Pediatric Respiratory Syncytial Virus (RSV)

RSV is a viral illness that causes symptoms such as trouble breathing. It’s the most common cause of inflammation of the small airways in the lungs (bronchiolitis) and pneumonia in babies.

RSV is spread when a child comes into contact with fluid from an infected person’s nose or mouth. This can happen if a child touches a contaminated surface and touches their eyes, mouth, or nose. It may also happen when inhaling droplets from an infected person’s sneeze or cough.

A child is more at risk for RSV if they are around other people with the virus. RSV often occurs in yearly outbreaks in communities, classrooms, and childcare centers. RSV is more common in the fall and winter.

RSV can affect a person of any age but causes the most problems for the very young. Most babies have been infected at least once by the time they are 2 years old. Babies can also be reinfected with the virus. Infection can happen again anytime throughout life. RSV infection in older children and adults may seem like an episode of severe asthma. Babies born prematurely or with heart, lung, or immune system diseases are at increased risk for more severe illness.

Symptoms start about 2 to 5 days after contact with the virus.

The early phase of RSV in babies and young children is often mild, like a cold. In children younger than age 3, the illness may move into the lungs and cause coughing and wheezing. In some children, the infection turns to a severe respiratory disease. Your child may need to be treated in the hospital to help with breathing.

The most common symptoms of RSV include:

• Runny nose
  
• Fever
• Cough
• Short periods without breathing (apnea)
• Trouble eating, drinking, or swallowing
• Wheezing
• Flaring of the nostrils or straining of the chest or stomach while breathing
• Breathing faster than normal, or trouble breathing
• Turning blue around the lips and fingertips 

The symptoms of RSV can seem like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

The healthcare provider will ask about your child’s symptoms and health history. They may also ask about any recent illness in your family or other children in childcare or school. They will give your child a physical exam. Your child may also have tests, such as a nasal swab or wash. This is a painless test to look for the virus in fluid from the nose.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Antibiotics are not used to treat RSV. Treatment for RSV is done to help ease symptoms. Treatment varies by how serious the symptoms are. It may include:

• More fluids. It's very important to make sure your child drinks plenty of fluids. If needed, your child will get an IV (intravenous) line to give fluids and electrolytes.
• Oxygen. This is extra oxygen given through a mask, nasal prongs, or an oxygen tent.
• Suctioning of mucus.  A thin tube is put into the lungs to remove extra mucus.
• Bronchodilator medicines. These may be used to open your child's airways. They are often given in an aerosol mist by a mask or through an inhaler.
• Tube feeding. This may be done if a baby has trouble sucking. A thin tube is put through the baby’s nose and down into the stomach. Liquid nutrition is sent through the tube.
• Mechanical ventilation. A child who is very ill may need to be put on a breathing machine (ventilator) to help with breathing.
• Antiviral medicine. Some children with severe infections may need treatment with an antiviral medicine.

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.

In high-risk babies, RSV can lead to severe breathing illness and pneumonia. This may become life-threatening. RSV as a baby may be linked to asthma later in childhood.

To prevent severe RSV disease in infants, CDC recommends either of these:

• Maternal RSV vaccination at 32 through 36 weeks of pregnancy, given immediately before or during RSV season.

or

• Infant immunization with the RSV monoclonal antibody, nirsevimab, for babies 8 months and younger born during or entering their first RSV season.

Most infants will not need both.

The RSV monoclonal antibody, nirsevimab, may also be advised for some infants and children ages 8 months through 19 months who are at increased risk for severe RSV disease and entering their second RSV season.

Babies and children at high risk for RSV infection may get a different monoclonal antibody medicine called palivizumab. This is given as a series of shots (injections) once a month during RSV season. They help prevent the illness in premature babies and children with health problems such as certain heart conditions.

To reduce the risk for RSV, the American Academy of Pediatrics recommends all babies, especially preterm babies:

• Be breastfed
• Be protected from contact with smoke
• Not go to childcare with lots of children during their first winter season
• Not have contact with sick people

Also make sure that household members wash their hands or use an alcohol-based hand cleaner before and after touching your baby. Don't allow people to smoke in your home or in your car. Remove your baby from any area where people are smoking.

RSV Vaccine

The Centers for Disease Control (CDC) has approved a vaccine called Nirsevimab (Beyfortus) to protect newborns and infants under 8 months against Respiratory Syncytial Virus (RSV).

Certain babies 8 to 19 months may also get Nirsevimab if they have a condition that makes RSV infection more dangerous for them. These conditions include:

• Prematurity (less than 29 weeks)
• Weak immune system
• Problems swallowing or clearing secretions
• Heart or lung disease that has been treated with lung medicines, steroids, diuretics or oxygen in the past 6 months.

Call the healthcare provider if your child has:

• Symptoms that don't get better, or get worse
• New symptoms