RSV In Babies: Signs, Symptoms, Causes, Diagnosis & Treatment

It may begin as a mild cold and cause severe respiratory symptoms in later stages.

Medically reviewed by Dr. Dur Afshar Agha, MS Dr. Dur Afshar Agha Dr. Dur Afshar AghaMS facebook_iconinsta_icon Specialty: Masters of Tropical PediatricsExperience: 26 years
Written by Dr Bisny T. Joseph
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Respiratory Syncytial Virus (RSV) In Babies: Symptoms, TreatmentAndPrevention

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Respiratory syncytial virus (RSV) is a highly contagious virus that is a common cause of respiratory tract infections in people across ages. However, it is most common in babies under two years. Since babies have an immature immune system, RSV in babies requires prompt medical intervention.

The symptoms of the infection may be mild to severe, depending on the infection’s severity. Timely diagnosis and treatment can help avert adverse complications such as breathing problems.

Keep reading to know more about the signs, causes, risk factors, complications, prevention, treatment, and effective home care strategies for RSV in babies.

Signs And Symptoms Of RSV Infection

The signs and symptoms of respiratory syncytial virus infection usually appear four to six days after the exposure to the virus. The following signs and symptoms are seen in infants with RSV infection (1).

  • Cough (dry or wet) and sneezing
  • Runny nose
  • Fever
  • Rapid breathing
  • Short or shallow breathing
  • Breathing difficulties such as apnea (pauses in breathing)
  • Belly breathing
  • Head bobbing while breathing
  • Wheezing
  • Irritability
  • Reduced alertness
  • Tiredness
  • Poor feeding

Babies may appear to struggle while breathing due to the pull of the chest muscles and skin during each breath. Fever is not always seen in RSV infection. You may seek pediatric care if your baby has breathing issues, despite the absence of fever.

RSV And The Common Cold

RSV may cause a cold at the beginning (2). You may notice cold-like symptoms, such as a runny nose, cough, and lack of appetite in babies. This may be followed by pneumonia or bronchiolitis in many babies, causing severe breathing difficulties.

Typical cold symptoms may resolve within a few days in most babies. However, RSV may become worse over the days. You may seek pediatric care when the baby has cold symptoms since it is difficult to differentiate RSV from the common cold at home.

RSV And COVID-19

Some symptoms of RSV infections can be similar to coronavirus disease 2019 (COVID-19) since respiratory viruses cause both conditions. COVID-19 may also result in cough, runny nose, and fever.

Decreased immunity due to RSV infection may increase the risk for COVID-19. The severity of COVID-19 can worsen if it occurs with RSV infection (3). Doctors may order testing of COVID-19 in babies with RSV symptoms since the respiratory symptoms can be similar.

Causes Of RSV Infection

The respiratory syncytial virus can reach the baby’s body through the nose, eyes, or mouth. It is a contagious infection since it can spread from an infected person to another through direct or indirect contact.

RSV commonly spreads in the following ways (4).

  • Respiratory droplets: The virus can reach the baby from the respiratory droplets of an infected person if they cough or sneeze near the baby.
  • Direct contact: The virus may spread through direct contact with an infected person.
  • Contaminated surfaces: RSV may survive on surfaces, such as countertops, doorknobs, toys, and crib rails, for hours after being contaminated by an infected person. Touching these surfaces and keeping toys or hands in the mouth could cause infection in babies.

Infected people can be most contagious during the first week of infection or even after the illness. Adults and older children may have flu or cold-like symptoms. Anyone with respiratory symptoms should limit contact with the baby to prevent the spread.

Babies with weakened immune systems may spread the virus to others up to four weeks after the symptoms disappear. Ensure that the daycare centers are taking standard precautions to prevent the spread of RSV among babies.

Risk Factors For RSV Infection

Babies younger than two years are at risk of RSV infection and its complications. RSV outbreaks usually happen from the fall to the end of the spring season.

Infants with the following conditions are at higher risk of developing RSV infection (5).

  • Younger than six months of age
  • Prematurely born
  • Congenital heart diseases
  • Chronic lung diseases
  • Weakened immune system from illness or treatments such as chemotherapy for cancer
  • Muscular dystrophy and other neuromuscular disorders
  • Attending child care or daycare centers
  • Having school-going siblings

Are RSV Infections Seasonal?

