Respiratory Syncytial Virus

What is a respiratory syncytial virus (RSV) infection?

An RSV infection is a condition that causes swelling in your child’s lower airway and lungs. The swelling may cause your child to have trouble breathing. The RSV virus is the most common cause of lung infections in infants and young children. An RSV infection can happen at any age, but happens more often in children younger than 2 years old. An RSV infection usually lasts 5 to 15 days. RSV infection is most common in the fall and winter and often leads to other lung problems, such as bronchiolitis or pneumonia.

How does RSV spread?

RSV is highly contagious. Germs may be spread to others through coughing, sneezing, or close contact. Germs may be left on objects such as doorknobs, beds, tables, cribs, and toys. Your child can get infected by putting objects that carry the virus into his or her mouth. Your child can also get infected by touching objects that carry the virus and then rubbing his or her eyes or nose. Your child may get RSV from a school-aged brother or sister or at a daycare center.

What increases my child’s risk for a severe RSV infection?

• Being born prematurely (less than 37 weeks) or at a low weight (less than 5 pounds)
• Age younger than 6 months
• A medical condition, such as a heart problem or cystic fibrosis
• A weak immune system caused by certain conditions, such as HIV or a bone marrow transplant
• Exposure to high levels of secondhand cigarette smoke

What can I do to help prevent an RSV infection?

• Wash your hands and your child’s hands often. Use soap and water. Use gel hand cleaner when soap and water are not available. Wash your child’s hands after he or she uses the bathroom or sneezes. Wash your child’s hands before he or she eats. Wash your hands after you change your child’s diaper. Wash your hands before you prepare food.
• Keep your child away from others who are sick. Separate your child from siblings who are sick. Ask friends and family not to visit if they are sick.
• Clean toys and surfaces. Clean toys that are shared with other children. Use a disinfectant solution to clean common surfaces.
• Ask about medicine that protects against severe RSV. Your child may need to receive antiviral medicine to help protect him or her from severe illness. This may be given if your child has a high risk of becoming severely ill from RSV. When needed, your child will receive 1 dose every month for 5 months. The first dose is usually given in early November. Ask your child’s healthcare provider if this medicine is right for your child.

What are the early signs and symptoms of an RSV infection?

RSV infection begins like a common cold. Your child may have any of the following:

• Runny nose
• A cough or wheezing
• Fever
• Breathing faster than usual
• Not eating or sleeping as well as usual

What are the signs and symptoms of a severe RSV infection?

• Very fast breathing (60 to 70 breaths or more in 1 minute), or pauses in breathing of at least 15 seconds
• Grunting and increased wheezing or noisy breathing
• Nostrils become wider when breathing in
• Pale or bluish skin, lips, fingernails, or toenails
• Pulling in of the skin between the ribs and around the neck with each breath
• A fast heartbeat
• Loss of appetite or poor feeding, or being fussier or more irritable than before
• More sleepy than usual, trouble staying awake, or not responding to you
• Having fewer wet diapers than usual or urinating less than usual

How is an RSV infection diagnosed?

Your child’s healthcare provider will examine your child and ask about his or her symptoms. Tell the provider if your child has other medical problems. Your child may need a blood test to check for RSV. A swab of your child’s nose or throat may be taken and tested for RSV. Nasal drainage may also be suctioned from your child’s nose and tested for infection.

How is RSV treated?

Young children with a severe infection may need to be monitored and treated in the hospital. Children at risk for a severe infection may also need to be monitored and treated in the hospital. Most children can be given medicine at home to help manage symptoms. Do not give over-the-counter cough or cold medicines to children under 4 years. The following can help you manage your child’s symptoms until the infection is gone:

• Acetaminophen: This may help decrease your child’s pain and fever. This medicine is available without a doctor’s order. Ask how much medicine is safe to give your child, and how often to give it. Follow directions. Acetaminophen can cause liver damage if not taken correctly.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If your child takes blood thinner medicine, always ask if NSAIDs are safe for him or her. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child’s healthcare provider.

What else can I do to help manage my child’s RSV symptoms?

• Have your child rest. Rest can help your child’s body fight the infection.
• Give your child plenty of liquids. Liquids will help thin and loosen mucus so your child can cough it up. Liquids will also keep your child hydrated. Do not give your child liquids with caffeine. Caffeine can increase your child’s risk for dehydration. Liquids that help prevent dehydration include water, fruit juice, or broth. Ask your child’s healthcare provider how much liquid to give your child each day.
• Remove mucus from your child’s nose. Do this before you feed your child so it is easier for him or her to drink and eat. Place saline (saltwater) spray or drops into your child’s nose to help remove mucus. Saline spray and drops are available over-the-counter. Follow directions on the spray or drops bottle. Have your child blow his or her nose after you use these products. Use a bulb syringe to help remove mucus from an infant or young child’s nose. Ask your child’s healthcare provider how to use a bulb syringe.
• Use a cool mist humidifier in your child’s room. Cool mist can help thin mucus and make it easier for your child to breathe. Be sure to clean the humidifier as directed.
• Keep your child away from smoke. Do not smoke near your child. Nicotine and other chemicals in cigarettes and cigars can make your child’s symptoms worse. Ask your child’s healthcare provider for information if you currently smoke and need help to quit.

When should I seek immediate care for RSV?

• Your child is 6 months or younger and takes more than 50 breaths in 1 minute.
• Your child is 6 to 11 months old and takes more than 40 breaths in 1 minute.
• Your child is 1 year or older and takes more than 30 breaths in 1 minute.
• Your child pauses between breaths.
• Your child is grunting and has increased wheezing or noisy breathing
• Your child’s nostrils become wider when he or she breathes in.
• Your child’s skin, lips, fingernails, or toes are pale or blue.
• The skin between your child’s ribs and around his neck is pulling in with each breath.
• Your child’s heart is beating faster than usual.
• Your child has signs of dehydration such as:
  • Crying without tears
  • Dry mouth or cracked lips
  • More irritable or sleepy than normal
  • Sunken soft spot on the top of the head, if he or she is younger than 1 year old
  • Urinating less than usual or not at all