It looks and sounds like a cold, but respiratory syncytial virus (RSV) can become something more. What’s the difference? What should you do about it? And when should you take your child to a healthcare provider?

Adults with RSV might have the symptoms of a common cold, such as a stuffy or runny nose, sore throat, mild headache, cough, fever, and a general feeling of being ill. In a child RSV can be much more. Respiratory syncytial virus is the leading cause of lower respiratory tract infections in infants and young children. The peak incidence of severe RSV disease is age 2-8 months. Overall, 4-5 million children younger than 4 years acquire an RSV infection each year, and more than 125,000 are hospitalized annually in the United States because of this infection. RSV infections often happen in epidemics that last from late fall through early spring.

RSV is highly contagious, and spreads through droplets containing the virus when someone coughs or sneezes. It can also live on surfaces (such as countertops or doorknobs) and on hands and clothing, so it can easily spread when a person touches something contaminated. RSV can spread rapidly through schools and childcare centers. Babies often get it when older kids carry the virus home from school and pass it to them. Virtually all children have had at least 1 RSV infection by the age of 2 years. Pre-term infants, and children born with heart and lung issues are at higher risk for contracting and developing complications from RSV.

Signs and Symptoms

These symptoms usually appear in stages and not all at once. In very young infants with RSV, the only symptoms may be irritability, decreased activity, and breathing difficulties. RSV can also cause more severe infections such as bronchiolitis, an inflammation of the small airways in the lung, and pneumonia, an infection of the lungs. It is the most common cause of bronchiolitis and pneumonia in children younger than 1 year of age. People infected with RSV usually show symptoms within 4 to 6 days after getting infected and may have the following symptoms:

  • Fever (typically low-grade)
  • Cough
  • Tachypnea (abnormally fast breathing)
  • Nasal flaring (spreading out of the nostrils with every breath)
  • Retractions (caving in of the chest in between and under the ribs)
  • Wheezing (high pitch whistling sound when breathing)
  • Difficulty drinking and dehydration
  • Lethargy or irritability
  • Associated ear infection (bacterial, viral, or both)
  • Cyanosis (bluish color around the mouth, lips, or fingernails)


Diagnosis of RSV is usually based on symptoms and assessment findings. However, there are special tests to detect the virus using a swab that is placed through the nose to the back of the throat.


There is no specific treatment for RSV, and antibiotics are not helpful for this infection (but they may be needed for secondary bacterial infection). There are medications that can help relieve symptoms (like acetaminophen for fever or albuterol for wheezing), but there are no specific medications that work against the virus.

Most symptoms improve within one to two weeks. In severe cases, hospitalization may be needed for a short period of time. People infected with RSV are usually contagious for three to eight days. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as four weeks.

Premature infants and infants with chronic heart or lung disease who are at high risk of severe infection from RSV may be given preventive treatment of a neutralizing antibody to RSV called palivizumab (Synagis) to reduce the risk of severe illness.

What should a parent do for a child suffering from RSV?

  • Give plenty of fluids.
  • Use a cool-mist vaporizer during the winter months to keep the air moist. (Be sure to clean the vaporizer regularly.)
  • Blow little noses frequently (or use a nasal aspirator for infants).
  • Give non-aspirin pain reliever, such as acetaminophen. Aspirin should not be used because it has been linked to Reye syndrome, a disease that affects the brain and liver.
  • Do not smoke around the child.

Preventing RSV

Because RSV can be easily spread by touching infected people or surfaces, washing hands well and often is key in stopping it. Try to wash your hands after having any contact with someone who has cold symptoms. School-age kids who have a cold should be kept away from any younger siblings - especially babies - until their symptoms pass. Avoid close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with others.

When to see medical care

Most children and some adults who develop RSV infections do not need to seek medical care. Individuals with premature infants, young children with chronic heart or lung conditions, and children or adults with weakened immune systems should seek medical care immediately if infection with RSV is suspected. Call your healthcare provider if your child has any of these symptoms:

  • a high fever and doesn't look well
  • thick nasal discharge
  • a cough that gets worse or produces yellow, green, or gray mucus
  • signs of dehydration
  • trouble breathing

In infants, besides the symptoms already mentioned, contact the healthcare provider if your baby is unusually irritable or inactive, or refuses to breastfeed or bottle-feed. Seek immediate medical help if you feel your child is having trouble breathing or is breathing very rapidly, is lethargic, or if his or her lips or fingernails appear blue.


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