Early Symptoms of RSV

• Nasal congestion
• Runny nose
• Fever (100.4 degrees F or higher)

• Cough — wet (producing mucus or phlegm) or dry
• Sore throat
• Fatigue

Babies 12 months and younger may be irritable and have breathing trouble; some may begin breathing faster than usual, says Sharon Nachman, MD, the chief of the division of pediatric infectious diseases at Stony Brook Medicine in New York.

In very young infants the only symptoms of RSV may be breathing difficulties, irritability, or lethargy (decreased activity).

Signs of Severe RSV

Some children develop severe lung infections from RSV, causing respiratory distress, says Flor M. Muñoz-Rivas, MD, a pediatric infectious diseases physician at Texas Children’s Hospital and an associate professor of pediatrics and infectious disease at Baylor College of Medicine in Houston. “They might look like they’re working hard to breathe and are actively moving their chest up and down,” she says.

• Wheezing or a “barking” cough (may indicate the virus has moved into the lungs)
• Flaring of the nostrils or straining of the chest or stomach area while breathing
• Turning blue around the lips and fingertips

The main complications from RSV are:

RSV spreads easily, including in the following ways:

• Through coughs or sneezes, which spread virus-containing droplets that may land in the eyes, nose, or mouth of another person.
• Through making physical contact with someone who is sick, such as by kissing the face of a baby with RSV.
• By touching a contaminated surface like a doorknob or a toy, then touching your face before washing your hands.

Most children get RSV at an early age, especially if they go to day care, attend school, or have siblings, says Dr. Nachman.

“RSV is very contagious — avoiding it completely is almost impossible,” she adds.

• Babies born prematurely (preemies)
• Infants under 6 months
• Babies or toddlers under age 2 with congenital heart disease or chronic lung disease
• Children with immune system diseases or a compromised immune system or a neuromuscular disorder (such as muscular dystrophy)

“The moment a parent is having any concerns that a child is not able to keep up with their feeding or is having more difficulty breathing, it’s best to see a pediatrician to get tested,” says Dr. Muñoz-Rivas.

• A temperature of 100.4 degrees F or above for babies under 3 months old
• A fever above 102 degrees at any age
• Symptoms that get worse after one week or last longer than 10 days
• Ear drainage (a possible sign of an ear infection)

A healthcare provider may diagnose RSV after asking about a child’s symptoms and conducting a physical exam. In some cases (but not always), they will confirm with an RSV test, which requires a quick swab to get a mucus sample.

Labcorp sells home test collection kits without a prescription; parents swab their child, then send the sample to the company’s lab via overnight mail, with results available a day or two after that. Health insurance may not cover this testing, so you may want to call your doctor to discuss your child’s symptoms and get their advice before proceeding.

Babies and children who need to be hospitalized for RSV may have additional tests such as a chest X-ray or CT scan, blood tests, or urine test.

Symptoms related to breathing and not getting enough oxygen are reasons to seek immediate care by calling 911 or your local emergency number.

“If a baby is working very hard to breathe, and you see not only the muscles between the ribs getting pulled in, but the muscles around their neck getting pulled in, that’s a reason to get emergency care. Go straight to the hospital — that child is working too hard to breathe,” says Nachman.

Other signs of an impending crisis include pausing while breathing; short, shallow, or fast breathing; and noisy breathing.

Currently, there is no RSV-specific antiviral medicine, though there are some drugs in various stages of development, says Nachman.

Over-the-Counter Medications, Home Remedies, and Comfort Care for RSV

It's important to keep your child or baby hydrated as a way to make them feel better, says Nachman. “The fact is, they don’t need to drink buckets of water; they need to have frequent sips,” she says.

Babies still breastfeeding may be fussy and not feed long, but keep trying, says Nachman. “If they take a bottle, they’re probably not going to take a full bottle, and they may spit some up, but keep trying to get them to drink a little bit,” she says.

If your child is old enough to be tempted by a salty snack such as chips or pretzels, you can often get them to drink a few sips of liquid after they take a few bites, says Nachman.

Other remedies to relieve RSV symptoms in children include:

• Honey Nachman typically recommends honey to soothe a sore throat or help with a cough. Children (provided they are over the age of 1) can have a scoop of honey on its own or in juice. “Don’t give honey to an infant or baby less than 12 months old,” Nachman says. A bacteria called Clostridium botulinum can be present in honey and cause infant botulism in babies under 1 year old.

• Vaporizers and humidifiers “I recommend these because they do get a lot of water into the air. For babies and kids who are breathing water off because they are breathing fast, that will help their secretions be a bit wetter,” says Nachman.
• Baths or showers For children old enough to take a bath or shower, the moisture in the air can help ease congestion, she says.
• Saline nose drops or sprays These can help keep nasal passages moist and help with stuffiness.

• Nasal suctioning with a bulb syringe Used with or without saline nose drops, these devices can help relieve stuffiness in children too young to blow their noses.
• Breathing exercises “Children who are old enough can take deep breaths and blow them out. That makes them cough and helps get rid of the thick, sticky secretions in their lungs,” says Nachman.

Nachman doesn’t recommend nebulizer treatments for RSV. “They don’t seem to make you get better faster and they can be difficult to use,” she says.

Treatment for Severe RSV

• Oxygen
• IV fluid (if they aren’t eating or drinking enough)
• Mechanical ventilation/CPAP machines if children are working too hard to breathe

There are a few options for heading off severe RSV in infants and some young children.

Maternal RSV Vaccine Abrysvo

RSV Preventive Antibody Treatments

Two available medications utilize monoclonal antibodies — laboratory-made versions of proteins produced naturally by the immune system — to prevent RSV in vulnerable infants and toddlers.

Except in rare cases, if the mother received the maternal RSV vaccine at least two weeks before giving birth, most infants under 8 months don’t need Beyfortus.

Doctors may also recommend Beyfortus for some babies between 8 and 19 months old who are at increased risk of severe RSV and are entering their second RSV season.

The injection is given monthly throughout the RSV season.

Everyday Ways to Reduce the Spread of RSV

• Wash your hands frequently. Use soap and water and scrub for at least 20 seconds, and help young children do the same.
• Avoid touching your face. If you have RSV germs on your hands you can get the virus when you touch your mouth, nose, or eyes.
• Avoid close contact with sick people and stay home when you are sick. Cough or sneeze into a tissue or your upper shirt sleeve.
• Clean frequently touched surfaces regularly. RSV germs from hands, sneezes and coughs can live on surfaces and objects.