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2021 Oct

Common Respiratory Virus: RSV

Learn about this infectious virus that targets young children.

You hear your baby coughing. You noticed a runny nose and a decreased appetite a few days prior. The baby feels warm and registers a temperature of 101.9° F. The cough sounds wheezy. Your pediatric healthcare provider diagnoses RSV. What is RSV?

RSV stands for Respiratory Syncytial (sin-SISH-ul) Virus. This very common and usually mild respiratory virus, discovered in 1956, causes cold-like symptoms. Most children have had RSV before 2 years of age.

RSV is very contagious. The virus enters the nose or mouth through infected air droplets or by touch as RSV can live on hard surfaces (like toys) for hours. Children are most contagious the first week but may spread the virus for up to 4 weeks. There is an incubation period of 4 to 6 days between exposure and illness.

RSV starts with a runny nose and decreased appetite. One to three days later the child will begin to cough, and a fever may or may not develop. Other symptoms include coughing, sneezing, nasal drainage, and wheezing. There may also be irritability, decreased activity, and difficulty breathing.

If your infant or child is coughing, it is best to have her evaluated by a pediatric healthcare provider. If she is having difficulty breathing, won’t wake to drink, isn’t urinating normally (dehydrated), has color change (bluish tinge) with cough, or is struggling to breathe, dial 911 or go directly to the nearest emergency department. Bronchiolitis is an inflammation of the small airways of the lungs that may be caused by RSV. Some children and infants can develop pneumonia requiring appropriate medical management and respiratory support following RSV infections.

Your pediatric healthcare provider will take a complete history and do a thorough examination of your child. Most mild cases of RSV do not need to be differentiated from the common cold. If your pediatric healthcare provider decides to test, there are lab tests to detect RSV. They generally require a nasal swab. Your provider may order a pulse-oximeter to check the oxygen level or a chest x-ray as well.

Most cases of RSV resolve without intervention. The disease generally lasts 1 to 2 weeks. There are no specific medications to treat RSV, as it is a viral illness. Children’s acetaminophen may be helpful for pain or fever if recommended by your healthcare provider. Nasal saline with bulb suction before feeds may open stuffy noses. Offer fluids frequently. Cool-mist humidification (clean humidifiers regularly) and rest may be helpful. Over-the-counter cough and cold medications are not indicated for children less than four years old.

RSV can be more serious in certain patients. Those at high risk for more serious RSV infections include infants (particularly pre-term infants and those less than 6 months of age), young children, children with immune issues, asthma, heart defects, or breathing difficulties. Second- hand smoke increases the risk for more severe infections. RSV is the most common cause of bronchiolitis and pneumonia in babies. RSV causes 2.1 million outpatient visits and 58,000 hospitalizations yearly in kids under 5 years old.

The CDC collects information on regional trends of RSV through the National Respiratory and Enteric Virus Surveillance System (NREVSS). RSV usually presents in the fall, winter, and spring, but this can vary. Mask-wearing and social distancing decreased the number of patients with RSV in 2020, however with the relaxation of safety measures, RSV flared in the summer of 2021, earlier than expected. 

Melanie J. Wilhelm, DNP, CPNP

Dr. Melanie J. Wilhelm, DNP, CPNP, is a Doctor of Nursing Practice, and a Certified Pediatric Nurse Practitioner as well as core faculty member at Walden University. Her book, Raising Today’s Baby: Second Edition, is available on


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