Respiratory Syncytial Virus: What You Should Know About RSV

Like many children’s hospitals across the country, Stanford Medicine Children’s Health is experiencing an increased number of pediatric patients hospitalized with respiratory viruses such as influenza and respiratory syncytial virus (RSV).

Anticipating that the number of respiratory cases was going to be higher than in prior seasons, as many children avoided these viruses during the height of the COVID-19 pandemic, Stanford Children’s providers have prepared to manage the volume of young patients coming into our hospital, Lucile Packard Children’s Hospital Stanford, and clinics.

In a continued effort to educate parents about RSV and its symptoms, David Cornfield, MD, chief of Pulmonary, Asthma, and Sleep Medicine, and medical director of Respiratory Therapy, answers frequently asked questions about RSV, vaccines, and how wellness visits can help in the future.

• What is RSV, and who is at higher risk of serious symptoms?
  • RSV is a highly contagious, seasonal virus that causes symptoms such as trouble breathing and other more severe disease in infants. Most cases are mild, with cold-like symptoms such as runny nose, rapid breathing, cough, and congestion, but a severe infection can lead to pneumonia and bronchiolitis. Infants less than 6 months may have more symptoms and can appear more ill.
  • Most kids get RSV before they turn 2, and most recover quickly. But RSV can cause serious complications for babies born prematurely or with heart, lung, or immune system diseases.
  • For the vast majority of children, RSV infection is a normal part of childhood and will pass without any need for medical attention or any long-term consequences.
  • RSV occurs in yearly outbreaks, often during the winter and early spring months, in communities, classrooms, and childcare centers.

• How do babies contract RSV?
  • RSV is spread when a child comes into contact with fluid from an infected person’s nose or mouth, or from their cough or sneeze. This can happen if a child touches a contaminated surface and then touches their eyes, mouth, or nose. It may also happen when inhaling droplets from an infected person’s sneeze or cough.

• What are the symptoms that parents should look for?
  • People infected with RSV usually show symptoms within four to six days after getting infected. Call your pediatrician if your child is experiencing any of the following:
    • High unremitting fever (a temperature of 101.3 F [38.5 C] or higher).
    • Signs of dehydration.
    • Trouble breathing, such as short, rapid, and shallow breaths or retractions, where the chest caves in and the belly expands with each breath.
    • Unusual irritability or inactivity.
    • Refusing to nurse or bottle-feed.
    • Turning blue around the lips and fingertips—seek out emergency care.

• How is RSV treated?
  • RSV is treated no differently than other standard winter viruses. Therefore, routine testing for RSV is not needed. According to the Centers for Disease Control and Prevention (CDC), most RSV infections go away on their own in a week or two.
    • Some steps to relieve symptoms:
      • Keep children hydrated, suction their noses, and treat fevers with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen (never give aspirin to children).
      • Talk to your primary pediatrician before giving your child nonprescription cold medicines. Some medicines contain ingredients that are not good for children.

• How do I know if my child has RSV, the flu, or COVID-19?
  • The signs and symptoms for the different viral infections are very similar, so it is difficult to know. However, for generally healthy, low-risk children, the treatment for each of the viruses is supportive, which means maintaining good hydration, controlling fever, and suctioning the nose. If there is concern about COVID-19, the rapid antigen tests are very effective, even for infants.

• Can my child get RSV again, and how can I prevent it? 
  • Yes, an individual can get an RSV infection more than once in their lifetime.
• RSV is going to spread. One-half of all children in the world normally get RSV in the first year of life, and virtually all children have gotten RSV by their third year of life.
  • For vulnerable children, especially infants born prematurely and in the first year of life, infants can develop antibodies against RSV that will protect from infection.
• If an adult or another child is coughing, they should do the following:
  • If an adult or another child has cold symptoms, it is best not to be too close to the baby.
  • A breastfeeding and/or caregiving mom should wear a mask and perform good handwashing.
  • Refrain from kissing high-risk children while they have cold-like symptoms.
  • Wash their hands often with soap and water for at least 20 seconds.
  • Avoid touching their face with unwashed hands.
  • Limit the time they spend in childcare centers or other potentially contagious settings during periods of high RSV activity.
  • Get a flu shot and a COVID-19 vaccine.

As we navigate through the respiratory illness season, it’s important to continue practicing good hand hygiene, cover coughs and sneezes, and get vaccinated. Those are best tools we have to get through the respiratory virus season together.