Pediatric Respiratory Syncytial Virus (RSV)

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

Respiratory syncytial virus 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.

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.

Symptoms start about two to five 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
• 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.

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.

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 thin tube is put into the lungs to remove extra mucus.
• Bronchodilator medicines. These may be used to open your child's airways. They are often given in an aerosol mist by a mask or through an inhaler.
• 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. Some children with severe infections may need treatment with an antiviral medicines.

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

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

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.

RSV Vaccine

The Centers for Disease Control (CDC) has approved a vaccine called Nirsevimab (Beyfortus) to protect newborns and infants under 8 months against Respiratory Syncytial Virus (RSV).

Certain babies 8 to 19 months may also get Nirsevimab if they have a condition that makes RSV infection more dangerous for them. These conditions include:

• Prematurity (less than 29 weeks)
• Weak immune system
• Problems swallowing or clearing secretions
• Heart or lung disease that has been treated with lung medicines, steroids, diuretics or oxygen in the past 6 months.

Learn more about the vaccine.

Call the healthcare provider if your child has:

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