) viruses (germs). Your baby/child’s doctor will discuss with you what you can do at home to support your baby/child and what signs to look out for.

How do doctors treat RSV in children?

Most cases of RSV go away on their own in 1-2 weeks. If your child needs treatment for RSV, the care team will help figure out which treatments can help.

Treatment for RSV may include:

• Acetaminophen (Tylenol®) or ibuprofen (Motrin® or Advil®) to reduce fever. (Ibuprofen should only be used for infants over 6 months.)
• Fluids to keep your child hydrated
• Nasal saline (sterile saltwater solution used in the nose) and/or suction to help with congestion
• Humidifier or shower steam to help with congestion
• In children and babies 12 months or older, honey to help with cough
• In severe cases, hospitalization (especially for babies age 6 months or younger or for children who are having trouble breathing)

Antibiotics and bronchodilators (medications that help widen the airways in the lungs) do not help treat RSV. If your baby/child has asthma, ask their care team if a bronchodilator may help with their breathing while they recover from RSV. Doctors typically do not recommend over-the-counter (purchase without a prescription) cough and cold medications for young children.

What are possible complications of RSV in children?

Possible complications (medical concerns that occur during a disease or after a procedure or treatment) of RSV are most common in babies age 12 months and younger. Complications may include:

• Dehydration (low levels of fluids caused by not drinking enough fluid or losing more fluid than your child takes in)
• Bronchiolitis (inflammation of the bronchioles, or the small airways in the lungs)
• Pneumonia (an infection that causes inflammation of the air sacs, or pouches, that surround and protect the lungs)
• Lung failure (a condition in which the lungs cannot pass enough oxygen through the blood, which makes it hard to breathe)

When should I call the doctor?

If your baby has trouble breathing, call 911 or go to the closest emergency room.

Call the doctor if your child shows any of the following symptoms:

• If your baby/child’s symptoms get worse or do not get better after a few days
• Trouble breathing
• Shortness of breath
• High fever
• Bluish color to the skin

You can also call the doctor if you’re concerned about your baby/child’s risk of RSV or RSV symptoms.

Rev. 11/2022. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treat any medical conditions.