RSV infection is seasonal. Outbreaks tend to happen in the fall to the end of spring in most places. Annual seasonality is observed in all countries, often overlapping with influenza’s seasonality. RSV peaks in the rainy seasons in the tropics and colder seasons in subtropics. RSV incidence is high in the autumn and winter seasons in temperate regions (6).

Complications Of RSV Infection

The respiratory syncytial virus may lead to the following complications in some babies (3).

  • Pneumonia and bronchiolitis: RSV spreads to the lower respiratory tract and causes inflammation of the lungs (pneumonia) and the airways (bronchiolitis). Lung inflammation can be severe in most babies, especially if they have immunocompromised conditions, such as heart or lung diseases.
  • Middle ear infection or otitis media: RSV virus may reach the space behind the eardrum in some babies and cause serious middle ear infection.
  • Recurrent infection: RSV virus may cause recurrent or repeated infection in some babies. This may reoccur in the same season.

Most babies with severe RSV infection may require hospitalization due to breathing difficulties. Doctors can monitor and treat breathing troubles during the hospital stay.

Prevention Of RSV Infection

There is no vaccine to prevent RSV infection. The following precautions may help to reduce the spread of the respiratory syncytial virus (7).

  • Wash hands with soap and water or sanitize with alcohol-based sanitizer before touching the baby or their items.
  • Avoid exposure by observing cough and sneeze etiquette if you have respiratory symptoms. Avoid kissing the baby if you have cold symptoms.
  • Try to use face masks whenever possible if you have cold symptoms.
  • Limit baby’s contact with persons with cold and fever.
  • Keep the house clean. Disinfect doorknobs, door handles, bathroom countertops, and other surfaces. Discard any used tissues appropriately.
  • Do not share the baby’s bottles, toys, and other personal items with others.
  • Wash toys regularly, especially if some family members or caregivers have respiratory symptoms.
  • Avoid smoking near babies. Smoking inside the house and car may make the smoke stay inside for more time. Cigarette or tobacco smoke may increase the risk for RSV infection in infants.

Medications, such as Synagis (palivizumab), are often given by doctors to prevent RSV in infants with a high risk of severe complications.

Synagis injection is usually recommended for babies younger than two years with certain lung or heart diseases, weakened immune systems, or premature birth.

The first shot of Synagis is given at the beginning of the RSV seasons, and monthly shots are offered during the season. This medication is not helpful to treat once the symptoms appear. Synagis is not a vaccine; it provides antibodies to assist the immune system in fighting RSV infection. No medicine should be given to children without a paediatrician’s advice.

When To See A Doctor?

Seek medical care if you suspect RSV infection in your baby. Symptoms, such as the blue color of skin, nails, and lips, high fever, and breathing troubles, require immediate medical care.

Less than one wet diaper in eight hours may indicate dehydration due to the infection. Seek pediatric care for dehydration and other symptoms.

Diagnosis Of RSV Infection

Doctors may suspect RSV infection after analyzing the symptoms and physical examination findings. Abnormal lung sounds, such as wheezing, are often heard on stethoscopes.

The following tests are ordered to confirm the diagnosis of RSV infection in babies.

  • Blood tests, including blood cell counts
  • Chest X-ray may help to identify lung inflammation
  • A swab of secretions from the nose or mouth may show signs of RSV infection
  • Pulse oximetry may help determine oxygen levels in the blood

Lab analysis may help to identify complications and exclude other possible causes. Doctors may order additional tests depending on your baby’s symptoms.

Home Remedies For RSV Infection

The following homecare measures may help to relieve some symptoms of RSV infection (8).

  • Cool-mist humidifier or vaporizer: This may moist the air and reduce congestion and coughing. Keep the humidifiers clean to avoid molds and bacterial growth.
  • Avoid overheating the rooms: During winter, keep the rooms warm but not overheated since this may alleviate breathing problems.
  • Saline nasal drops: You may try OTC nasal saline drops to relieve congestion as per the pediatrician’s instructions.
  • Drink fluids: Bottle-feed or breastfeed the infant regularly. You may give water or water-based foods to weaning infants.Breast milk also contains immune factors to fight the infection.
  • Acetaminophen: The medicine can be given for fever after consulting a pediatrician.
  • They will suggest the exact dosage depending on the baby’s age and health status.
  • Avoid secondhand smoke: Exposure to cigarette smoke may increase RSV symptoms in babies.

