What is RSV in babies?
Respiratory syncytial virus, commonly known as RSV, is a specific virus that has similar symptoms to the common cold but may cause inflammation of the smallest air passageways in the lungs.
"RSV causes what we call bronchiolitis, which is different than bronchitis," explains Andrew Gelfand, M.D., Chief of Pulmonology and Sleep Medicine at Children's Health℠ and Clinical 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 in young children who have challenges with lung disease for other reasons, RSV can be a quite severe 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."
Thankfully, a new RSV prevention shot has been approved for infants. Read on to learn more about RSV signs, treatment and the best ways you can keep your baby healthy.
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. It can be hard to tell the difference between a cold and RSV. If your baby comes down with symptoms of a cold, you can monitor them to detect if it may be RSV. Symptoms of RSV in a baby may include those of a cold plus the additional symptoms listed below.
Symptoms of RSV in infants include:
- Rapid breathing
- Runny nose and/or congestion
- Possible fever
- Increased work of breath – retractions (using neck and rib muscles to breathe)
- Apnea (pauses in breathing) in young infants
- Difficulty drinking
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 is RSV diagnosed in babies?
RSV is usually diagnosed by your doctor asking questions about your baby's symptoms and performing a physical exam.
There is a swab test that can be done to diagnose RSV. However, most doctors will diagnose RSV based on symptoms and prevalence in the community.
"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 nasal swab test is used to help isolate patients with RSV to prevent the spread of the virus to other patients.
Depending on your child's symptoms, a doctor may order imaging of the chest to check for severe lung congestion or need for oxygen. However, these tests typically aren't necessary, and most children recover on their own.
How to treat RSV in infants
If your child is diagnosed with RSV, you can expect the symptoms to last about one week but they may last as long as two to three weeks. The best treatment for RSV is to focus on supportive care.
If your baby has RSV, take steps to keep them comfortable during illness :
- Clear congestion: For babies who are too young to blow their nose, you can use a nasal suction device to help clear congestion (see tips for nasal suctioning)
- Focus on hydration: 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.
- Keep air moist: Avoid dry air, which can dry out mucus. If needed, try a cool mist humidifier or run a steamy shower or bath to moisten the air in the room. If using a humidifier, take care to clean it so mold does not grow.
- Relieve pain, if needed: If your child has a fever, you can treat with age-appropriate medication, such as infant acetaminophen (Children's Tylenol) or infant ibuprofen (Children's Motrin). Check the label or call your pediatrician for the correct dosage for your child. Ibuprofen is not safe for infants under 6 months of age.
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 majority of babies 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
In 2023, the U.S. Food and Drug Administration (FDA) approved a new medicine called Beyfortus (also called nirsevimab) to prevent RSV in infants. This RSV antibody shot is recommended for all babies up to 8-months-old and for some older babies who are increased risk of severe illness.
“This is the first widely available prevention for RSV and it's a huge advance,” Dr. Gelfand says. “It decreases the risk of hospitalization for babies with RSV by 70% and reduces the need for intensive care by 90%. It's also very safe with the only side effect being mild pain or redness at the injection site.”
The new RSV prevention shot will be added to the list of recommended immunizations for all babies and should be widely covered by insurance. The shot is recommended before your baby's first RSV season, which is typically from November through March. If your baby is born during RSV season, the shot is recommended during the baby's first week of life.
A dose is also recommended for babies from 8-19 months who are at increased risk of severe RSV disease as they enter their second RSV season. This includes babies with:
- Chronic lung disease
- Cyanotic heart disease, a group of heart diseases a child is born with which includes Tetralogy of Fallot, total anomalous pulmonary venous return and transposition of the great arteries
- Immune deficiencies
- Neuromuscular weakness
Nirsevimab should be available fall 2023. "Ask your pediatrician about the shot in September or October," Dr. Gelfand says. "We're recommending this to all babies, and especially those with a family history of RSV or asthma, because there's a link between an early RSV infection and asthma and recurrent wheezing later in life."
In addition to this new shot, you can help prevent RSV in children by minimizing your child's risk of exposure. You can do this by:
- Keeping your baby away from people who are sick
- Frequent hand washing
- Avoiding large public gatherings during RSV season, especially places with lots of children
- Keeping your child at home if they are sick to avoid spreading RSV and other illnesses
If you have questions about the new RSV prevention shot and ways to keep your baby healthy, ask your pediatrician for more information.
Respiratory syncytial virus (RSV) can be dangerous in infants. @Childrens explains how to tell if your infant has the virus and what to do.