RSV: Parents’ top questions answered

A common seasonal illness known as RSV, or respiratory syncytial virus, is on the rise among children this fall. The increase has many parents concerned, especially since it coincides with higher than usual rates of the flu and talk of a possible winter surge in COVID-19.

Most children with RSV have mild, cold-like symptoms that go away on their own. But for some children under 1 year old, RSV can be more serious.

Pediatricians Nicole Makram, MD, and Kate Land, MD, both with Kaiser Permanente in Northern California, share guidance on what to do if you think your child may have RSV.

What is RSV?

RSV is a common respiratory virus that typically causes illness during the winter months. RSV is starting earlier and spreading faster than usual during the 2022-23 cold and flu season. Children who were protected from getting RSV by widespread masking and social distancing over the last 2 winters now have little immunity. This makes a greater number of kids susceptible.

What are the symptoms of RSV?

RSV causes illness in the nose, throat, and lungs. For most children, it’s like a bad cold with a cough and lots of nasal discharge. The cough can last 2 to 3 weeks, and the runny nose can continue even longer.

But other children can get very ill from RSV, especially those under 6 months old, premature infants, and children with underlying heart or lung disease.

Who gets RSV?

Everyone can get RSV, regardless of their age, and it’s typical to get reinfected several times throughout your life. Most children have had their first infection by the time they’re 2 years old.

Is there a test for RSV?

There is a test for RSV, but it’s usually only used for infants under 1 who are very sick. A positive test for RSV does not change how a child is treated, so a test is generally unnecessary.

What can I do to help if my child gets sick?

There’s no medication to treat RSV directly. Instead, treat your child’s symptoms.

Reduce nasal congestion. Start by squirting or spraying saline nasal drops into your child’s nose. Then use a rubber bulb to remove mucus. Children may fight the process but reducing congestion makes it easier for them to eat, drink, and sleep.

Use a humidifier to keep airways moist. This helps your child clear their nose and lungs. You can also take your child into the bathroom and turn on the shower. Stay in the room while he or she breathes the moist air for several minutes.

Offer plenty of fluids. Staying hydrated is important. But a breast- or bottle-fed baby may find it hard to suck because of nasal congestion. To help, use a rubber bulb to remove mucus before each feeding and offer fluids more often than usual.

Give a teaspoon of honey to help control your child’s cough, but only if he or she is over 1. Do not give honey to children under 1.

If your child has a fever, use acetaminophen (brand name Tylenol) or ibuprofen (brand name Advil or Motrin) to bring the fever down. Ibuprofen should only be given to children ages 6 months and up. Check the label to find the right dose based on your child's weight.

When does my child need medical attention?

Most children with RSV don’t need to be seen by a doctor. But if your child is having difficulty breathing or feeding, it’s time to seek care. Red flags include:

• Breathing much faster than usual
• Working hard to breathe with flaring nostrils, muscles sucking in between ribs, or tummy moving in and out
• Wheezing or grunting
• Bluish discoloration of the lips or fingertips
• Struggling to take the bottle or breast
• Extreme fatigue or irritability
• Urinating infrequently
• Fever over 100.4 degrees in a child under 3 months

What can I do to prevent RSV?

Many of the measures we follow to prevent COVID-19 can also help protect your child from RSV. Try to make sure young children:

• Avoid close contact with sick people
• Wash their hands often with soap and water for at least 20 seconds
• Avoid touching their face with unwashed hands
• Limit time spent in child care or other crowded places

There is no vaccine for RSV yet, but children 6 months and older are eligible for flu and COVID-19 vaccines, as are their family members. By making sure everyone is vaccinated as soon as possible, you can help prevent the dreaded “tridemic” of RSV, flu, and COVID-19.