RSV in Babies & Children

What is RSV in babies and children?

Respiratory syncytial virus (RSV) is a seasonal virus that spreads easily among babies and children. For many kids, RSV feels like a cold. However, RSV can sometimes lead to complications that cause severe symptoms, like trouble breathing.

Babies born early (preemies), infants under 6 months and children with other health problems face the highest risk of complications. Each year in the U.S., about 58,000 to 80,000 children under age 5 need care at a hospital for RSV.

RSV in infants

RSV hits infants (babies younger than 1 year) especially hard. RSV is the most common cause of hospitalization in infants. In the U.S., up to 3% of infants who develop RSV need a hospital stay. This stay can be scary for parents even if it just lasts a few days, but some babies also need treatment in intensive care.

RSV in toddlers

About 90% of children get RSV before their second birthday. It’s usually just like a common cold, but some little ones have more severe symptoms. Of all babies and toddlers under age 2 who get RSV for the first time, up to 40% develop complications like bronchiolitis or pneumonia. These complications require immediate medical attention.

RSV in kids

For many children, RSV is mild and goes away with at-home care just like other colds. But younger kids may have more severe symptoms. RSV easily spreads among kids in group settings like schools and daycares. It also spreads within families as siblings pass it to one another.

What are the symptoms of RSV in kids?

RSV symptoms vary according to your child’s age and whether the infection leads to complications.

RSV symptoms in infants

Babies younger than 1 year usually have symptoms of a common cold, which include:

• Fever (100.4 F or higher).
• Cough that can either sound wet or dry.
• Runny nose.
• Congestion.
• Sneezing.

Your baby may also fuss a lot and not eat much.

RSV sometimes leads to bronchiolitis. This is swelling in the small airways of your baby’s lungs that makes breathing difficult. Babies who develop bronchiolitis may have cold symptoms, as well as:

• Fast breathing.
• Flaring (spreading out) of their nostrils while breathing.
• Grunting sounds while breathing.
• Chest caving in while breathing.
• Wheezing.

Newborns and infants younger than 6 months may not develop the typical cold symptoms and instead only have:

• Symptoms related to breathing (listed above).
• Fussiness or irritability.
• Decreased appetite.
• Minimal interest in activities.

If your baby has any breathing trouble or changes to their usual breathing, call 911 or take them to the nearest emergency room.

RSV symptoms in toddlers

Toddlers (kids between the ages of 1 and 3) may have the following symptoms:

• Runny nose.
• Coughing and sneezing.
• Decreased eating or drinking.
• Less interest in playing.
• Trouble swallowing.
• Faster-than-normal breathing.

RSV symptoms in older children

Children over age 5 usually have typical cold symptoms, including:

• Runny nose.
• Congestion.
• Sore throat.
• Mild headache.
• Lack of energy.
• Fever.
• Cough.

Infections that lead to complications may cause wheezing, a barking cough (croup) and trouble breathing. Kids with underlying medical conditions face a greater risk of severe symptoms. These include conditions that:

• Weaken your child’s immune system.
• Cause difficulty swallowing.
• Make it hard for them to clear out mucus.

Talk to your pediatrician about what to look out for and when to seek medical care.

When should I take a baby with RSV to the hospital?

Babies and toddlers with severe RSV symptoms need care at a hospital. Take your child to the emergency room or call 911 if you notice:

• Noisy breathing.
• Flaring of their nostrils with every breath.
• A blue or gray color to their lips, mouth and fingernails.
• Belly breathing or “caving in” of their chest when they breathe.
• Breathing that’s shallow or fast.
• Pauses while breathing.
• Signs of dehydration.

What causes RSV in babies and children?

RSV is a viral infection, meaning a virus causes it. The respiratory syncytial virus (RSV) is the name of the specific virus responsible.

RSV is one of several viruses that spread most widely during respiratory season.

Is RSV contagious?

Yes, RSV is very contagious. The infection spreads easily from person to person through respiratory droplets. When kids with RSV cough or sneeze, the droplets can spread up to several feet away — and they’re rarely good at covering their mouths! Anyone close by can get sick if the droplets reach their eyes, nose or mouth. This is common among babies and kids who play together.

RSV can also live on hard surfaces like tables or toys for several hours. If your child touches a contaminated object and then touches their face or puts a contaminated toy in their mouth, there’s a good chance they’ll get sick.

Is RSV serious in babies and toddlers?

Yes, it can be serious. Possible complications include bronchiolitis and pneumonia. These are lower respiratory infections that can lead to hospitalization.

Any baby, toddler or child can develop lower respiratory tract infections from RSV. In fact, RSV sends many healthy, full-term infants to the hospital. However, RSV is especially dangerous for:

• Babies born early (premature birth).
• Infants, especially those 6 months or younger.
• Kids under age 2 who have congenital heart disease or chronic lung disease.
• Kids who have a compromised immune system or a neuromuscular disorder.

These babies and children face an increased risk of severe illness or death from RSV.

How is RSV diagnosed in babies and children?

Pediatricians diagnose RSV by talking to you about your child’s symptoms and doing a physical exam. Your child may not need any tests. But your provider may do a swab test to check your child’s mucus for RSV and confirm the diagnosis.

Babies and children who are hospitalized might need tests to check for signs of complications or other concerns. Possible tests include:

• A chest X-ray or CT scan (computed tomography scan).
• Blood tests.
• Urine tests.

What is the treatment for RSV in babies and children?

