Respiratory Syncytial Virus (RSV) in Children

Pediatric Basics

Few things strike as much fear in parents of young children as RSV or Respiratory Syncytial Virus infections.

When they think about RSV, most parents have a picture of a child with a non-stop cough, who is also wheezing and huffing and puffing away. While RSV can cause such serious symptoms, it is important to remember that many children infected with RSV just get a simple cold or mild symptoms. So while most children become infected with RSV by age 2 years, fortunately, most of them do not have serious infections.

RSV Symptoms

Children usually develop symptoms of RSV about 3-5 days after being exposed to someone else who is sick with RSV, either by direct contact with their respiratory secretions or indirect contact with contaminated toys and other objects.

Again, the symptoms of RSV infections can range from having a simple clear runny nose and occasional cough that can be treated at home, to severe difficulty breathing that may require hospitalization. Other symptoms might include a low-grade fever, sore throat, headache, and irritability. Younger children, especially those under 2 or 3 years old, are most at risk for more severe symptoms, such as high fever, wheezing, difficulty breathing, a persistent cough, or apnea.


Although testing of nasal secretions can detect the RSV virus, the diagnosis is usually made by the pattern of a child's symptoms (a clinical diagnosis), especially if they have a cold and are wheezing.

Testing is sometimes helpful when a child is hospitalized for infection control and quarantine purposes.

RSV Treatments

The treatment of RSV infections is controversial. Some doctors aggressively treat the wheezing with nebulizer treatments and steroids, like they would for a child with asthma, while many others feel that they have no effect.

Others try breathing treatments and just continue them if a child has a good response.

Children with trouble breathing may need to be hospitalized to get intravenous fluids, oxygen, and sometimes respiratory support on a ventilator. An antiviral drug, Ribavirin, is available but is typically only used for serious, life-threatening RSV infections, and even then, its use is controversial.

For children with mild symptoms, a cough and cold medicine, pain and fever reducer, and a cool mist humidifier may help your child feel better until he gets better on his own.

What You Need To Know

  • RSV season usually runs from November or December through March or April.
  • Synagis is a monthly shot that can be given to high-risk children, especially premature babies, to prevent them from getting RSV.
  • While older children and adults with RSV typically get a simple cold, younger children can get bronchiolitis, with wheezing and trouble breathing.
  • It is not uncommon for RSV infections to linger for 1 to 3 weeks.
  • Antibiotics do not help treat RSV but may be needed if a child gets a secondary bacterial infection, like an ear infection.
  • Like other viruses that can cause a cold, it is possible to get RSV more than once. And there are other viruses besides RSV that can cause bronchiolitis, including the flu and parainfluenza virus infections. If your child is diagnosed with RSV or bronchiolitis over and over, you might consider that it might instead be asthma though.
  • Frequent handwashing and not sharing toys, bottles, pacifiers, etc., may help prevent the spread of RSV in a home or daycare.
  • Infants with bronchiolitis may be at increased risk for asthma and other respiratory problems later in life.

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