Reassuring Details About Respiratory Syncytial Virus

Finding out your child has a respiratory syncytial virus (RSV) infection can be scary. If you're like most parents, you've probably heard nightmarish stories about this illness—tales of babies struggling to breathe and running sky-high temperatures. But in reality, such severe symptoms are not typical of RSV. In fact, by the age of 2, most children will have been exposed to RSV.

Not All RSV Symptoms Are the Same

RSV season typically runs from mid-September through April, peaking from late December to mid-February. Typically kids are exposed to RSV either by direct contact with respiratory secretions (droplets spewed into the air when an infected person coughs or sneezes) or by touching toys or other objects a sick child has touched.

Symptoms tend to kick in three to five days after someone is exposed to RSV. More often than not, a child who's infected with RSV comes down with a simple cold or develops very mild symptoms—a clear runny nose, say, or an occasional cough—that can easily be treated at home.

Other possible symptoms include a low-grade fever, sore throat, headache, and irritability. Most of the time a doctor will diagnose RSV infection based purely on these symptoms, although it is possible to detect the virus in nasal secretions.

Young Children and Babies

Babies and children under 2 years of age are most at risk for the more severe (and notorious) symptoms caused by RSV, such as very high fever, sleep apnea, and bronchiolitis—an infection of the tiny airways that lead to the lungs called bronchioles. When the bronchioles become inflamed, they swell and get plugged with mucus, making it hard for a child to breathe.

Infants who develop bronchiolitis may be at increased risk for asthma and other respiratory problems later in life.

Treating and Preventing RSV Infection

If your child comes down with an RSV infection, their symptoms may linger for as long as three weeks. How your pediatrician chooses to treat them will depend largely on her age and how severe the symptoms are.

Most likely, if your child is over the age of 2 and has mild symptoms, they'll likely need nothing more than an over-the-counter medicine for pain and fever (such as ibuprofen) and maybe something for the cough if it's really bothering them or keeping them up at night. The infection should clear on its own. A cool mist humidifier can help relieve a stuffy nose.

Treatment for Serious Symptoms

A doctor might treat a baby or toddler who develops serious symptoms with nebulizers just as they would for a child with asthma. The evidence for and appropriate use of corticosteroids or nebulizers in the treatment of RSV infection remains controversial.

A very young child who has to be hospitalized because of difficulty breathing will likely be treated with intravenous fluids and oxygen. Severe cases may require putting an infant on a ventilator.

There are no drugs for treating RSV. If a child's symptoms are serious enough to be life-threatening, their doctor may prescribe an antiviral medication called ribavirin, but this approach is controversial. Because RSV is a virus, antibiotics won't be helpful, but if a child develops a secondary bacterial infection, such as an ear infection, they may need an antibiotic to clear it up.

Prevention

The best way to protect a child from infection with RSV is the same strategy you'd use to prevent another viral illness: frequent handwashing by all family members. Older siblings who go to daycare or are in school are especially likely to bring RSV home, so make a trip to the bathroom sink for a thorough scrub-down before touching or playing with a baby brother or sister an important house rule. It's also a good idea to not allow kids to share bottles or pacifiers.

Synagis (palivizumab) is a monoclonal antibody that helps prevent severe lower respiratory tract illnesses in premature babies and children 2 years old and younger who are at high risk of serious complications from RSV. It's a shot given once a month during RSV season.

Palivizumab is not a vaccine and cannot cure or treat a child diagnosed with RSV. However, if your child is at very high risk for RSV infection, your pediatrician may discuss this option with you.