Recognizing and Preventing RSV in Children

If you have young children, then you have certainly seen your fair share of runny noses and sniffles. In most cases, symptoms come and go. In instances where respiratory syncytial virus (RSV)—and not a common cold virus—is at work, things can get serious rather quickly.

In fact, among children under 5 years of age, RSV accounts for roughly 2.1 million outpatient visits, 58,000-80,000 hospitalizations, and 100-300 deaths in the United States each year.

The challenge with RSV is that it often mimics a bad cold in toddlers and children. However, unlike a cold, RSV attacks the tiny airways of the lower respiratory system. The resulting inflammation and mucous production can make it difficult for infants and young children to breathe.

So how do you tell if it’s RSV or just a cold? Unfortunately, RSV can only be diagnosed by a clinical lab test. Common symptoms that may point to RSV include: runny nose, decrease in appetite, coughing, sneezing, fever, and wheezing.

Symptoms usually appear in stages over the course of five to ten days. In some cases, coughing may persist for several weeks. In the case of infants, the only symptoms may be irritability, decreased activity, and breathing difficulties.

Symptoms that should raise a red flag for caregivers include:

Breathing difficulties: Breathing faster than usual, using extra muscles to breathe, and flaring nostrils are all signs that a child is struggling for oxygen. If you see these symptoms, take your child directly to the emergency room.

Signs of dehydration: If your child has fewer than one wet diaper every eight hours, cries without producing tears, appears irritable, or the soft spot on their head (the fontanelle) is depressed or sunken, they are suffering from dehydration. If your child displays any of these symptoms, contact their doctor for advice.

Not eating: In infants and small children, RSV can cause severe congestion and makes it difficult to eat. In the case of infants, shorter than usual feedings and/or a lack of wet diapers is a good indicator that your child is not getting adequate nutrition. If you’re concerned your child isn’t getting enough nourishment, contact their doctor for advice.

Gray or blue color to tongue, lips, or skin: Any bluish or grey discoloration of the skin suggests a child is not getting enough oxygen. If you notice any discoloration, head straight to the emergency room.

Because infants are at a greater risk of severe RSV, caregivers are encouraged to have their child vaccinated against the virus. While relatively new, the vaccine nirsevimab (sold as Beyfortus) is endorsed by the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, and the American Academy of Pediatrics. Currently, the CDC recommends vaccines for babies up to 8 months old who were born during or entering their first respiratory syncytial virus season (early fall), as well as for infants between 8 and 19 months who are at increased risk of severe RSV disease.

NOTE: SVMC will offer the RSV vaccine as soon as it becomes widely available. For updates on availability, contact your pediatrician’s office or look for news in a future issue of the Weekly Wellness Update.

RSV tends to emerge between October and May with the bulk of infections happening  in January and February. If you have questions about RSV or the vaccine, speak to your child’s doctor.

Meghan Gunn, MD, FAAP is the Medical Director of SVMC Pediatrics.