RSV: When It’s More Than Just a Cold

By: Mary Caserta, MD, FAAP & Andrea Jones, MD, FAAP

Almost all children get infected with 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.

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.

These infections usually occur 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 in the US 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. Many of these children get better and can go home after a few days.

The latest ways to protect babies from RSV

There are now
immunizations to 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 the maternal RSV vaccine or the infant immunization, but not both.

RSV vaccine during pregnancy

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

The RSV vaccine for pregnant people is given just once. If you received the RSV vaccine during any pregnancy, you should not get another dose if you are pregnant again. Babies born from later pregnancies should receive the immunization for babies. See below for information about infant immunization.

RSV immunization for babies

An RSV immunization can be given as a single injection during or just before RSV season. Two products have been approved to protect babies from severe RSV disease.

Babies can receive one of these immunizations at the hospital when they are born or at their first checkup visit. If your baby was born before the RSV season and they are younger than 8 months old, they should receive the RSV immunization. It is also recommended for some children age 8 through 19 months who are at increased risk for severe RSV disease and entering their second RSV season.

Immunizations for babies have been shown to be approximately 80-90% effective in preventing infants from being hospitalized with RSV. These immunizations work a little differently than a traditional vaccine. They provide preventive antibodies that start working to protect babies right away. The protection lasts throughout a typical RSV season.

RSV symptoms in babies

Typically, RSV causes cold symptoms. Those symptoms may be followed by bronchiolitis or pneumonia. These are infections of the lower airways in the chest or lungs.
RSV symptoms are typically at their worst on days 3 through 5 of illness. Symptoms generally last an average of 7-14 days.

Call your pediatrician right away if your child has:

• 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 less activity and alertness

Some children with RSV may be more likely to get 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 doing a physical exam and checking oxygen saturation.

Your pediatrician may do a nasal swab test to determine if your child has RSV or another virus. A chest x-ray test may also be done to check for lung infection.

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. They might not feel like eating because they are having trouble breathing.

• Supplementing with water or formula is unnecessary for breastfed babies.

• If it’s difficult to breastfeed the baby,
  expressing breastmilk into a cup or bottle may be an option.

• Try to suction baby’s nose before trying to breast or bottle-feed

• 
  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

• Get the whole family annual flu and COVID shots.

• Adults over age 60 years can get the
  RSV vaccine.

• Getting vaccinated with
  Tdap―to protect against
  whooping cough—is especially important for pregnant people during each pregnancy and for household members and caregivers who are around infants.

• 
  Limit your baby’s exposure to crowds, other children, and anyone with colds. Keep children home from school or childcare 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 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! Researchers continue to explore new options to prevent and treat RSV. Don’t hesitate to talk with your child’s pediatrician about the best ways to keep your child healthy.

More information