Respiratory syncytial virus, commonly known as RSV, is a specific virus that has similar symptoms to the common cold, but causes inflammation of the bronchioles (the smallest of the air passageways in the lungs).
"RSV causes what we call bronchiolitis, which is different than bronchitis," explains Andrew Gelfand, M.D., Director of Pulmonology at Children's Health℠ and Associate Professor at UT Southwestern. "The difference is that bronchitis is an infection or inflammation in the large airways, and RSV affects the bronchioles, which are the smallest airways of the lungs."
Older children and adults who have RSV may simply notice they have a bad cold. However, in infants or young children who have challenges with lung function for other reasons, RSV can be a challenging and even life-threatening virus.
"The airways in young infants are so small that any amount of inflammation can have a large effect on their ability to breathe," says Dr. Gelfand. "When the small airways of an infant are inflamed, they swell and get clogged with mucus. Infants then have trouble getting the air out of their lungs, which can cause problems with oxygenation and significant wheezing."
Does my baby have RSV or just a typical cold?
According to the Centers for Disease Control & Prevention (CDC), RSV is the most common cause of bronchiolitis in children younger than 1 year of age in the United States. If your baby comes down with symptoms of a cold, you can monitor symptoms to detect if it may be RSV.
Symptoms of RSV in infants include:
- rapid breathing
- runny nose and/or congestion
- possibly fever
- increased work of breath – retractions (using neck and rib muscles to breathe)
- apnea in young infants
Because RSV is a small airway disease and infants have the smallest airways, it can quickly become serious, especially in babies born prematurely. Your child's doctor can help determine if it's RSV.
How to diagnose RSV in infants
There is a test that can be done to diagnose RSV, similar to a swab test done to diagnose influenza. However, most doctors will diagnose RSV based on symptoms.
"In infants with RSV, they typically begin having symptoms of a runny nose, congestion, and then cough and wheezing may begin," explains Dr. Gelfand. "They can progress to breathing hard and fast and sometimes retractions can be seen, which looks like their chest sinking in and their ribs coming and going with each breath, such as how it would look if someone had been running hard."
In the hospital, the test is used to help isolate patients with RSV to prevent the spread of the virus to other patients.
How to treat RSV in infants
If your child is diagnosed with RSV, you can expect the symptoms to last one week but they may last as long as two to three weeks. The best treatment is to focus on supportive care.
There is no medication that treats RSV, but there are things you can do to help keep your infant more comfortable during the illness, including frequent suctioning of their nose to reduce secretions and keeping the air around them humidified so their mucus doesn't dry out. It is also very important to make sure your child stays hydrated. When children work hard to breathe, it is harder for them to drink and keep up with their fluid needs.
Over-the-counter remedies, including cough medicine and decongestants are not recommended for infants due to evidence that they can cause more harm than good. Your doctor may also use a breathing treatment, including albuterol or a steroid, to help open the airways; however, there is no evidence that these types of treatments are helpful to most children with RSV.
"The current recommendation is that if you have a child with a strong family history of asthma or the child has had wheezing in the past, you may try a breathing treatment and then re-assess the situation," explains Dr. Gelfand. "However, breathing treatments are not needed for the average baby with RSV."
In some serious cases, an infant with RSV may need to be hospitalized and put on oxygen, or even transferred to the intensive care unit (ICU) to use a ventilator to help support their breathing.
How to prevent RSV in infants
With no specific medicine to treat RSV, it's important to try to prevent infants from catching it in the first place. However, this is a very difficult task as RSV can be everywhere. RSV is a seasonal, contagious disease that spreads mostly during the fall, winter and early spring. Typically, RSV is seen in the community and peaks earlier than the flu.
The best way to keep your infant healthy is to keep him or her from being exposed. This is especially true for premature and other high-risk infants. Adults and other children can transmit RSV, so avoid having the baby around sick people. Careful hand washing is one of the best ways to prevent the spread of RSV.
Dr. Gelfand suggests, "If at all possible, limit taking small infants to public places, especially places with a lot of children, to reduce their exposure to RSV and the other viruses that are around in the winter."
It's best to keep your baby at home if they become sick so they will not spread the illness to other children. If you can, avoid nurseries, play dates or other group settings while your infant is still very small.
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