Almost all children get infected with respiratory syncytial virus (RSV) at least once
before they are 2 years old. For most healthy children, RSV is like a cold. But some
children get very sick with RSV.
What is RSV?
RSV is one of the many viruses that cause respiratory illness. It spreads like a cold virus
from person to person. It enters the body through the nose or eyes, usually from contact
with infected saliva, mucus or nasal discharge.
These infections usually occur in the late fall through early spring months. The timing
can vary in some parts of the country.
RSV is the most common cause of hospitalization in children under age 1 year. Two to
three out of every 100 infants in the US with RSV Infection may require a hospital stay .
Those babies may need oxygen to help with breathing or (intravenous) IV fluids if they
are not eating or drinking. Most of these children get better and can go home after a few
days.
New ways to protect babies from RSV
There are new immunizations to protect babies from severe illness during RSV season.
You can choose RSV immunization during pregnancy, or your baby can be immunized
after they are born. Most infants will likely only need protection from either the maternal
RSV vaccine or infant immunization, but not both.
RSV vaccine during pregnancy
Pregnant people can receive the maternal RSV vaccine (Abrysvo) at 32 through 36
weeks of pregnancy if their baby will be born during RSV season. The vaccine is given
from September through January and reduces the risk of RSV hospitalization for babies
by 57% in their first six months after birth.
The RSV vaccine for pregnant people is given just once. If you received the RSV
vaccine during any pregnancy, you should not get another dose if you are pregnant
again. Babies born from later pregnancies should receive immunization for babies.
RSV immunization for babies
For infants and some toddlers, an RSV immunization called nirsevimab (Beyfortus) can
be given as an injection during or just before RSV season. Babies can get it at the
hospital when they are born or at their checkup visit. Nirsevimab has been shown to be
approximately 80-90% effective in preventing infants from being hospitalized with RSV.
The shot works a little differently than a traditional vaccine. It provides preventive
antibodies that start working to protect babies right away. The protection lasts
throughout a typical RSV season.
What about palivizumab?
For some children, there is another product called palivizumab that is given as an
injection once a month during RSV season. It is for children under 24 months with
certain conditions that place them at high risk for severe RSV. High risk children should
receive palivizumab if nirsevimab is not available.
Children who receive nirsevimab should not get palivizumab. However, if your child did
not get all doses of palivizumab, they may be eligible for nirsevimab. Children who
received palivizumab in their first season can get nirsevimab in their second season if
they are eligible.
RSV symptoms in babies
Typically, RSV causes cold symptoms, which may be followed by bronchiolitis or
pneumonia which are infections of the lower airways in the chest or lungs. RSV
symptoms are typically at their worst on days 3 through 5 of illness. Symptoms
generally last an average of 7-14 days.
Call your pediatrician right away if your child has any:
- Symptoms of bronchiolitis (listed above)
- Symptoms of dehydration (fewer than 1 wet diaper every 8 hours)
- Pauses or difficulty breathing
- Pale, gray or blue-colored skin, lips or nail beds, depending on skin tone
- Significantly decreased activity and alertness
Some children with RSV may be at an increased risk of developing a bacterial
infection, such as an ear infection. Call your doctor if your child has:
- Symptoms that worsen or do not start to improve after 7 days
- A fever (with a rectal temperature of 100.4°F or higher) and they are youngerthan 3 months of age (12 weeks).
- A fever that rises above 104°F repeatedly for a child of any age.
- Poor sleep or fussiness, chest pain, ear tugging or ear drainage
Pediatricians diagnose children with a cold or bronchiolitis by asking about their
symptoms and by doing a physical exam. Your pediatrician may do a nasal swab test to
determine if your child has RSV or another virus. A chest x-ray and/or oxygen saturation
test may also be done to check for lung infection. Because most children recover
without difficulty and because there is no treatment specific for RSV, these tests are
often not necessary.
How to help your child with mild RSV feel better
There is no specific treatment for RSV and medications, like steroids and antibiotics,
do not help with RSV.
To help your child feel more comfortable, begin by doing what you would for any bad
cold:
- Nasal saline with gentle suctioning to allow easier breathing and feeding.
- Cool-mist humidifier to help break up mucus and allow easier breathing.
- Fluids & frequent feedings. Make sure your child is staying hydrated. Infants with a common cold may feed more slowly or not feel like eating because they are having trouble breathing. Try to suction baby’s nose before trying to breast or bottle-feed. Supplementing with water or formulas is unnecessary for breastfed babies. If difficult for the baby to feed at the breast, expressing breastmilk into a cup or bottle may be an option.
- Acetaminophen or Ibuprofen (if older than 6 months) to help with low-grade fevers. Always avoid aspirin and cough and cold medications.
Keep in mind, children and adults can get RSV multiple times—even during a single season. Often, however, repeat infections are less severe than the first one.
Other ways to help prevent RSV
- Stay up to date on vaccines. Keep your children up to date on their immunizations and get the whole family annual flu and COVID shots. Adults over age 60 years can get the RSV vaccine. And getting vaccinated with Tdap ―to protect against whooping cough—is especially important for pregnant people during each pregnancy and for household members and caregivers who are around infants.
- Limit your baby’s exposure to crowds, other children, and anyone with colds. Keep children home from school or childcare when they are sick and teach them to cover their coughs and sneezes.
- Wash your hands. Just as you would to prevent germs at any time, use soap and water and scrub for at least 20 seconds. Remind children to practice good hand hygiene all through the year.
- Go germ-free. Disinfect objects and surfaces in your home regularly and avoid exposing your child to smoke from tobacco or other substances.
- Feed your baby breastmilk. It has unique antibodies to prevent and fight infections.
Medicine is always advancing! Scientists continue to explore new options to prevent and treat RSV. In the meantime, rest assured that most people recover well from RSV.
