Respiratory syncytial virus (RSV) is such a common virus that nearly all adults and young children are affected by it sooner or later.
The virus and its accompanying cold-like symptoms will typically cause a week or two of discomfort for your baby, but luckily it’s usually not something to be worried about. The truth is, most of the time you won’t even know that your baby’s cold symptoms are due to an RSV infection.[1]
But for little ones with certain chronic health problems, RSV can lead to complications. To protect your child, get the facts about preventing RSV and managing its symptoms.
What is RSV in babies?
RSV is a contagious virus that's spread just like the common cold, often between October and April. Almost every child will get RSV by the age of 2, and for the majority of babies, the illness is mild, with symptoms lasting for about one or two weeks.
But some infants have a higher risk for severe RSV, including premature babies, whose lungs are underdeveloped, or babies born with heart conditions, lung problems or immune deficiencies.
In these babies, the infection can escalate from mild to severe, and can lead to pneumonia or bronchiolitis, an infection that causes the small, inner branches in the lungs to swell, making breathing more difficult.[2]
In fact, RSV is a leading cause of severe bronchiolitis among young children under 1 year old, and it's estimated that approximately 70 percent of infants are infected with RSV during their first year of life.
Statistics show that out of 100 babies under the age of 6 months who get RSV, about one or two of them may need to be hospitalized and given oxygen or other help breathing.[3]
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What are the signs of RSV in babies?
Most of the time, babies with RSV have mild, cold-like symptoms that tend to peak on the third to fifth day of the illness. The symptoms of RSV usually appear two to eight days after contracting the virus.
Common symptoms of RSV in infants include:[4]
- Runny nose
- Cough
- Low-grade fever
- Sneezing
- Irritability
Babies who are younger than 6 months old may show different symptoms of an RSV infection, including:
- Irritability
- Decreased activity
- Loss of appetite
- Apnea (pauses during breathing)
A child with RSV can be contagious for at least three to eight days before showing symptoms.
How do babies get RSV?
An RSV infection can be spread through the air by coughing or sneezing, which is how babies often come into contact with this virus.
RSV can also survive on surfaces for up to six hours, which makes it easy to pick up. Children can get RSV by touching an infected playmate’s hand and then putting their own hands in their mouths, eyes or noses; picking up toys a sick child was using and then putting their hands in their mouths; or sharing cups and utensils with someone who has the virus.[5]
The babies who are at most risk for a severe infection include:[6]
- Low birth weight or premature babies (especially those born before week 29)
- Babies with a chronic lung disease
- Babies who have certain types of heart defects
- Babies with weakened immune systems
- Babies who are 3 months old or younger at the start of the RSV season
How is RSV treated in babies?
There's no specific treatment for RSV in babies since it's a virus — antibiotics are only effective against bacteria — but you can manage your little one's symptoms at home, just like you would for a cold. Here are some ways to help him feel better.[7]
- Keep your child hydrated. Your little one may not feel like drinking when he’s sick, but he’ll need plenty of liquids during this time. If he doesn’t feel like breastfeeding, you can offer him pumped or expressed milk in a bottle or cup.
- Use a cool-mist humidifier. A humidifier will help break up mucus and ease congestion, which can help your child breathe easier. Avoid using hot-water humidifiers, however, which can cause burns if they tip over.
- Keep his nose clear. Use a bulb syringe to suction mucus out of his nose, which can also make it easier for him to breathe. You can also clear a stuffy nose with frequent blowing or an infant aspirator. Try doing this before feeds so your little one can breathe wihle eating.
- Use OTC pain relievers. To ease a low-grade fever, you can give acetaminophen (like Tylenol) to babies aged 2 months and older with your doctor's approval or ibuprofen to babies 6 months and older.[8]
- Do not give your child aspirin or cough and cold medications. If your baby is under 2 months, don’t give him any medication unless it’s been approved by your doctor first.[9]
When to seek medical care for a baby with RSV
If your baby was born prematurely, suffers from congenital heart disease or has other problems that increase his risk for complications, contact your doctor immediately if you notice serious cold symptoms such as:
- Loss of appetite
- Fever
- Runny nose
- Coughing
- Retractions (fast breathing or sucking in the stomach while breathing)
While cold symptoms may not be a concern for babies who are not at high risk for RSV complications, the symptoms of a more severe RSV infection, which warrant a call to your doctor, include:
- Fever of 100.4 degrees Fahrenheit or higher in babies under 3 months old[10]
- Fever of more than 100.4 degrees F or higher in older children, since that's the threshold for COVID-19, which may need to be tested for. The normal guideline is to call if a fever persists for more than 24 hours, specifically a temp of 101 degrees F in babies 3 to 6 months old and 103 degrees F in babies older than 6 months.
- Apnea
- Breathing that’s labored, rapid or accompanied by a lot of wheezing, flaring of the nostrils and/or rhythmic grunting during breathing
- Gray or bluish skin, tongue or lip color
- Worsening cough or coughing up mucus
- Extreme lethargy
You should also be on the lookout for symptoms of dehydration — for example, fewer than one wet diaper every eight hours.
Can RSV be prevented in babies?
Unfortunately, RSV is one of those infant and childhood illnesses that can't really be prevented, in part because there's no vaccine for it yet.
In 2014, the American Academy of Pediatrics (AAP) released new recommendations urging doctors to only prescribe Synagis (palivizumab) — a drug that can prevent serious RSV — to infants born before 29 weeks gestation or those with certain illnesses like congenital heart disease or chronic lung disease.[11]
For other infants who are not at risk, the AAP says, the drug does not reduce rates of more serious side effects, including wheezing and asthma.
In most cases, the best defense is good offense — which in this case means good hygiene habits. Here are a few to try:
- Wash your hands. Make sure that everyone in the family — including toddlers — washes their hands regularly with soap and water, scrubbing for at least 20 seconds.
- Get the flu vaccine. Everyone who’s 6 months old or older should receive a flu vaccination to limit the chances of getting infected with other viruses that can weaken the immune system during the winter season, when RSV infection rates are higher.
- Don’t smoke. You can help protect your child by not smoking or vaping, since smokers are at greater risk of developing respiratory infections that can then be passed on to little ones and secondhand smoke and vaping fumes can be harmful to children and others in the house.
- Breastfeed (if possible). Breastfeeding can help pass along antibodies that protect against RSV.
- Wipe out germs. Keep some disposable disinfectant wipes on hand and wipe down surfaces in your home such as bathroom counters, faucets, doorknobs and cellphones, which could be harboring viruses that family members or friends were carrying.
You should also vigilantly watch that they are not putting unsanitary items in their mouths. Regularly sanitize their toys, pacifiers and items that they tend to chew on.
Thankfully, almost all children will recover from an RSV infection on their own, without any need for a trip to the doctor’s. Still, call your pediatrician if you have any concerns, especially if your little one may have a higher risk for the virus.
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