These measures do not shorten the course of infection or cure it. It may help to relieve respiratory symptoms. You may seek a pediatrician’s advice before giving OTC medications and trying other home remedies for your baby.

Treatment For RSV Infection

There is no specific cure for RSV infection. Infants may require hospitalization and supportive care due to breathing problems. The following treatments are usually given in the hospital for babies with severe respiratory syncytial virus infection (4).

  • Intravenous (IV) fluids are given to maintain hydration
  • Humidified oxygen may ease breathing troubles in many babies
  • Mechanical ventilation or breathing machines may be needed for babies with severe respiratory issues
  • Antiviral medications are prescribed for some babies
  • Acetaminophen (Tylenol) could be prescribed for fever
  • Antibiotics are only prescribed if the baby has bacterial complications, such as bacterial pneumonia

Frequently Asked Questions

1. How long does RSV last in babies?

RSV typically resolves completely without treatment in one to two weeks if the baby does not experience complications (9).

2. What percentage of babies with RSV are hospitalized?

1–2% of babies under six months of age may require hospitalization to help them breathe well (1).

3. How often is RSV fatal?

In a study on 2,588 infants with RSV, 0.9% of cases proved fatal where sufficient medical care facilities were available (10).

4. Can breastfed babies contract RSV?

Breastfed babies have a lower risk of contracting RSV and may experience lesser symptoms (11). However, the risk of contracting the virus is not eliminated in breastfed babies.

5. How do I feed my baby with RSV?

Babies with RSV may have a poor appetite. However, you can encourage them to feed by offering plenty of skin-to-skin contact throughout the day, having short but frequent feeding sessions, and feeding whenever the infant shows even subtle feeding cues (12).

The symptoms of RSV in babies, which resemble cold symptoms, are severe in those under two years. Therefore, it necessitates immediate medical attention due to the baby’s undeveloped immune function. RSV infection is more likely to occur in premature babies, school-going toddlers, and babies with a weaker immune system or underlying medical condition. Hand cleanliness, cough and sneeze etiquette, and keeping the newborn away from people who have a cold may help avoid the infection. Consult a pediatrician if your child is suffering from cold-like symptoms or fever.

Key Pointers

  • The respiratory syncytial virus (RSV) is responsible for causing respiratory infection, mostly in babies younger than two years.
  • Symptoms may include rapid or shallow difficult breathing with cough, runny nose, or tiredness.
  • Prematurely born infants with congenital heart or lung anomalies are more likely to be affected.
  • Severe infection may cause complications such as pneumonia, asthma, and middle-ear infection.
  • Cool-mist humidifiers and nasal saline drops may be used for symptomatic relief.

References

1. RSV in Infants and Young Children; Centers for Disease Control and Prevention
2. RSV: When It’s More Than Just a Cold; American Academy of Pediatrics
3. Respiratory syncytial virus (RSV); St. Clair Health
4. Respiratory Syncytial Virus (RSV) in Children; Cedars-Sinai Medical Center
5. Respiratory Syncytial Virus (RSV) in Children; University of Rochester Medical Center
6. Trends and Surveillance; Centers for Disease Control and Prevention
7. RSV Prevention; Centers for Disease Control and Prevention
8. Respiratory Syncytial Virus (RSV); Nationwide Children’s Hospital
9. Respiratory Syncytial Virus in Children and Adults; Cleveland Clinic
10. Sarah Geoghegan et al.; Mortality due to Respiratory Syncytial Virus. Burden and Risk Factors; American Journal of Respiratory and Critical Care Medicine
11. Min Jeong Jang et al.; Positive association of breastfeeding on respiratory syncytial virus infection in hospitalized infants: a multicenter retrospective study; Clinical and Experimental Pediatrics
12. Feeding your baby with RSV / Bronchitis; HCRG Care Group
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Dr. Dur Afshar Agha
Dr. Dur Afshar AghaMS
Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association.

Read full bio of Dr. Dur Afshar Agha
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