IllnesschevronRespiratory Syncytial Virus

Respiratory Syncytial Virus

By Chelsea Roberts (She/Her)
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What is RSV?

RSV, short for Respiratory Syncytial Virus. Sometimes referred to as hRSV (where the “h” stands for "human").

How severe is RSV?

RSV is not unique to children—adults can get it as well, albeit usually with milder symptoms. It matters for children, especially babies because it’s the most common cause of respiratory-related hospitalization for infants. Most children experience at least one bout of RSV before the age of 2 years.

In infants and children <2 years

Symptoms can vary from fever and cough to development of wheezing and difficulty breathing, to the point of needing hospitalization. Approximately 20% of infants develop RSV-associated wheezing during the first year of life; 2% to 3% require hospitalization.

In older, healthy, children and adults

Symptoms often mimic that of a common cold, but wheezing can still occur in up to 35% of adults and older children that are affected.

What causes RSV?

RSV is caused by infection from viral particles via contact or inhalation. Close contact with someone who is infected is the most likely source of transmission. It may also be picked up from contaminated surfaces. The virus attaches to and infects cells within the upper and lower airways.

Who gets RSV?

Humans of all ages may develop RSV infections, but the more severe cases most often present in children under 2 years of age. There are currently no vaccines to prevent RSV infection, and reinfection is common over the course of a lifetime.

Is RSV contagious?

Highly contagious
Spreads by exposure

Those infected with RSV should be considered contagious for 2-7 days on average, but younger children and the immunocompromised can be contagious for up to a month. Adults can infect children and vice versa.

What are the symptoms of RSV?

Although the symptoms of RSV resemble those of many other common respiratory infections, it can often be diagnosed clinically based on the symptoms your child is experiencing. When necessary, RSV can be identified via several testing methods, most commonly collected via a nasopharyngeal or nasal swab. Sometimes, a saliva sample or a nasal wash which is a rarely used method, is also able to test for RSV. A pulse oximeter test (a painless device that gently attaches to the finger or toe of the child) is also typically performed, to check oxygen levels.

Most common symptoms are
Runny nose
Coughing
Sneezing
Decreased appetite
Fever, typically around 101 °F
Congestion

It’s not immediately necessary to distinguish between RSV and other viruses. If symptoms remain mild and the child continues eating, drinking, and passing urine and stool as normal, there is no need for immediate alarm. 

However, especially in children under 2 years of age, symptoms may worsen. Concerns over the oxygen levels or pneumonia development due to infection of the lower respiratory tract is something your pediatrician will monitor which may eventually warrant a test for RSV.

Severe symptoms are
Fever above 101
Severe, hacking cough
Discoloration of the skin (bluish) due to lack of oxygen
Secondary ear infections, and croup may develop
For children having difficulty breathing, frequent waking is common, and the child may prefer to sit or lay at an elevated position instead of lying down flat. Infants who are feeding will likely have difficulty, and often appear sleepy and/or irritable.
Wheezing, signs of difficult breathing or retractions, which is when the skin between the ribs or above and below the ribcage gets sucked in when they are breathing.
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How to protect your child from RSV

What to do if your child has RSV

When to seek medical care

Because RSV is a viral infection, antibiotics are not effective in treatment and are not recommended. If RSV is suspected, a clinical evaluation is recommended in order to provide proper diagnosis and treatment. This will result in avoiding overuse of antibiotics, which can result in long-term antibiotic resistance.

Treatment

Most cases of RSV can be cared for at home following a diagnosis with “supportive care.” This could include:

  • Managing fevers with over-the-counter (OTC) fever reducers like acetaminophen (Tylenol), or ibuprofen (Advil or Motrin). Note - never give aspirin to children and ibuprofen is only to be used in children 6 months of age and older.
  • Plenty of fluids and rest
  • Use of a cool-mist humidifier at bedtime, naptime, or throughout the day
  • Monitoring changes in breathing
  • Nasal saline drops and/or suctioning to clear nasal passages
  • Possible prescribed nebulizer breathing treatments, if indicated

It’s important to reach out to your healthcare professional once severe symptoms appear or you notice significant changes in your child’s wellness so that a proper evaluation can be conducted. Most cases are not severe, but distinguishing between RSV and other viruses can help form a better treatment plan.

Duration

Most RSV infections resolve with at-home supportive care within 1-2 weeks. Many children may continue to cough even after recovering. This is commonly referred to as a “post-viral cough.” After they have fully recovered, the cough should not be treated as a sign of ongoing infection. 

Anything else?

RSV infection in infancy has been associated with recurrent wheezing and the development of asthma in some patients. Therefore, if your child continues to experience wheezing or chronic cough, follow-up with your primary care provider is very important.

DisclaimerThis illness guide is not a substitute for professional medical advice, diagnosis or treatment.
911If you think your child may have a life threatening emergency, immediately call your doctor or dial 911.
Headshot of Chelsea Roberts
Chelsea Roberts (She/Her)

Born and raised in the Portland area, Chelsea received her Masters in Physician Assistant Studies from Oregon Health and Science University, and is currently working on her Doctor of Medical Science degree. She has over 11 years of experience in pediatric medicine, in both primary and urgent care. When not at work, she enjoys traveling, hiking, camping, and exploring the beautiful Pacific Northwest with her family and their rambunctious dog.

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