RSV In Children: Signs, Symptoms, Diagnosis And Treatment

Respiratory syncytial virus (RSV) is highly contagious and the most common cause of respiratory tract infections in children (1). The infection manifests mild, cold-like symptoms, such as fever and runny nose. According to the Centers for Disease Control and Prevention (CDC), almost all children experience RSV infection before two years of age (2).

For most healthy children, the infection causes a mild cold. But for some, RSV infection may turn serious, leading to life-threatening complications, such as pneumonia and bronchiolitis (inflammation of the bronchioles). Thus, staying informed about RSV in children can help keep children safe.

Read on as we give you an insight into the signs and symptoms, causes, diagnosis, treatment, and prevention of RSV in children. 

Signs And Symptoms Of RSV In Children

Respiratory syncytial virus (RSV) affects the respiratory system, that is, throat, nose, and lungs. About four to six days after RSV infection, children develop cold-like symptoms, such as (1) (3):

• Fever

• Stuffy or runny nose

• Sore throat

• Mild headache

• Coughing

• Sneezing

• Wheezing

• Reduced appetite

• Fast breathing

• Apnea (short intervals without breathing, commonly seen in infants and young children)

• Irritability

• Lethargy and inactivity

These symptoms usually appear in stages, and their intensity and frequency may vary from one child to another. Generally, children with RSV infection recover in a week or two. However, in some cases, it may stay for several weeks.  

Transmission Of RSV In Children

RSV is a highly contagious virus that spreads from one child to another through airborne droplets. These droplets come in the air when an infected child coughs and sneezes without covering their mouth and nose. The virus can also spread through contaminated surfaces, such as doorknobs, hands, and clothing.

Direct contact with the infected child when you hug or kiss them also causes the virus to spread (4). The incubation period for RSV infection is usually three to eight days. However, an individual with weak immunity can stay contagious for as long as four weeks.  

Risk Factors For RSV In Children

People across ages can get infected with RSV. However, children are at a higher risk of contracting the infection if they have the following conditions (4) :

• Weakened immune system due to a medical condition or medical treatment

• Congenital heart disease

• Chronic lung disease

• Exposure to secondhand smoke

• Neuromuscular disorders, such as muscular dystrophy

Children can contract RSV infection from schools or daycare centers. It’s more common during winters and early spring (5). Also, the infection can reoccur at any time throughout life.  

Diagnosis For RSV In Children

RSV has symptoms similar to several other illnesses. Therefore, don’t do self-diagnosis. Instead, consult a pediatrician who will do the child’s thorough examination. The doctor will evaluate the child’s symptoms and suggest tests such as blood tests. Additionally, they may collect a sample of nasal discharge to test for the virus and suggest a chest X-ray to observe the lungs (6).  

Treatment For RSV In Children

The treatment for RSV depends on the child’s age, the severity of infection, and overall health. RSV is a viral infection, so antibiotic therapy isn’t followed. According to the American Academy Of Pediatrics (AAP), “RSV symptoms are typically at their worst on days 3 through 5 of illness (7).”

Most cases of RSV are mild and don’t require medical attention. Instead, the child is given home care that mainly aims to offer symptomatic relief. Here’s what you can do (7).

• Use nasal saline to clean your child’s nasal blockage and make breathing easier for them.

• Use a cool-mist humidifier to add moisture to the air, breaking your child’s mucus and alleviating their cough and congestion.

• Serve your child plenty of fluids to keep them hydrated. Warm liquids, such as soups and stews, are easy to consume and nourishing.

• Administer antipyretics, such as acetaminophen or ibuprofen, to reduce fever and let your child rest.

• Don’t give your child aspirin to reduce fever, as the medicine can cause a life-threatening illness called Reye’s syndrome. Likewise, avoid using cold and cough medications for your child unless directed by your doctor.

If the syncytial virus infection affects the lungs, heart, or immune system, it could lead to adverse complications, such as pneumonia and bronchiolitis. Generally, only three percent of the children with RSV infection require hospitalization (7). However, if the child has a severe infection, they may require (5) (6):

• Intravenous (IV) fluid to fight dehydration and replenish lost fluids and electrolytes.

• Mucus suction to remove extra mucus from the lungs to help ease breathing.

• Antiviral medication to help the body fight virus and prevent infection spread.

• Bronchodilator medicines to help open the child’s airways and make breathing easier.

If a child is very ill, they may require hospitalization to be given breathing support (mechanical ventilation) using a breathing machine (ventilator). 

Prevention Of RSV In Children

Every year, about 58,000 children younger than five years get affected by RSV infection in the US (2). Children can prevent contracting and spreading this infection through simple preventive measures (8).

• Avoid close contact (hugging or kissing) with an infected person.

• Maintain optimum hygiene standards and wash their hands for 20 seconds. If a child can’t wash their hands, help them use a sanitizer.

• Avoid touching face with unwashed hands. RSV can survive on unwashed hands for 30 minutes or more.

• Cover mouth while coughing or sneezing.

• Avoid sharing utensils or clothes with an infected person.

• Keep the child’s immunizations up to date.

Besides these, parents should frequently clean touched surfaces, such as keyboards and doorknobs, with a disinfectant. RSV can survive for six hours or more on these surfaces.

A couple of preventive medications called Palivizumab and Ribavirin are recommended for babies and children at high risk of RSV infection. These medicines protect against the serious complications of the illness (6) (8). However, these drugs are not vaccines and cannot prevent the viral infection entirely. Speak to a pediatrician if your feel your child is at a high risk of contracting RSV infection, and the preventive medicines could be suitable for them. 

When To See A Doctor

Most cases of syncytial virus infection are mild and don’t require medical care. However, you should call your doctor promptly if the child shows the following conditions (1) (7).

• Symptoms of bronchiolitis, such as flaring of the nostrils and rhythmic grunting during breathing

• High fever

• Thick nasal discharge, making breathing laborious

• Intense coughing with yellow, green, or grey mucus

• Severe dehydration

If the child has rapid breathing, is very drowsy, or their lips and fingernails are turning blue, go to your nearest emergency center right away.

RSV is a major cause of common respiratory illnesses in babies and young children, resulting in cold-like symptoms. Most cases of RSV infection are mild, and recovery occurs within a week or two without medical intervention. However, in some cases, the illness may cause life-threatening complications, such as pneumonia. Currently, there’s no vaccine for RSV infection. Adequate rest and requisite prescribed medications can help most children feel better and recover faster.

References

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Reviewer

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