One of the most common causes of respiratory illness in young children is Respiratory Syncytial (sin-SISH-uhl) Virus, or RSV, according to the Centers for Disease Control and Prevention (CDC). By age 2, nearly all children have had the virus at least once. RSV affects the lungs and airway passages, and in most healthy people, it can feel like a mild cold. But in more vulnerable populations, such as young children and the elderly, RSV can be much more serious and lead to bronchiolitis, an inflammation of airways in the lungs, and pneumonia, an infection in the lungs – both of which may need medical intervention.
RSV on the Rise
RSV cases typically rise in the late fall and taper off in early spring, with peak levels in December or January. However, we have been seeing an uptick in the number of cases in the fall of 2022. Because of COVID restrictions, such as social distancing, mask mandates and handwashing, cases of RSV dropped in 2020. From late March through May 2022, as COVID restrictions have relaxed, the rates of RSV-associated hospitalizations spiked and appear to be rising again. According to the CDC, because of low RSV cases in 2020-2021, young children may be at risk for a more serious infection since their immune systems weren’t exposed to the virus as much over the last few years. This lack of exposure may also be why children are more susceptible to RSV as well as the flu and other respiratory illnesses, such as the flu, rhinovirus and general colds.
Signs and Symptoms of RSV
Symptoms of RSV are like that of a mild cold. They typically start to show around four to six days after infection. Look for:
- Nasal and/or chest congestion
- Coughing
- A decrease in appetite
- Fever (a temperature of 100.4 or higher)
- Fussiness and poor feeding in infants
- Runny nose
- Sneezing
- Sore throat
In very young infants, symptoms may only include irritability, decreased activity and difficulty breathing.
To diagnose RSV, your child’s health care provider can perform lab tests; however, in mild cases not requiring hospitalization, these tests are not needed for diagnosis and treatment.
Severe RSV
A barking or wheezing cough is one of the first signs that RSV is infecting the lower respiratory system, which might be an inflammation of the small airways of the lungs, a condition called bronchiolitis.
Infants might struggle to breathe, or breathe in quick, shallow breaths. Look for flaring nostrils, belly breathing and head bobbing. His or her lips or fingernail beds may appear blue due to a lack of oxygen.
Severe RSV can also cause dehydration. In children, this could mean fewer tears when crying, fatigue, irritability and a decrease in how often they urinate. In infants, they will typically have fewer wet diapers—less than six wet diapers a day—and a soft spot that looks sunken on top of the head.
If your child shows any signs or symptoms of bronchiolitis, pneumonia or dehydration, call your child’s health care provider right away.
Is your child at a greater risk for severe Respiratory Syncytial Virus?
Those at greater risk for severe RSV include:
- Children under age 2 with chronic lung diseases or congenital heart disease
- Children with a neuromuscular disorder that causes them to have trouble swallowing or clearing mucus
- Children with compromised immune systems
- Infants 6 months old and younger
- Premature babies
Treatment
Most RSV infections get better within a week or two. People with mild cases of RSV can be cared for at home with over-the-counter medications, like fever reducers and pain relievers. Since RSV is a virus, antibiotics and steroids will not help. Your child should start feeling better after a week or two of resting comfortably and staying hydrated. In severe cases, as many as 2 out of every 100 infants under 6 months old may need hospitalization for treatments that might include oxygen, intubation or mechanical ventilation, according to the CDC. Your child also might receive an IV to help with hydration. Typically, hospital stays will last only a few days.
Due to the rise in RSV cases, the American Academy of Pediatrics (AAP) recommends the use of palivizumab, an anti-viral prescription medication to prevent hospitalization from severe cases of RSV infection during the 2022-2023 RSV season. This preventive treatment consists of five consecutive monthly doses which provide protection for six months, the typical length of an RSV season. The AAP and CDC will continue to monitor the situation and revise guidelines as appropriate.
How to Prevent Respiratory Syncytial Virus
RSV is highly contagious and spreads by the air in water droplets from coughs or sneezes. RSV can also be passed along by contact with infected people and contaminated objects. There isn’t currently a vaccine, but to prevent infection, wash your hands often, avoid touching your face and avoid contact with sick people. If you or your child is ill, you can help control spread by:
- Avoiding sharing cups and toys
- Cleaning surfaces, doorknobs, light switches, toys and other high-touch objects often
- Avoiding close contact with others, such as kissing and shaking hands
- Avoiding sharing toys, cups or utensils
- Covering coughs and sneezes
- Staying home as much as possible
Medically reviewed by Rebecca Carter, MD.
