Though RSV, or respiratory syncytial virus, can mimic the symptoms of a common cold, it is not the same illness, and it can actually be more dangerous for young children. The Centers for Disease Control estimates that RSV in infants and young children under 5 years old results in up to 80,000 hospitalizations per year. For early RSV prevention, pediatricians can vaccinate pregnant women or immunize infants to reduce the symptoms, such as coughs and labored breathing.
We asked Wilmington Health Pediatrician Erin Adonnino about preparing for RSV season, and she provided her recommendations for preventing, treating, and managing the symptoms of this virus.
RSV Season
In most regions of the U.S., including North Carolina, RSV season begins in the fall and peaks in the winter. But the timing can vary slightly due to environmental conditions and changes in public behavior, so taking steps early to protect your children before outbreaks is key to staying healthy.
As with all contagions, the virulence of RSV also changes from season to season.
“If something has more virulence, it often makes you sicker,” Adonnino said. “I think that the virulence of RSV has increased with the time, especially after we had the COVID pandemic.”
Children at Risk of RSV
Anyone of any age can be affected by RSV, but the symptoms and risks will be highest for vulnerable populations with compromised immune systems, including older generations (ages 75 and up) and young infants under 6 months of age.
Most children will contract RSV by the time they reach two years of age, and without preventive measures, some infants and toddlers can be infected multiple times. Generally, older children experience milder RSV symptoms, as Dr. Adonnino explains: “After six months, most infants are older and strong enough to fight off the illness, with symptoms presenting like a common cold.”
“In children less than six months old,” she continues, “RSV often presents as a ton of snot and mucus coming out of their nose. It almost feels like a constant drain.” These younger infants may also contract lower respiratory infections that can present more serious complications.
While a child’s age is an important factor, many underlying conditions can also impact the severity of RSV, including:
- Preterm birth (underdeveloped immune system)
- Suppressed or weakened immune systems
- Neuromuscular disorders or congenital anomalies (increase challenges with swallowing and clearing mucus secretions)
- Severe cystic fibrosis
RSV Symptoms in Children
When an infant or young child contracts RSV, they may remain symptomatic the entire duration of the illness, which often lasts 7 to 10 days and sometimes longer. The signs a child has developed RSV may vary, and those who contract it multiple times may have milder symptoms due to built immunity.
When a child older than six months contracts RSV, the symptoms often include:
- A runny nose
- Decreased appetite and thirst
- A cough
These usually remain mild, but a cough may progress to wheezing or difficulty breathing for some children.
Infants six months and younger who contract RSV usually experience worse symptoms that progress with the illness. Parents will notice signs including:
- Irritability
- Decreased activity
- Labored breathing
- A low-grade fever (for some)
A slight fever could be triggered by congestion, but a high fever isn’t a hallmark of the virus. Symptoms related to respiratory distress, such as wheezing, rattling, or other sounds upon exhalation, may worsen as the sickness develops.
Severe RSV Symptoms To Watch For
If your baby gets RSV, closely monitor their breathing status. Certain RSV symptoms may indicate respiratory distress—here’s what to watch for:
- Rapid belly movements
- Chest wall retractions (where the child’s skin between the ribs pulls inward when inhaling)
- Flaring nostrils
- A bluish tint on the lips or skin
Babies may also show a panicked look on their faces that may be alarming, but noticeable, to parents.
“If you were to see these signs, you would need to call your doctor or go to the emergency room right away,” Adonnino said. “If they are handling their breathing fine, then we can help them with supportive care.”
Preventing and Treating RSV in Children: Tips for Parents
All parents can take part in preventing RSV by immunizing their children, promoting good hygiene, and managing the symptoms to stop the virus from spreading. As Dr. Adonnino stated, “I do not think that RSV will ever completely go away, but with greater awareness and prevention, we can hopefully lower the prevalence within our young infant population.”
Here are a few tips for RSV prevention and symptom management to make cold and flu season easier and safer for everyone:
Consider Immunizations
Adonnino recommends immunizations as preventive measures. When an immunized baby comes into contact with RSV, their body already has the antibodies to fight off that virus. He or she would experience minimal to no symptoms.
Here are some options for immunizations (most babies will not need more than one method):
- Pregnant mothers may opt to be vaccinated for RSV to protect the baby from severe illness. The best time for expecting mothers to get the RSV vaccine is between 32 and 36 weeks of gestation.
- If the mother is unable to receive the vaccine, Adonnino recommends the baby receive monoclonal antibodies, lab-made proteins that stimulate the immune system.
- An older infant approaching his or her first RSV season can also be vaccinated for protection from the illness.
Practice Good Hygiene
Unlike the noticeable RSV symptoms in children, infected adults may not show any signs of the virus. This can result in people unknowingly passing the illness to a child. Anyone handling a young infant during RSV season should properly wash their hands to reduce the spread of germs. If family members are showing signs of any communicable illness, they should avoid contact with the baby to help decrease potential virus transmission.
Manage the Symptoms
Dr. Adonnino noted that the worst RSV symptoms in infants tend to occur on days 3 to 4, and the entire virus lasts about 7 to 10 days. Suctioning the baby’s nose with a bulb syringe can help manage secretions, making it easier for a baby to eat and drink. Fluids are important for sick children. Dehydration can impair the child’s ability to fight the virus and cause other complications.
The baby’s positioning also alleviates some congestion. Adonnino says, “It is often easier for babies to breathe if they are in a more upright position, so having your child sleep on you while you’re awake in an upright position can be helpful.”
“I highly recommend using a humidifier or having baby sit in the bathroom with a steamy shower.” Adonnino explains, “This helps to break up and thin out the mucus that is in the airways so that children can clear it more easily from their bodies.”
Managing the symptoms for older siblings, grandparents, and others who interact with the baby is also key to preventing the illness from spreading to everyone in the household.
See a Pediatrician
Make a pediatric appointment to see your doctor if the illness worsens or your concerns linger. They can recommend supportive care to help ease some symptoms. A doctor can also confirm that RSV didn’t spread to the lower respiratory tract, causing pneumonia or bronchiolitis.
While Adonnino agrees that RSV can often be managed at home, she also says, “Your baby might also need to be followed more closely by their doctor with several follow-up appointments to make sure that they are improving.” If you haven’t chosen a pediatrician for your child, begin the process soon so you’re prepared for any complications with this illness.
Reducing Severe RSV Infections With Vaccinations
Adonnino is seeing a positive trend: RSV hospitalizations in children are decreasing, mainly because preventive treatment is available. Early fall is the best time to get the RSV vaccine for infants approaching their first flu season and children with a compromised immune system. If you haven’t made an appointment, speak to your provider about your options.
“At this point, most cases that I see are due to outbreaks that happen in daycares or when an older sibling exposes their younger sibling to the virus,” Adonnino said. “Unlike in years past, I found that I need to send fewer and fewer infants to the hospital to help manage their symptoms.”
Dr. Adonnino provides expert care that is comprehensive and collaborative for patients. She has enjoyed serving pediatric patients from birth to approaching adulthood, and she has completed several research and educational projects in the areas of neonatal, pediatric, and adolescent care. Contact her at (910) 763-2072.