What Is RSV?

Witnessing a young child who is coughing and feeling congested is nothing short of heartbreaking. If your kid is dealing with those types of symptoms, it’s possible that they have RSV, or respiratory syncytial virus.

RSV is a very common respiratory illness that causes fever and cold-like symptoms and can affect people of all ages. It normally circulates during the fall and winter months, especially in close-knit quarters where young children congregate. While most children experience mild cold symptoms, babies, toddlers, and kids with underlying health conditions may face complications, including breathing problems.

For children under the age of 5, RSV can be serious. In a typical year, RSV sends over 2 million children to the emergency room, and about 58,000 children under 5 are hospitalized with RSV.

RSV can be scary, but education is power. Understanding what RSV looks like, how to treat it, what complications can arise, and when to seek emergency care, will help prepare you for managing RSV season and keeping your kids healthy.

Symptoms of RSV

RSV is a respiratory infection that affects both the upper and lower respiratory tract, explains Melissa St. Germain, MD, pediatrician, vice president and medical director of Children’s Physicians and Urgent Care at Children’s Hospital & Medical Center in Omaha, Nebraska. RSV usually starts off like a typical cold, with a runny nose, cough, and fever. In young babies, symptoms can sometimes progress to wheezing and difficulty breathing, Dr. St. Germain says. “The worst days for young children are often day four or five of the illness,” she notes.

The virus can produce a whole lot of snot (respiratory secretions), adds Steven C. Jensen, MD, pediatrician, pediatric critical care specialist, and chair of the department of pediatrics at Torrance Memorial Medical Center. “The copious respiratory secretions can make breathing challenging, especially for younger children less than 6 months of age,” Dr. Jensen describes. “Children of this age group often have difficulty clearing their secretions.”

How Is RSV Diagnosed?

RSV is usually diagnosed based on your child’s symptoms and your physician’s knowledge of what viruses are circulating in the community, says Dr. St. Germain. “The hallmarks of RSV are wheezing and lower respiratory tract symptoms, such as difficulty breathing,” she describes.

Your child may be tested for RSV with a PCR test. “It’s important to know if the illness is caused by RSV because we can help families understand what potential symptoms might mean a baby needs to be re-evaluated,” Dr. St. Germain says. Often, your child will also be tested for COVID-19 and the flu in order to rule those viruses out, she adds.

Treatment for RSV

RSV is a virus, so can’t be treated with antibiotics. Most of the time, you just need to let RSV run its course and keep your child comfortable.

It’s common for young children to get very congested when they have RSV, which can make it hard for them to sleep, eat, drink, or breathe well. That’s why it’s important for parents to learn how to clear young kids’ noses, says Kristina Deeter, MD, pediatric intensivist and medical director at Pediatrix Critical Care and Hospitalists of Nevada.

“Any mucus in the nose of a baby should be managed with saline drops (sold over the counter) and a suction bulb,” she explains. “This is the most common and effective treatment to keep your baby breathing well.”

If your child has a fever or is fussy, you can consider over-the-counter fever reducers such as acetaminophen, says Dr. Deeter.  “Acetaminophen (Tylenol) can be used for any fever over 100.5 every four hours to keep your child comfortable if they appear fussy,” she advises. Of course, consult your child's pediatrician or healthcare provider regarding any medication you wish to offer.

It’s also important to keep young children hydrated. “Continue to offer breast milk, formula, and/or Pedialyte regularly to keep your baby hydrated and having regular wet diapers,” Dr. Deeter emphasizes.

Children who are hospitalized with RSV will receive many of the same treatments given at home, such as nose suctioning, fever reducers, and hydration. But in the hospital, your child would likely receive supplemental oxygen and IV fluids, says Dr. Deeter.

Complications of RSV

Again, most children experience RSV as a simple cold with no worsening symptoms. But some children are more vulnerable to complications than others. “The younger a child is, the higher the risk of severe illness,” says Dr. St. Germain. “Babies have smaller lungs that are still developing and have less capacity for reserve when a virus like RSV causes inflammation.”

Infants with other health conditions, such as prematurity, lung disease, heart issues, or immune system problems are also at high risk for complications, Dr. St. Germain adds. Additionally, certain older children may be at higher risk of developing breathing issues from RSV if they experience other respiratory illnesses, such as asthma.

When to Seek Emergency Care

In the vast majority of cases, at-home treatment with nasal clearing, fever reducers, and hydration will be enough to keep your little one comfortable and on the road to recovery. But in some cases, your child may need emergency medical treatment.

How can you tell that it’s time to go to the emergency room? “If your baby starts breathing more heavily, wheezing, using abdominal muscles while breathing, or their nostrils are flaring, go to the emergency room to check oxygen levels and to make sure the child does not have pneumonia,” advises Daniel Ganjian, MD, pediatrician at Providence Saint John’s Health Center in Santa Monica, CA.

Other signs that your baby may need emergency care include anytime their cough makes it hard for them to eat or sleep, says Dr. Deeter. A fever over 100.5 degrees and difficulty latching or feeding, along with decreased wet diapers are all signs that your baby should get help quickly, she adds.

You can also note how your baby looks. “A baby can have a lower oxygen level before they actually start to look dusky or blue,” Dr. Deeter describes. “The lips are the first place that we usually start to see pink turn more gray or blue as oxygen levels drop.”

The bottom line is that any baby having trouble eating or breathing, or who just doesn’t look quite right, should be assessed right away.

A Word From Verywell

RSV is a common respiratory virus that many kids catch at one point or another. Most children will do fine, but certain babies and toddlers are more prone to complications, and may need emergency treatment. Educating yourself on how to care for your child and knowing when extra help may be needed is a great way to protect your family during RSV season. You should also be in touch with your child's pediatrician or healthcare provider if you suspect a case of RSV, and contact them with any questions or concerns.