Almost every child will have respiratory syncytial virus, or RSV, by the time they turn 2. For most older children and healthy adults, RSV feels like a mild cold that runs its course in a week or two. But for babies, premature infants, and young children with certain health conditions, RSV can escalate quickly into a serious illness requiring hospital care.
RSV season runs from fall through spring each year. Understanding what RSV is, how to recognize when it is becoming serious, and how to protect your child before they get sick can make a real difference during the months ahead.
What Is RSV?
Respiratory syncytial virus (RSV) is a common respiratory virus that infects the lungs and breathing passages. In healthy older children and adults, it usually presents like a typical cold and resolves on its own. In infants and young children, especially those under 6 months old, it can cause significant breathing difficulty.
RSV spreads easily:
– Through the air on respiratory droplets when an infected person coughs or sneezes – Through direct contact such as shaking hands or touching an infected person’s face – Through touching contaminated surfaces (RSV can survive on hard surfaces like countertops, crib rails, and toys for several hours) and then touching the eyes, nose, or mouth
An infected person is most contagious during the first week of illness, but infants and people with weakened immune systems can remain contagious for up to four weeks, even after symptoms improve.
Note: Children in daycare settings or with school-age siblings face a higher risk of RSV exposure and reinfection. RSV can be caught more than once, even within the same season, though repeat infections are usually milder.
RSV Symptoms: Mild vs Severe
RSV symptoms typically appear 4 to 6 days after exposure to the virus.
Mild symptoms (most children and adults):
- Congested or runny nose
- Dry cough
- Low-grade fever
- Sore throat
- Sneezing
- Headache
Note: Severe RSV develops when the virus spreads from the upper to the lower respiratory tract, causing bronchiolitis (swelling of the small airway passages in the lungs) or pneumonia. Watch for: high fever, severe cough, wheezing (a high-pitched sound when breathing out), rapid or labored breathing, or a bluish tint to the lips or fingernails (cyanosis). In infants specifically, also watch for short shallow breathing with visible chest retraction, poor feeding, unusual tiredness, and unusual irritability.
Who Is at Highest Risk of Serious RSV?
While RSV is common across all ages, certain children and adults are significantly more likely to develop severe illness.
- Infants under 6 months old
- Premature babies (born before 37 weeks) under 12 months old
- Children under 24 months old with congenital heart disease, chronic lung disease, or a neuromuscular condition such as muscular dystrophy
- Children or adults with weakened immune systems from conditions like cancer or chemotherapy
- Older adults, especially those 65 and older with heart or lung disease
Note: There is evidence that severe RSV infection in early childhood may increase the likelihood of developing asthma or recurrent wheezing later in life. RSV is also the leading cause of pneumonia and bronchiolitis in infants.
When to Seek Medical Care
Most RSV cases in healthy older children can be managed at home with supportive care. Seek medical attention promptly if your child:
– Is under 6 months old and has any RSV symptoms (infants this young should always be evaluated) – Has difficulty breathing, is breathing very rapidly, or seems to be working hard to breathe – Shows signs of dehydration: dry mouth, very little urine output, sunken eyes, or extreme listlessness – Has a high fever – Develops a bluish color on the lips or around the fingernails – Has symptoms that are worsening rather than improving after a few days – Stops eating or feeding significantly
Call 911 or go to the ER immediately for any child with severe breathing difficulty, a blue color to the skin, or loss of consciousness. For milder but concerning symptoms, urgent care can evaluate your child, perform testing, and determine whether hospital care is needed.
RSV vs the Flu and COVID-19
RSV, influenza, and COVID-19 are all respiratory viruses that share overlapping symptoms, which can make it difficult to tell them apart without testing.
Key differences:
– RSV particularly affects infants and toddlers and is associated with wheezing and bronchiolitis in young children – The flu typically comes on suddenly with significant body aches, fatigue, and high fever – COVID-19 symptoms range widely and may include loss of taste or smell, which is not typical of RSV – All three can cause runny nose, cough, fever, and sore throat
Having RSV can also temporarily weaken immunity and increase vulnerability to other infections, including COVID-19. If you are unsure what your child has, testing at a clinic can help identify the virus and guide treatment decisions.
Note: It is possible to have RSV and another respiratory illness at the same time. Co-infections can make symptoms more severe, particularly in high-risk individuals.
Treating RSV at Home
There is no antiviral medication that treats RSV directly in most cases. Treatment focuses on keeping your child comfortable while the virus runs its course, typically 1 to 2 weeks.
