Every fall and winter, pediatric offices fill with children who have runny noses and coughs. Many of those children have respiratory syncytial virus, better known as RSV. For most older children and adults, RSV feels like a common cold. For babies, especially those in their first months of life, it can be much more serious. RSV is the leading cause of hospitalization for infants in the United States.
The good news is that parents now have more ways than ever to protect young babies from severe RSV, and most children who catch it can be cared for safely at home. This guide explains how RSV spreads, what symptoms to watch for, how to keep your child comfortable and when to get medical help right away.
What Is RSV?
RSV is a very common virus that infects the nose, throat and lungs. Almost all children catch RSV at least once by their second birthday, and people can be infected again later in life. In the United States, RSV season usually starts in the fall and peaks in winter, although the exact timing varies from year to year and by region.
In young babies, RSV can spread down into the small airways of the lungs and cause bronchiolitis (swelling and mucus in the tiny airways) or pneumonia. Because babies' airways are so small, even a little swelling and mucus can make it hard for them to breathe and feed.
How RSV Spreads
RSV spreads through droplets when an infected person coughs or sneezes, through direct contact such as kissing a baby's face, and by touching contaminated surfaces like toys, crib rails and doorknobs and then touching the eyes, nose or mouth. The virus can survive on hard surfaces for several hours. People with RSV are usually contagious for 3 to 8 days, but young infants and people with weakened immune systems can spread the virus for longer, even after they start to feel better.
Symptoms of RSV
Symptoms usually appear 4 to 6 days after exposure and tend to come on in stages. Common symptoms include:
- Runny or stuffy nose
- Decreased appetite
- Coughing and sneezing
- Fever (not every child has one)
- Wheezing
In very young infants, the only signs may be irritability, decreased activity, poor feeding or pauses in breathing (apnea). Cold-like symptoms often peak around days 3 to 5 of the illness, and the cough can linger for a couple of weeks even as your child improves.
Which Children Are at Higher Risk?
Any child can get very sick from RSV, but the risk of severe illness is highest for:
- Babies 6 months of age and younger, especially those born during RSV season
- Babies born prematurely
- Children with chronic lung disease or congenital heart disease
- Children with weakened immune systems
- Children with neuromuscular conditions that make it hard to swallow or clear mucus
Caring for a Child With RSV at Home
There is no medicine that cures RSV, and antibiotics do not work against viruses. Treatment focuses on keeping your child comfortable and well hydrated while the body fights off the infection.
Clear the nose
Babies breathe mainly through their noses, so congestion can make feeding difficult. Use saline drops in each nostril and gently suction with a bulb syringe or nasal aspirator, especially before feeds and sleep. Don't suction so often that the inside of the nose becomes sore.
Keep up with fluids
Offer breast milk or formula more often and in smaller amounts. Older children can have water and other fluids. Track wet diapers: fewer wet diapers than usual is an early sign of dehydration.
Use a cool-mist humidifier
Moist air can help loosen mucus. Clean the humidifier daily and avoid hot steam, which can cause burns.
Treat fever for comfort
Acetaminophen can be used for fever or discomfort in babies older than 2 to 3 months; ibuprofen is only for babies 6 months and older. Dose by your child's weight and ask us if you are unsure. Never give aspirin to children. Avoid over-the-counter cough and cold medicines in young children unless your pediatrician recommends them.
Keep the air smoke-free
Smoke and vapor irritate the airways. Don't let anyone smoke or vape in your home or car.
When to Get Help Right Away
Call 911 or go to the emergency department if your child:
- Is struggling to breathe: breathing very fast, grunting, flaring the nostrils, or sucking in the skin between or under the ribs
- Has pauses in breathing or lips, tongue or skin that look blue or gray
- Is extremely sleepy, limp or hard to wake
Contact your pediatrician promptly if your child:
- Is younger than 3 months and has a temperature of 100.4°F (38°C) or higher
- Is not feeding well or has significantly fewer wet diapers
- Has a fever lasting more than 2 to 3 days, or a fever that goes away and comes back
- Has symptoms that are getting worse instead of better, or ear pain
- Has a chronic heart or lung condition, or you are simply worried
Some children with severe RSV need care in the hospital for oxygen, help with feeding or fluids through an IV. Most improve within a few days.
How to Protect Your Baby From RSV
There are now two main ways to help prevent severe RSV in infants. The American Academy of Pediatrics recommends that most babies are protected by one of these options, not both:
RSV vaccine during pregnancy
A maternal RSV vaccine given during pregnancy, during a specific window late in the third trimester and in the months leading up to and during RSV season, helps the parent make antibodies that pass to the baby before birth. Talk with your obstetrician about whether this vaccine is right for you.
RSV antibody for infants
Long-acting RSV antibody products, such as nirsevimab and clesrovimab, are given as a single injection to infants younger than 8 months who are born during or entering their first RSV season, if they did not get protection from a maternal vaccine. Some children with certain medical conditions may also receive an antibody dose for their second RSV season. These antibodies give protection right away and have been shown to greatly reduce RSV-related doctor visits and hospital stays. Ask us whether your baby should receive one; see our immunizations page for the current schedule.
Everyday prevention
- Wash hands with soap and water before holding your baby, and ask visitors to do the same.
- Keep babies away from people who are sick, and avoid crowds during peak season when possible.
- Don't let people with cold symptoms kiss your baby's face.
- Clean frequently touched surfaces and toys.
- Breastfeed if you can; breast milk contains antibodies that help fight infections.
- Keep your baby's home and car smoke-free.
- Keep sick older children home from school or child care.
RSV, Flu or a Cold?
RSV, influenza, COVID-19 and common cold viruses can cause similar symptoms, and it is not always possible to tell them apart without testing. Your pediatrician can decide whether testing would change your child's care. For more on telling illnesses apart, read our article on cold vs. flu and our guide on protecting your family during flu season.
The Bottom Line
RSV is common, and most children recover at home with good supportive care. Babies, especially those under 6 months, need extra attention because they can get sick quickly. Watch their breathing, feeding and wet diapers closely, and trust your instincts. If your baby is born during RSV season or will soon enter one, talk with us about RSV immunization. It is one of the best ways to keep your little one out of the hospital this winter.
This article is general health information for parents and is not a substitute for medical advice. If you are worried about your child, contact your pediatrician; in an emergency, call 911.
Questions about your child's health?
Our Chestertown pediatric team cares for newborns, children and teens. Request an appointment, read our new patient information or browse more articles on the pediatric health blog.