What you need to know about RSV

Respiratory syncytial virus—most often known as RSV—is a very common infection of the lungs and respiratory tract. RSV is highly contagious, and spreads easily.

Older children and adults can catch RSV, but typically only have mild, cold-like symptoms. However, RSV can be dangerous for:

• Infants aged 12 months and under, especially premature infants and infants under 6 months
• Adults over age 65
• Children or adults with compromised immune systems
• Children or adults with chronic heart or lung conditions

In severe cases, RSV can lead to pneumonia (an infection in the lungs) or bronchiolitis (inflammation of the airways in the lungs). Read on to learn more about RSV, and the steps you can take to protect yourself and your family from infection.

How common is RSV?

RSV is very contagious, so in previous years, most children would have been exposed to it already by age 2. But due to the COVID-19 pandemic, fewer children aged 2 and under have been exposed to RSV. Maven Pediatrician Beth Rosenberg, MD, MHS explains, “Due to COVID-19 lockdowns and restrictions, many children under age 2 have not yet been exposed to RSV or other common viral illnesses. Young children are at risk for more severe disease, so there is a larger portion of vulnerable children with less robust immune systems than in a typical year.”

How does RSV spread?

RSV spreads through close contact with an infected person. When an infected person sneezes or coughs, the virus becomes airborne and can enter the body of someone close by through the eyes, nose, or mouth. You can also catch RSV from touching objects or surfaces the virus has landed on, then touching your face. RSV is most contagious when the infected person has had symptoms for 3 to 7 days, but some infants or older children and adults with compromised immune systems can be contagious for as long as 4 weeks.

What are the symptoms of RSV?

It can take anywhere from 2 to 8 days for symptoms of RSV to present after a person has become infected. Symptoms can vary by age and the severity of the infection.

Symptoms of mild to moderate RSV in infants include:

• Coughing and sneezing
• Runny nose
• Decreased appetite
• Fever over 100 degrees Fahrenheit (but not all infants have a fever)

Symptoms in infants younger than 6 months can also include:

• Crankiness, fussiness, or irritability
• Decreased appetite
• Pausing in breathing
• Fatigue and decreased activity

Symptoms of severe RSV in infants include:

• Shallow, rapid breathing with short breaths
• Wheezing
• Struggling to breathe
• Blue-colored lips, mouth, or fingers
• Decreased appetite

Symptoms in older kids and adults:

Older children and adults usually have no symptoms or very mild symptoms of RSV. The most common symptoms in mild cases include:

• Cough
• Runny nose and congestion
• Sore throat
• Fever
• Fatigue

Severe cases of RSV can lead to pneumonia or bronchiolitis. If your child has any of these symptoms, call a pediatrician right away—especially if you have an infant aged 12 months or younger, a premature infant, or a child who is immunocompromised.

When is RSV an emergency?

Call your family’s pediatrician or take your child to an urgent care or emergency room right away if:

• They have a fever over 100 degrees Fahrenheit that lasts longer than 2 days
• Their lips, mouth, or fingers are bluish in color
• They have trouble breathing or can’t clear mucus from their nose
• They’re dehydrated (for infants, this means fewer than 6 wet diapers in a day or 0 wet diapers in 6 hours)
• They’re extremely fussy and do not seem alert

“Regardless if your child has RSV, COVID, flu, or any other respiratory illness, it’s important to closely monitor them for any labored breathing (like retractions [a pulling in motion] under their ribs or under their chin, nasal flaring) or signs of dehydration (decreased wet diapers, decreased tears) which would require more medical intervention,” says Rosenberg.

How do I know if it’s RSV or something else?

RSV is a seasonal illness that shares many symptoms with the flu and the common cold. The best way to diagnose RSV is to see your child’s pediatrician.

Your family’s pediatrician will look at your child’s medical history and conduct a physical exam. The exam will most likely include:

• Listening to your child’s lungs
• Checking your child’s oxygen levels with a monitor that goes on their finger
• A nose swab to check for viruses

Your pediatrician may also order a blood test to check for signs of infection. If your child has a severe case of RSV, they might order imaging tests like X-ray or CT scan to check on their lungs.

What is the treatment for RSV?

Mild cases of RSV don’t usually need prescription medication for treatment, but you might consider giving your child acetaminophen (Tylenol) or ibuprofen (Motrin) if symptoms are making them uncomfortable or they have a fever. You should never give your child aspirin—it can cause a rare, but very serious condition called Reye’s Syndrome in children. If you’re not sure about the correct dosage of acetaminophen or ibuprofen for your child, ask your pediatrician for help. If your child has a severe case of RSV and develops bacterial pneumonia, their pediatrician will prescribe antibiotics. You should always finish the course of antibiotics, even if your child seems better. Stopping antibiotics too early can make the illness come back. About 3% of younger children who catch RSV will need to stay in the hospital for treatment. Those who are hospitalized are usually able to go home after a short, 2 to 3 day stay.

Your child may need to stay in the hospital if:

• They develop bronchiolitis and need oxygen
• They are unable to drink due to rapid breathing and need IV fluids to stay hydrated
• They need a respirator to help them breathe (this is very rare)
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Adults with very severe cases of RSV may need oxygen treatment and IV fluids in the hospital, too. If you or someone in your family develops symptoms of RSV, call your healthcare provider right away.

How can I protect my family from RSV?

Unfortunately, there currently is no vaccine or cure for RSV, but taking the same precautions as you would for the flu or common cold can help protect you and your family.

Some steps you can take yourself and that you can teach to your kids:

• Wash your hands often with soap and water for at least 20 seconds (or sing “Happy Birthday” twice). If you don’t have access to soap and water, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
• Avoid touching your eyes, nose, and mouth (which can be difficult with younger children)
• Avoid close contact with anyone who has RSV or is suspected to have RSV
• Wipe down common and shared surfaces with disinfectant spray
• Stay home when you’re sick or keep your children home from daycare or school when they’re sick

How can I manage my child’s symptoms?

If your child catches RSV, here are some things you can do to help them feel better:

• Keep them home from daycare or school
• Give them acetaminophen (Tylenol) or ibuprofen (Motrin) for fever or headache. Remember to never give your child aspirin. Ask their pediatrician or a Maven Pediatrician about dosage.
• Help your child gently blow their nose or use a baby nasal aspirator (lovingly referred to as a “snot sucker”) on infants
• Keep them hydrated (for infants, stick to breastmilk or formula)
• Give them all medications as prescribed by their pediatrician. If your child needs antibiotics, be sure to complete the entire treatment, even if they seem better.

Does having RSV make my child immune from catching it again?

Unlike many viruses, having RSV does not make you or your child immune from getting it again. The good news is that if your kiddo gets RSV again, the symptoms are usually milder.

The bottom line

RSV is a highly contagious and extremely common infection of the lungs. For most people, RSV causes mild, cold-like symptoms. But for young babies (aged 12 months or younger), children or adults with compromised immune systems, or those with existing heart or lung conditions, RSV can be dangerous. Severe cases can even lead to pneumonia or bronchiolitis. If you or your child develops symptoms of RSV, call your healthcare provider right away. Mild cases don’t usually need treatment (besides staying hydrated and rested), but serious cases require treatment and potentially hospitalization.

Have questions about RSV? Sign up for access to Maven to meet with a Maven Family Physician or Pediatrician today.