At-home supportive care:
Manage fever and discomfort: Use acetaminophen (Tylenol) to reduce fever and relieve soreness. Never give aspirin to a child. Ask your provider for the correct dose based on your child’s age and weight.
Clear nasal congestion: Saline nasal drops are safe and effective for young children. Follow with gentle suctioning using a bulb syringe or nasal aspirator to help clear the nose, which is especially important before feeding.
Keep airways moist: A cool-mist humidifier in the child’s room can ease congestion and coughing. Keep it clean to prevent bacterial or mold buildup.
Maintain hydration: Continue breastfeeding or bottle feeding as usual for infants. For older children, offer frequent small amounts of cool water, warm broth, or ice pops. Watch carefully for signs of dehydration.
Create a comfortable environment: Keep the room warm but not overheated. For a child struggling to breathe, sitting up may feel more comfortable than lying down.
Avoid smoke exposure: Secondhand smoke significantly worsens RSV symptoms and increases the risk of serious complications. Do not smoke inside the home or car.
Note: Antibiotics do not treat RSV because it is a virus, not a bacterial infection. However, a provider may prescribe antibiotics if RSV leads to a secondary bacterial complication such as bacterial pneumonia or a middle ear infection. Inhalers (bronchodilators) and steroids have not been proven effective for RSV.
When RSV Requires Hospital Care
Severe RSV infections, particularly in infants and high-risk children, may require a hospital stay. Hospital treatment can include:
– IV fluids to treat or prevent dehydration – Supplemental humidified oxygen to maintain safe oxygen levels – Mechanical ventilation in severe cases where the child cannot breathe adequately on their own
Most children recover fully from RSV, even after hospitalization. The goal of hospital care is to support the child’s breathing and hydration while the immune system clears the virus.
Protecting Your Child From RSV
There are now more tools than ever to help protect babies and young children from serious RSV illness.
RSV Monoclonal Antibody Protection (Nirsevimab / Beyfortus)
Nirsevimab is not a vaccine but works similarly by providing ready-made antibodies that protect against RSV. The American Academy of Pediatrics recommends it for:
– All babies under 8 months old, given as a single shot before or at the start of their first RSV season – Children 8 to 19 months old who are at higher risk of severe RSV, before their second RSV season – Babies born during RSV season can receive the shot within the first week of life
Nirsevimab provides approximately 5 months of protection. It can be given at the same visit as routine vaccines.
RSV Vaccine During Pregnancy
The FDA-approved RSV vaccine Abrysvo can be given to pregnant people between weeks 32 and 36 of pregnancy during September through January. Antibodies from the vaccine cross the placenta and protect the baby from birth through approximately the first 6 months of life.
If you receive the RSV vaccine at least 14 days before delivery, your newborn likely does not need a separate nirsevimab shot after birth, because the protection from your vaccine is already in their system.
RSV Vaccines for Older Adults
Adults 60 and older can speak with their provider about RSV vaccines (Abrysvo or Arexvy). The CDC recommends older adults at higher risk of severe RSV, particularly those with heart or lung disease, discuss RSV vaccination with their provider.
Note: If you are pregnant and in your third trimester during RSV season, talk to your provider about whether the RSV vaccine is right for you. It is a straightforward conversation with a meaningful protective benefit for your baby.
Everyday Steps to Reduce RSV Spread
Beyond vaccines and antibody treatments, practical hygiene habits significantly reduce RSV transmission:
- Wash hands frequently with soap and water, especially after contact with anyone who is sick
- Disinfect frequently touched surfaces: countertops, doorknobs, crib rails, and toys regularly during RSV season
- Avoid close contact with people who have cold-like symptoms, and limit time in crowded indoor spaces during fall and winter
- Cover coughs and sneezes with an elbow or tissue, throw tissues away immediately, and wash hands
- Do not share cups, utensils, or feeding equipment when anyone in the household is ill
- Never smoke inside the home or car, and avoid exposing babies to secondhand smoke
Note: Children under 2 should not wear masks. For caregivers and older family members, a well-fitted mask in crowded indoor settings during RSV season can reduce the risk of bringing the virus home.
Questions to Ask Your Doctor About RSV
At your next well-child visit or if your child is showing symptoms, consider asking:
- Is my child at high risk for serious RSV and do they qualify for nirsevimab?
- If I am pregnant, should I get the RSV vaccine and when?
- What symptoms should prompt me to bring my child in or call right away?
- How can I tell if my child is getting enough fluids at home?
- Is my child’s cough or breathing pattern concerning?
- How long should symptoms last before I come back in?