Respiratory Syncytial Virus (RSV): What Parents Should Know About the Latest Surge

Many parents are aware of respiratory syncytial virus (RSV), a common respiratory virus that affects the lungs and airways. Over the last couple months, cases of RSV in children have risen sharply across the country, leading to more hospitalizations and emergency room visits than most health care systems were expecting.

Pediatric infectious diseases specialist Tibisay Villalobos, MD, and pediatric emergency medicine physician Teresa Romano, MD, both with Lehigh Valley Reilly Children’s Hospital, share everything parents and guardians should know about RSV and what to do if your child becomes sick during the latest surge.

According to the Centers for Disease Control and Prevention, almost all children will become infected with RSV by the time they’re 2 years old, with a majority only experiencing mild, cold-like symptoms. Mild RSV symptoms include:

• Congested or runny nose
• Decreased appetite
• Dry cough
• Headache
• Low-grade fever
• Mild irritability or decreased activity (specifically in infants)
• Sneezing
• Sore throat

However, children under 1 year old and kids with chronic lung disease, congenital heart disease or a weakened immune system can become very sick from RSV, developing bronchiolitis (an infection of the lungs’ small airways) or pneumonia (an infection of the lungs’ air sacs).

“While most children will be able to rest and recover at home from RSV, some may become severely dehydrated or have trouble breathing and need to be hospitalized,” Romano says.

Pediatric RSV cases tend to increase annually around October, but this year, they began rising in August and have not settled down.

“One reason for the surge could be how well we’ve protected ourselves during the COVID-19 pandemic with masking and social distancing,” Villalobos says. “While these practices were very important, especially since COVID-19 can also cause serious illness in children, they have limited our kids’ exposure to all viruses, making them more likely to become sick with RSV now that pandemic guidelines are relaxing.”

While there is no vaccine for RSV, there are a few preventive steps Villalobos and Romano recommend for people of all ages:

• Frequently wash your hands with soap and water (or hand sanitizer)
• Try not to touch your face
• Avoid close contact, like kissing and sharing cups and utensils, with people who are sick
• Cover your coughs and sneezes
• Clean and disinfect surfaces and objects that are touched often, including toys, doorknobs, counter tops and electronics
• Stay home when you aren’t feeling well

Most children will completely recover from RSV within a week or two.

“If your child is showing mild, cold-like symptoms, they should rest, have their fever treated if they are uncomfortable and drink plenty of fluids until they feel better,” Villalobos says. “If their mild symptoms aren’t getting better or are getting worse over time, you should make an appointment with their pediatrician or take them to an ExpressCARE or Children's ExpressCARE location.”

When it comes to fever, call your pediatrician if your child is:

• 3 months old or younger and has a fever of 100.4°F or higher for any length of time
• Between 4 months and 2 years old and has a fever of 100.4°F or higher for more than a day
• 2 years old or older and has a fever of 100.4°F or higher for more than three days

If your child experiences any of the following symptoms, they should be seen at an emergency room (like the Children’s Hospital’s Breidegam Family Children’s ER, which is the region’s only 24/7 emergency room specifically for kids) as soon as possible:

• Severe drowsiness or lack of alertness
• Severe cough
• Skin, lips or fingernails that appear blue
• Trouble breathing
  • Struggling for each breath or being short of breath
  • Tight breathing that makes it difficult to speak or cry
  • Retractions (when the ribs pull in with each breath)
  • Noisy breathing (such as wheezing)
  • Breathing much faster than normal

Infants with a severe case of RSV may have trouble feeding or produce fewer wet diapers than usual (which is a sign of dehydration). If your infant is sick and experiencing either of these symptoms, you should contact their pediatrician as soon as possible for guidance.

If you need help deciding on the next steps for your child based on their symptoms, Lehigh Valley Reilly Children’s Hospital has a free Symptom Checker on our website, which can help you determine if your child needs to be seen by a health care professional.

The Children’s Hospital’s PedsPartner app also can help you determine the next best next steps for your child’s care and connect you with additional resources.

“Emergency rooms across the country are filling up with RSV cases,” Romano says. “If your child is experiencing mild symptoms, there are steps you can take at home, such as nasal suctioning with saline before and after naps and prior to feeding as well as giving appropriate over-the-counter medications recommended by your child’s pediatrician. These practices can help your child feel better and prevent the need for emergency care.”