The antiviral medication ribavirin can help treat RSV in very ill kids or kids with other health conditions. But like most viral infections, most kids don’t need a specific treatment for RSV. Instead, pediatricians recommend at-home care to ease symptoms and help your child feel more comfortable. Here are some tips:

• Keep up the fluids. Infants may not breastfeed (chestfeed) or drink from their bottle as much as usual because they’re congested. Toddlers may also have little interest in eating or drinking. It’s important to help your child stay hydrated. Your pediatrician can give you tips depending on your child’s age.
• Use suction to clear out your baby’s stuffy nose. Devices like nasal aspirators and Swedish snot suckers can ease congestion in babies and toddlers. Clearing out some of that mucus can help your child eat and drink more easily. You can help your older child by teaching them how to blow their nose.
• Use saline spray and humidifiers. Saline spray can work wonders for kids of all ages. It’s especially helpful for breaking up thick mucus. Setting up a cool mist humidifier in your child’s room can also help them breathe more easily.
• Follow your pediatrician’s advice on medications. Certain medications aren’t safe for babies and kids. Medications you should never use without your provider’s advice include cough and cold medications and aspirin. It’s typically safe to use children’s versions of acetaminophen or ibuprofen for babies older than 6 months. These can help lower a fever. However, you should always check with your pediatrician first.

If your child is very sick, they may need care at a hospital. While there, your child may receive oxygen, antiviral medications and/or IV fluids depending on their needs. Healthcare providers will monitor their breathing and oxygen levels. Most babies and children can go home after just a few days but some may even need treatment in intensive care.

Can I prevent my child from getting RSV?

It’s not always possible to prevent RSV. It’s a common infection that spreads easily among babies and kids. However, you can take some steps to help protect your child. These include:

• Get the RSV vaccine while pregnant. You’re eligible to receive the RSV vaccine between weeks 32 and 36 of pregnancy. This vaccination protects your infant during their first six months of life. Talk to your healthcare provider to learn more.
• Get your baby immunized. Babies up to 8 months old can get a monoclonal antibody immunization against RSV (nirsevimab). Your pediatrician can give your baby a single dose during their first RSV season. They may recommend your baby get a second dose the following year if they’re at risk for severe RSV. Some children under age 2 at risk of severe RSV are eligible for a different monoclonal antibody immunization (palivizumab). Your pediatrician may want to give them this immunization multiple times during RSV season. Your baby may not need immunization in their first year if you receive the vaccine while pregnant. 
• Breastfeed (chestfeed). Human milk contains antibodies that help your baby ward off infections. Experts recommend exclusive breastfeeding during your baby’s first six months of life. The antibodies from human milk help protect your baby from RSV (and many other possible infections) when they’re most vulnerable.
• Limit your child’s exposure to germs. During RSV season, avoid taking your baby to crowded areas if you can, keep them away from anyone who’s sick and make sure anyone who touches your baby washes their hands first. This is especially important during your baby’s first six months when their immune system is still forming and they face a higher risk of severe RSV.

How long does RSV last in babies and children?

Babies and children usually have RSV symptoms for a week or two. Symptoms are often the worst during days three through five.

When can my child go back to daycare or school?

Your pediatrician can tell you when it’s safe for your child to return to daycare, school or other group settings. In general, you should always wait at least 24 hours after your child’s fever breaks without the help of fever-reducing medicine, and nasal discharge should be manageable.

Are there long-term effects of RSV?

Infants with RSV who develop severe bronchiolitis may face a higher risk of an asthma diagnosis during childhood. Researchers know there’s a connection — kids who were hospitalized for RSV as babies are more likely to develop severe asthma than kids who weren’t hospitalized. But a connection, or association, isn’t the same as a cause-and-effect relationship. Researchers continue to explore whether RSV complications cause these long-term issues or are more of a coincidence.

Is RSV fatal in infants?

Most infants and children recover from RSV. However, in some cases, RSV can be fatal. Each year around the world, over 3 million children age 5 or younger are hospitalized for RSV. Over 100,000 of those children don’t survive.

The mortality rate is much higher in nations with higher poverty, where up to 9% of children age 5 or younger who develop RSV die from it. These deaths account for 99% of RSV-related deaths around the world.

Infants and children face a higher risk of serious illness if they have underlying conditions affecting their heart, lungs or immune system. Still, it’s possible for otherwise healthy babies and kids to get very sick from RSV and need care in a hospital or even die.

When should I call a pediatrician?

Call your pediatrician if your child has one or more of the following:

• A temperature above 100.4 degrees Fahrenheit (38 degrees Celsius) if your baby is under 3 months old.
• A fever above 102 degrees F (39 degrees C) at any age.
• Symptoms that worsen after one week or last longer than 10-14 days
• Ear drainage, which may be a sign of an ear infection.

When should I seek emergency care for my child?

Symptoms related to breathing and oxygen intake are a cause for concern. Call 911 or your local emergency number if your child:

• Is struggling to breathe.
• Pauses while breathing.
• Has short, shallow and/or fast breathing.
• Has noisy breathing.
• Has a blue or gray color to their skin.

What questions should I ask a pediatrician?

Talking to your child’s pediatrician can help you learn a lot about RSV and ways to protect your child. This can happen even before your child gets sick. Here are some questions to get the conversation started:

• What are common signs and symptoms of RSV in children at this age?
• How can I care for my child at home if they have RSV?
• When should I take my child to the hospital?
• How long will my child be contagious with RSV?
• How can I protect others in my family from catching it?
• How can I protect my child from RSV and other common infections?

A note from Cleveland Clinic

One of the hardest things about parenting is seeing your child sick. That’s true even when it’s just the sniffles or a cough. RSV usually causes just that. But sometimes, RSV can lead to severe symptoms and a hospital visit. Take heart in knowing that most babies and kids recover just fine, even when they have to stay at the hospital for a bit. Your pediatrician can tell you more about what to expect and how to keep your child as healthy as possible during respiratory season.