RSV: When It's More Than Just a Cold

By Raquel Fernandez, MD – Pediatrician, Torrance Memorial Physician Network

What is RSV?

RSV stands for Respiratory Syncytial Virus. It is the leading cause of lower respiratory tract infections in infants and young children. An estimated 58,000-80,000 children are hospitalized each year in the United States due to RSV. Those at highest risk for severe illness from RSV include: premature infants, infants younger than 6 months of age, children younger than 2 years old with chronic lung disease or congenital heart disease, and children with weakened immune systems and neuromuscular disorders.

How can a child get RSV?

RSV is a respiratory virus and can spread when an infected person coughs or sneezes and virus droplets get into your eyes, nose and mouth. RSV can also spread through direct contact with the virus like kissing the face of a child with RSV or touching a surface that has the virus on it.

Why is there a current surge in RSV cases?

RSV is typically prevalent from October through March each year. However, due to COVID-19, RSV lost its seasonality and RSV cases are peaking earlier than usual. Additionally, due to the isolation and masking precautions taken during COVID-19, many children’s immune systems have not been challenged by the typical viral pathogens seen in daycare and preschool. Now that they are returning to school, many without masking, they are more vulnerable to these typical viral infections.

What are the symptoms of RSV?

Early symptoms of RSV may be mild and often include runny nose, decreased appetite and cough. However, the symptoms can become more severe a few days into the illness. Severe symptoms include: fever, wheezing and shortness of breath, dehydration due to poor intake of fluids or vomiting due to coughing spells. Very young infants may demonstrate irritability, decreased activity, poor feeding and even apnea (pauses in breathing) spells. The most common complications of RSV infection include Bronchiolitis (inflammation of the small airways in the lungs) and Pneumonia.

How is RSV treated?

Initially RSV can be treated at home with supportive care: Using saline drops and suctioning the nose before meals and bed to help improve appetite and sleep,as well as use of a humidifier/steam to help keep nasal secretions thin. Fever reducers can help manage high temperatures, and supplementing feeds with oral rehydration solutions like Pedialyte help keep patients hydrated. If symptoms persist or worsen, pediatricians often prescribe breathing treatments using a nebulizer machine and occasionally prescribe antibiotics or steroids depending on co-existing symptoms. 1 to 2 out of every 100 children younger than 6 months of age may need hospitalization. Those hospitalized may require oxygen therapy, IV fluids if dehydrated, nebulized medications and/or IV antibiotics and steroids. Rarely, some of the most severe presentations may even require mechanical ventilation to help support breathing. Most patients, however, improve with supportive care and are discharged in a few days.

When should I go to my pediatrician vs. urgent care vs. emergency department?

If your child is presenting with mild symptoms of RSV, call your pediatrician’s office for advice. An Urgent Care physician can examine your child, check oxygen levels and even perform X-rays, if needed. However, if your child demonstrates the following severe RSV symptoms, do not hesitate and take your child straight to the ED for evaluation: fever for 5 days, wheezing, shortness of breath, decreased urine output/dehydration or change in mental status.

How can parents prevent the spread of RSV?

Parents can help minimize the risk of RSV spread by encouraging hand washing, keeping hands off one’s face, avoiding sick contacts, covering coughs and sneezes/using a face mask, cleaning and disinfecting surfaces and keeping kids home when sick. A vaccine for RSV called Synagis (palivizumab) does exist and is given as a series of monthly shots during RSV season. However, only very premature infants or young children with certain heart and lung conditions are eligible for this vaccine. Talk to your pediatrician to see if your child qualifies. Lastly, parents should consider vaccinating their children against Influenza and COVID-19 in order to prevent co-infection with multiple viruses.

Do I need to isolate my child with RSV?

Children with RSV are typically contagious for 3-8 days. Children with RSV should isolate during this time period, especially if they have a fever. It typically takes a child 7-10 days to fully recover. In order for a child to return to daycare or school they must be fever free for 24 hours without fever reducers and no longer wheezing or having trouble breathing.