RSV – Respiratory Syncytial Virus

What is RSV?

RSV stands for Respiratory Syncytial Virus. It is a virus that is transmitted from person to person in the late fall, winter, and early spring months. The peak number of cases occur December through February. RSV is especially common in children in childcare or school settings because it is spread by coughing and sneezing and can survive on a number of surfaces such as toys, counters/desks, doorknobs, clothing and hands. Each winter RSV is the leading cause of bronchiolitis – infection/inflammation of the smallest airways in the lungs called bronchioles. This is not to be confused with bronchitis, which is seen more commonly in older children and adults and is infection/inflammation of the bronchi (the two main branches of the lungs that come off the windpipe/trachea). If you think of the lungs as an upside down tree with the windpipe being the trunk, the bronchi are the two main branches off the trunk and the bronchioles are the smallest branches at the very tips of the tree. When these smallest branches get inflamed it can be hard for young children, in whom these branches are already very narrow, to move air through them. The result is often a cluster of symptoms that can be very worrisome to parents and healthcare providers alike.

Watch Dr. Weber and some of our former faves Dr. Mapp and Dr. Shreve explain RSV or read below for more information.

What are the symptoms with RSV?

For adults and children 3 years & older RSV resembles nothing more than typical cold symptoms – runny nose, congestion, cough and possibly fever. For younger children such as infants (less than 1 year old) and toddlers (1-3 years old), in addition to the upper respiratory symptoms noted above, RSV can cause lower respiratory tract symptoms such as difficulty breathing, rapid breathing and/or wheezing.

How long does RSV last?

RSV may last anywhere from 5 to 14 days. RSV typically peaks in severity (i.e. your child will look/act most sick) on days 4 or 5, then congestion and cough slowly improve over the following 3-7 days

How do I know if my child has RSV?

RSV is what we call a ‘’clinical diagnosis.’’ While there is a test to confirm RSV, we typically do not test for it in our office; we diagnose RSV based on the symptoms you report to us, the things we see and hear when we examine your child, and the time of year. Children with symptoms and exam findings typical of bronchiolitis are often presumed to have RSV if it is wintertime. Many other viruses can cause bronchiolitis, however, and management of bronchiolitis is usually not dependent on knowing which virus is causing it. One exception is influenza (the flu), for which a medicine called oseltamivir (Tamiflu ®) may help to shorten the duration of the illness. Your healthcare provider will inform you if testing for RSV or influenza is helpful in the management of your child’s illness.

What is the treatment for RSV?

Unfortunately, there is no medicine that attacks or affects the RSV virus itself. Managing RSV – and really, all causes of bronchiolitis – is largely supportive care. Supportive care means keeping your child as comfortable and hydrated as possible while monitoring for signs that your child is having a hard time breathing. For most this means using saline drops and suction devices (bulb suction aspiratorsNoseFrida®, Naspira®, etc.) to get mucous out of the nasal passages. This allows children to breathe more easily, eat more easily (they are used to breathing through their noses while they eat), and sleep more easily (also prefer breathing through their noses while they sleep). To minimize the risk of nose irritation and nose bleeds we recommend limiting mucous-sucking to before feedings and before sleeping. Cool-mist humidifiers may help to minimize the thickness of the secretions and allow your child to clear the mucous a little more easily.

In a small percentage of children who have wheezing with RSV, a breathing treatment with albuterol may help to provide short-term relief of symptoms (NOTE: albuterol does not affect the RSV virus that is causing the symptoms, only some of the symptoms caused by it). Your healthcare provider will inform you after examining your child if a trial of albuterol is warranted. If the albuterol treatment has no effect, we won’t likely try another or provide you with albuterol for home use. If the albuterol allows your child to breathe more easily, we will assist you in getting the machine or spacer, and medicine prescription necessary to continue the breathing treatments at home.

If your child requires hospitalization due to RSV, deep suctioning and other interventions geared toward improving work of breathing may be used. These treatments require close monitoring afterwards and are neither available for the office or home setting, nor shown in research studies to alter the course of RSV infection for non-hospitalized patients.

I think my child has RSV. Do I need to bring him/her in to the office?

Not necessarily. Reasons for calling us or bringing your child into the office include concerns about:

  • Dehydration (dry-looking mouth, less than 4 wet diapers/24 hrs in infants, or less than 3 wet diapers/24 hrs in toddlers)
  • Difficulty Breathing (nostrils flare out, belly sucks under ribs, neck muscles suck underneath collarbones, or skin/muscles suck in between each rib with every breath)
  • If your child is 2 months old or younger and has a fever (100.4 or greater), please always call us. Older children with RSV and fever do not necessarily need to come into the office for evaluation.
  • Young age. If your child is younger than 3 months and you think he/she has RSV, we prefer to examine them. Young infants with RSV are more prone to developing complications from RSV and we monitor them much more closely/frequently than older infants and toddlers.
  • How your child looks or is acting. If you’re worried, give us a call at (804) 282-4205.

How can I prevent my child from getting RSV?

While there is no fail-safe way of preventing your child from getting RSV, regular handwashing is the most effective and most important method for lowering the risk of getting RSV. Additionally, avoid playdates if the children or adults with whom you’re supposed to meet have been sick recently.

Is there a vaccine for RSV?

No, unfortunately not. Palivizumab (Synagis®) is an antibody injection given to high-risk children (think premature babies and those born with heart diseases) during RSV season to help lower the risk of lung infection if the child gets RSV. It does not prevent RSV, however, and is not considered a vaccine. Due to its cost, palivizumab is only administered to high-risk children as noted above. If you believe your child is “high risk”, please discuss with your healthcare provider if palivizumab is indicated. In 2023, the FDA approved nirsevimab (Beyfortus®) for infants younger than 8 months old entering their first RSV season. Nirsevimab provides passive immunity for infants. Vaccines stimulate the body to make antibodies to protect against germs. Passive immunity is giving the already-made antibodies to the infant. In the case of nirsevimab, the immunity has been shown to last 5-6 months, which should protect them for the majority (if not entirety) of RSV season. Clinical trials have shown nirsevimab decreasing hospitalization rates due to RSV by approximately 80%. Because RSV is the leading cause of hospitalization in infants in the United States, we are eager to have this additional tool available.

Is there anything else I can do to help my child if he/she has RSV?

Yes. Be mindful that they often swallow the vast majority of mucous their bodies make in response to the virus. Consequently, appetite will likely be less than usual. You can help your child stay hydrated by doing more frequent smaller (if bottle-fed) or shorter (if breastfed) feedings so that the stomach doesn’t get too stretched out. A typical feeding in a belly already full of mucous may result in increased spit up or vomiting.