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What is RSV?: The symptoms parents need to look out for

Respiratory Syncytial Virus (RSV) is not a new or uncommon virus, but it has been making headlines this year as children’s hospitals across the country are reporting winter-level cases of the virus. Even in a typical year, an estimated 58,000 U.S. children under age 5 are hospitalized due to RSV, and the Centers for Disease Control and Prevention (CDC) predicts that “almost all children will have had an RSV infection by their second birthday.” 

When Connecticut mom Megan Zander’s twins were just 3 weeks old, they both developed coughs, runny noses and fevers. She panicked. Her babies, born prematurely, were at high risk for serious infections, and their congestion made it nearly impossible for them to eat. Zander immediately took her twins to the pediatrician. Soon after, they were admitted to the hospital with RSV. 

The newborns spent their 1-month birthdays under the constant care of doctors and nurses. “It was reassuring to know their oxygen was being monitored, but I felt like a giant failure as a mom,” Zander says. “I felt very helpless. There was nothing I could do except hold them and hope with all I had that they would get better.”

Zander is far from the only parent to have this experience. While RSV doesn’t always lead to a hospital stay, it is a highly contagious virus that impacts kids of all ages. Here, pediatricians, a respiratory therapist and other parents share what you need to know about RSV, and how to keep kids safe.

What is RSV?

“RSV is a viral illness that impacts breathing and is spread through fluids from the nose and mouth,” says Dr. Amna Husain, a board-certified pediatrician in Marlboro, New Jersey. “Early phases of RSV often present as a mild cold; however, as RSV is a common cause of inflammation of the small airways in the lungs, it can turn into severe respiratory disease.”

Like many other respiratory infections, RSV spreads through droplets from coughs and sneezes that are left on surfaces or transmitted during close contact. Young babies and children and those with weakened immune systems are typically most susceptible to the virus.

So, how do I know if my child has RSV?

At onset, RSV presents like the common cold. Dana Evans, a pediatric respiratory therapist and respiratory care director at Ann & Robert H. Lurie Children’s Hospital of Chicago, says symptoms can last for up to two weeks and vary in severity. 

Common symptoms of RSV, according to Evans, include:

• Runny nose.
• Cough.
• Sore throat.
• Congestion.
• Fever.
• Decreased appetite.

RSV is the most common cause of bronchiolitis and pneumonia in U.S. children younger than 1 year of age, according to the CDC. 

“It can progress beyond the upper respiratory tract and involve the lower respiratory tract, causing severe symptoms like wheezing and difficulty breathing,” Husain says. “When children experience difficulty breathing, they may be unlikely to take in fluids and also encounter dehydration. This combination of symptoms can land children in the hospital.”

Who gets RSV?

Because babies are more susceptible to RSV, there’s a common misconception that only parents of infants need to worry about the virus. Christine A., a mom of three from Cleveland, Ohio, was stunned when her three kids, ages 8, 13 and 15, recently developed symptoms of RSV. “My husband came home after taking our [oldest] daughter to the doctor and said she has RSV, and I said, ‘No, she doesn’t,’” Christine says. “I was like, ‘How do you not know RSV is for babies?’”

“RSV is a very common virus that anyone can get,” Evans explains. Symptoms are typically milder in older children and adults, but an estimated 177,000 people over age 65 are hospitalized with RSV each year.

“Taking precautions not to spread the virus to others is important,” Evans says. To prevent the spread of RSV, she recommends taking many of the same steps used to prevent transmission of COVID-19, the flu or any other respiratory virus. 

Safety precautions against RSV may include:

• Practicing good hand hygiene.
• Covering coughs and sneezes.
• Staying home from work and school when ill.
• Sanitizing frequently touched surfaces.
• Avoiding close contact with others.

A vaccine for RSV is currently being developed but is still in clinical trials. For extremely high-risk infants, such as those who have underlying medical conditions, there is a medication called palivizumab that may decrease the risk of severe RSV symptoms. Your child’s pediatrician can tell you if your child is eligible.

When should you see a doctor?

Most babies and children recover from RSV without needing medical interventions, but Husain says a visit to the pediatrician is still a good idea if you suspect your child has the virus. “Testing is the best way for parents to conclusively know if their child has RSV,” she says.

Since COVID-19 can cause similar symptoms, it’s important for doctors to rule that out as a possible cause of illness. It’s also time to call or visit the pediatrician if you notice:

• Wheezing.
• Persistent high fever.
• Symptoms that worsen over time.
• Symptoms that last longer than two weeks.

While RSV is generally mild, it’s still important to watch for signs of severe illness, says Dr. Daniel Ganjian, a pediatrician at Providence Saint John’s Health Center in Santa Monica, California. 

Seek immediate emergency care, advises Ganjian, if you notice your child is:

• Breathing rapidly or struggling to breathe.
• Using their stomach muscles to facilitate breathing.
• Flaring their nostrils while trying to breathe.
• Developing blue lips.

Evans says the most common reasons for hospitalization with RSV are dehydration and the need for oxygen, particularly among infants. “In general, parents should trust their instincts when it comes to their babies,” she says. “If their breathing doesn’t look right, call your pediatrician.”

How is RSV treated?

Since RSV is a virus, it cannot be treated with antibiotics. Instead, do what you can to curtail and ease the child’s discomfort and symptoms. 

The most common advice to help manage symptoms includes:

• Resting.
• Offering plenty of fluids.
• Talking with your child’s doctor to see if over-the-counter medications can be used safely.

Evans says her number one tip for helping babies with RSV is to keep their airways as clear as possible. “Make sure to suction their nose often,” Evans says. “Keeping their nose clear makes it easier for them to breathe and take a feeding.”

Is RSV becoming more common?

Cases of RSV are on the rise in a number of states. The Texas Tribune reports that Texas Children’s Hospital in Houston has diagnosed more than 1,600 cases of RSV in the past three months, compared with fewer than 30 cases per month during an average summer. 

“Typically, we see viruses spike in the wintertime,” Evans explains. “We have nearly two years of babies that have likely never been exposed to RSV due to pandemic restrictions. Now that people are going out more and restrictions are more relaxed in many areas, we are seeing the early return of these viruses in their ‘off season.’”

Unfortunately, the rise in RSV cases has coincided with an increase in the number of kids being hospitalized for COVID-19. In Ohio, Christine A. describes the emergency rooms in her area as being “standing room only.” After being told the wait for emergency care could be 15-24 hours when her child was severely ill, Christine wants other parents to know RSV is out there and to take whatever precautions they can to prevent it. 

“We are so busy trying to determine risk and decide whether to send our kids to school during COVID-19,” she says. “When we hear on the news once or twice that RSV is spiking, it just goes in one ear and out the other. I didn’t think anything of it. I just want more awareness.”