What every parent should know about RSV

Children's Health

by Dominic Lucia, MD

Oct 31, 2022

If you’re a parent of young children, you’ve likely heard about RSV, or Respiratory Syncytial Virus. As a pediatric ER doctor and a father of six, I’m no stranger to RSV. Here’s everything you need to know to keep your kids healthy and what to do if you think your child has RSV.

What is RSV? 

RSV is a virus that infects the lungs and breathing passages in children—particularly in babies and premature babies. Adolescents and adults can also get it, but it’s often much less severe if they do.

RSV is the leading viral cause of bronchiolitis (which is inflammation of the small airway passages in the lungs). Bronchiolitis can be caused by other viruses as well, like rhinovirus, COVID-19 or the flu. But the most common bronchiolitis pathogen is RSV.

Who is most severely affected by RSV?

  • Premature infants
  • Children who have spent time in the NICU or have chronic lung problems
  • Babies under one year old

These are the ones who are most susceptible to RSV and bronchiolitis. When you talk about children who actually need intervention care and hospitalization, you are typically talking about that under 1 year of age crowd, particularly the preemies.

How is RSV transmitted? 

RSV is a respiratory virus, so it’s transmitted through droplets via coughing, sneezing and being close to someone who has it who does those things. Then you intake those virus particles into your respiratory tract through the mouth, nose and even eyes.

How can you protect your kids from RSV? 

For those high-risk groups in particular, you should keep them away from large group of kids if possible, other babies, and certainly anyone showing any signs of infection. Sometimes this can be an early fever, but it can also be a small cough or congestion.

Other than that, it’s mostly the commonsense things we all know to do to try and stay healthy—cover your mouth when sneezing or coughing, and wash your hands often and well. This goes for you and your whole family. Make sure any older kids in the house are also following these measures.

If you’re worried about your child’s risk of RSV (especially if they fall in one of the above high-risk categories), you can always talk to your pediatrician about ways to lower their risk.

We also don’t want our children to contribute to the spread of it and infect their friends or peers. So, if your child is showing symptoms, don’t send them to a group setting like daycare or school. 

What are the symptoms of RSV? 

RSV in infants

  • Persistent nasal congestion. This makes it hard for them to breathe because infants are what we call “obligate nasal breathers,” meaning until you get past a year and a half to two years, your brain tells you that you should breathe through your nose and only your nose. It becomes very difficult for them to breathe normally (especially when it comes to feeding and sleeping) because they are often using a pacifier or thumb. This has a ripple effect through their sleep and their intake of fluids, because their nose gets so congested that it can cause a lot of problems.
  • Inflamed lungs. When a baby’s lungs get inflamed, they will then have a persistent cough, wheezing and sometimes (on the severe scale) respiratory difficulty, meaning they’re breathing harder and faster than they normally would.  

RSV in older kids (past two years of age)

If you are an otherwise healthy kid, RSV is going to look a lot like any other cold virus. Now, if you have asthma or chronic lung disease, you could have more of those lung symptoms talked about with the infants.

Most of the time, the older kids aren’t going to feel well but they certainly are not prone to getting near as ill as the infants do. So, they will have some:

  • Congestion
  • Runny nose
  • Cough
  • Maybe even a bit of wheezing

But it’s extremely rare for RSV to be the sole cause of hospitalization in an otherwise healthy kid over the age of two. 

RSV symptoms vs. the flu

There is definitely some overlap between RSV symptoms and flu symptoms. Let’s break it down in older vs. younger kids.

For younger kids, it can be tough to tell—and it can also be multiple viruses at the same time. This is what’s called a poly-viral infection. They are getting RSV, but they are also getting rhinovirus, adenovirus, COVID, the flu or some other combination of two or three of those at the same time. That can make all the symptoms worse and certainly require intervention, especially in the very young. 

For older kids, typically with the flu, you are going to get more of a body achiness, more cough, more of a systemic-type picture of illness that can include some of the respiratory symptoms. It depends on the strain and it depends on the kids. On the flipside, RSV is going to be really centered on respiratory symptoms with the cough, congestion and mucus production. 

How is RSV treated?  

Unfortunately, there is no medicine to give for RSV. The treatment for RSV is based in what’s called “supportive care.” The good news is, the vast majority of RSV (even in infants) can be treated with supportive care at home.

At-home care

  • Frequent nasal suctioning. This can be done via bulb suction or another product designed for this purpose (ask your pediatrician for recommendations), typically proceeded by some saline in the nose. We recommend that you do this with your infant if they are congested before feeds and before any nap/sleep time. It’s going to make those processes easier and their odds of staying hydrated are much higher if we are staying consistent with nasal suctioning at home.
  • Keeping them hydrated is also important. Oftentimes, supplementing with Pedialyte in between feeds can help keep their secretions a little bit thinner and manageable.
  • Fever-reducing medications. If they are running a little bit of a fever and they look well otherwise, you can treat children under six months with Tylenol (acetaminophen). Any child with a fever (over 100.4 F) under two months needs to be evaluated by a physician. So, between two and six months, Tylenol is fine if they look well overall. Once they are over six months, you can use either Tylenol or Motrin (ibuprofen). This can help them feel a little better. Keep in mind that a fever is the body’s natural response to an infection in the body (if your immune system is working right). That’s normal and expected.

In the hospital

For more ill kids, if they do come into the hospital, we’ll do nasal suctioning and depending on how sick the kids seems, we may add supplemental oxygen if they do require it to help their lungs open up.

Those that get severely sick (which is typically the little ones with lung problems) occasionally require higher respiratory support. We’ll use a nasal canula, a CPAP machine or in worst-case scenarios, some children need to be intubated and put on a breathing machine for a period of time.

These cases are fortunately rare, but it does happen. IV fluids are often used when they show up to the hospital if they’ve been dealing with it for a significant amount of time.

What to do if your child has RSV

For the low-risk kids, if the child is drinking liquids well and the parent isn’t worried about their breathing, patience is key. The first week to 10 days are the roughest. Then it tends to get better, but it gets better much slower than any of us want. It can sometimes take around four weeks until a child is finally rid of all the symptoms. So, patience is key.

I have six kids myself and I’ve been through it with four of them. Trust me, you just have to be patient and get through those long nights. It is exhausting, but there are not any quick fixes.

Signs you should go to urgent care or ER

You should consider heading to the hospital or urgent care if:

  • You’re worried about their fluid intake (they aren’t drinking/peeing).
  • You’re worried about their respiratory rate (it’s hard/fast).
  • They have a fever and they are under two months.
  • They have a fever (defined as 100.4) at any age for more than five days. Once you reach that fifth day, most physicians would like to check their ears, listen to their lungs and look at their throat to make sure there is no sign of a secondary bacterial infection that has joined the RSV party,

In urgent care or emergency care, they are often able to do a deep nasal suction—and that can make a world of difference. They’ll also assess their hydration status and oxygenation status to see if they need any further supportive care. But most of the time, you’ll be able to go home with instructions on supportive care and indications for when to return to the hospital.

It’s sometimes difficult to evaluate an infant over a video visit, but they can still be helpful. When emergency rooms and clinics are really busy, a video visit via MyBSWHealth can help you determine whether to take your child to the emergency room or if you can wait for an urgent care appointment the next day (which in many cases is appropriate).

At the end of the day, trust your instincts as a parent. If you’re worried about your child, get them evaluated or call your pediatrician.

About the Author

Dominic Lucia, MD, is a pediatric emergency medicine physician on the medical staff at Baylor Scott & White McLane Children’s Medical Center, where he serves as Chief Medical Officer and Medical Director of the Emergency Department.

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