Respiratory syncytial virus

Wintertime has most parents on the lookout for symptoms of colds and flu in their children, but as you wipe those runny noses, you should also be watching for symptoms of RSV (respiratory syncytial virus). RSV infects most children at least once before the age of two, and can sometimes be quite serious. “Children can get RSV almost any time of the year, but it is very common from October to March,” says Stanford Shulman, MD, head of Infectious Disease at Children’s Memorial.

Symptoms of RSV

RSV symptoms are similar to those of many other common childhood illnesses. Symptoms can include:

• Fever
• Runny nose
• Cough
• Wheezing
• Earache
• Fussiness
• Low energy
• Decreased appetite

Because these symptoms are so common, RSV is often mistaken for a simple cold or cough. The infection is often only as serious as a simple cold or cough, and the child recovers in a week or two without treatment from a physician.

When is it serious?

However, sometimes RSV can cause a more dangerous illness such as pneumonia or severe bronchiolitis, an ailment that includes inflammation in the small airways in the lungs, severe coughing, wheezing, and difficulty breathing. RSV is the most common cause of pneumonia and bronchiolitis in children under age one; these illnesses are especially dangerous in premature babies, or young children who have lung or heart problems or certain other chronic diseases. 

RSV can also cause ailments such as croup (a disease that includes a “barky” cough and difficulty breathing) or ear infections.

When to call the doctor

Call your child’s pediatrician or seek medical attention if your child: 

• Begins breathing fast, wheezing, or has other difficulty breathing
• Has a cough that continues to get worse and worse
• Looks blue around the mouth or fingertips
• Has difficulty sucking and swallowing
• Develops any fever of more than 100.4° F at the age of 0-3 months, 101° F or greater at the age of 3 to 6 months, or 103° F at the age of 6 months or older

Dr. Shulman advises not waiting too long to seek medical advice, particularly when very young children develop these symptoms.

Diagnosing RSV

There are tests for RSV, but they usually are not necessary. A pediatrician can often diagnose RSV after hearing about your child’s symptoms, especially if there has been an outbreak in your area. If your doctor decides that your child should be tested, all that is needed is a sample of mucous from the nose.

Treatment

With a mild case of RSV, you can treat your child’s symptoms at home, in the same way that you would treat a bad cold: 

• If the child has pain or a fever, give a pain and fever reducer such as children’s acetaminophen (such as Tylenol) or children’s ibuprofen (such as Advil).
• Ease congestion with a cool mist humidifier.
• Give your child lots of fluids to prevent dehydration.
• Use a bulb syringe to clear mucous from the nose if your child is too young to use a tissue. 

In more serious cases, a pediatrician may prescribe medications to help your child breathe more easily. Antibiotics are not generally helpful in treating RSV, but may be necessary if your child develops an ear infection or other secondary infection. 

About 0.5% to 2% (one in 50 – 200) of children with RSV need to be hospitalized to receive treatment; most of the hospitalized children are under 6 months of age. Treatment in the hospital can include use of an oxygen mask, a ventilator, or intravenous fluids (an IV) if your child is having trouble eating and drinking. 

If your baby is at high risk for developing a serious illness from RSV (such as previous heart or lung disease), there is a medication that can be injected monthly to help prevent it. Talk to your pediatrician if you think your baby might benefit from this treatment.

How can I prevent RSV?

RSV is spread the same way colds are—through droplets that come from sick people’s mouths and noses. Therefore, you can help prevent RSV the same way you would prevent other contagious illnesses: 

• Wash your hands frequently, especially after touching public surfaces like doorknobs.
• Limiting your child’s contact with people who may be sick, especially if your child is very young or especially at risk for getting sick.
• Frequently wash toys, pacifiers, and other items that children tend to put in their mouths.
• Cover your mouth and nose when coughing or sneezing, and teach your children to do the same (if they are old enough). 

Special attention should be paid to these infection-control methods in situations where children are in large groups, such as preschools and day-care centers. These methods will not only help protect children from RSV, but also colds, flu, and many other contagious illnesses. 

Also, please note that it is possible to get RSV more than once, so if your child has already had the illness this season, you should still take precautions.