RSV: What You Need to Know When It’s More Than a Cold

RSV: Three letters every parent is taught to fear and for good reason.  

RSV, formally known as respiratory syncytial virus, poses a significant health threat to children, particularly for children who are under the age of 1 or who have chronic lung disease, congenital heart disease or a weakened immune system.

RSV is also the No. 1 cause of hospitalizations for children under the age of 1. While nearly every child will get RSV at least once by the time they turn 2, not every child who gets RSV will find themselves in the Breidegam Family Children’s ER. In fact, in most healthy children, RSV often closely resembles a cold where your child will experience symptoms such as:

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

“While RSV is more likely to cause a minor illness than a hospital stay, we don’t know how a child is going to be affected by RSV until they get RSV. That’s what makes RSV so scary for parents,” says Tibisay Villalobos, MD, pediatric infectious diseases specialist at Lehigh Valley Reilly Children’s Hospital. “Prevention is the key to protecting your child against RSV.”

When it comes to preventing RSV, encourage your family to follow these must-dos:

• 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.
• Always cover your coughs and sneezes. When you don’t have a tissue, cough or sneeze into your elbow, not your hands.
• Clean and disinfect surfaces and objects that are touched often, including toys, doorknobs, countertops and electronics.
• Stay home when you aren’t feeling well.

Now, families have access to more protection than ever before. While there is currently no RSV vaccine for children, this year the first RSV vaccine for expectant moms was approved by the Food and Drug Administration. This vaccine is given from 32 through 36 weeks of pregnancy to prevent lower respiratory tract disease (LRTD) caused by RSV in infants from birth through 6 months of age.

Also, for children under age 2 who are more vulnerable to RSV illness, a preventive monoclonal antibody treatment called Nirsevimab became available as well. (This is not an RSV vaccine.) Talk to your child's pediatrician or primary care clinician for guidance on whether your child would benefit from this treatment.

Thanks to vaccines that are now available to both expectant moms and infants, families have access to more protection than ever before. 

To prevent severe RSV disease in infants, expectant mothers can choose to receive the RSV vaccine when they are between 32 and 36 weeks pregnant to prevent lower respiratory tract disease (LRTD) caused by RSV in infants from birth through 6 months of age. 

If mothers did not receive the RSV vaccine during pregnancy, there is also a preventive monoclonal antibody treatment called nirsevimab that LVHN offers to all newborns. Most infants will not need both maternal vaccination and infant RSV antibodies.

Infant RSV antibodies are highly effective in preventing RSV-associated hospitalization. The optimal timing for infant RSV antibody administration is shortly before the RSV season begins (October through November), or within a baby's first week of life, if they are born in October through March (ideally during birth hospitalization).

If you have any questions, talk to your doctor about protecting your infant against RSV this season.

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. There are also at-home steps you can take to help your child feel better and prevent the need for emergency care. They include 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.

“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,” Dr. 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 our Children’s ER or one of our Children’s ExpressCAREs.”

If your child experiences any of the following symptoms, they should receive care 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. If so, we’re here to help. With an entire health network built just for kids, a 24/7 Children’s ER and two Children’s ExpressCAREs, Lehigh Valley Reilly Children’s Hospital is here for whatever childhood brings your family’s way.