RSV: Recognition and Management in Infants

It is officially RSV season. If you haven’t heard of RSV, it is the acronym used for Respiratory Syncytial Virus (RSV). RSV has seasonal outbreaks throughout the world, but in the US, RSV season typically occurs October/November through April, with a peak in cases in January and February each year.  All three of my children have had a minimum of an emergency room visit for RSV, with my youngest, who is medically fragile, spending 4 days in the ICU because symptoms were so bad. 

RSV is transmitted through droplets when people cough or sneeze. The virus can live on hands and surfaces for hours, making it extremely contagious. Proper hand washing is KEY to prevent the spread. 

RSV is very common. In fact, most kids have been infected at least once by the time they are two years old. RSV in most age groups presents like any other typical common cold, otherwise known as upper respiratory tract infections, with symptoms including nasal congestion, fever, cough, sore throat or headache. Oftentimes, older children who have been exposed many times to RSV don’t show symptoms at all, which is why it is spread so rapidly among siblings.  In younger children, specifically under 1 year old, RSV can cause serious symptoms. This is also true for premature infants. In babies, RSV can progress to lower respiratory tract infections, meaning the virus has settled lower in the lungs. This can cause wheezing and difficulty breathing. As you can imagine, these symptoms are terrifying for parents of infants. 

With most common colds, symptoms are at their worst in the first few days, however, with RSV, symptoms tend to worsen with the peak of symptoms happening on days 3-5. 

Okay, so knowing that RSV can look like a normal common cold in lots of kids, how can you help differentiate at home? When should you let your kiddo ride out symptoms at home and when should you take them to a professional? 

First, RSV presents with a lot of clear snot. These kids and infants have extremely runny noses often associated with cough and fever. As long as infants and childrens are continuing to take in fluids and pee normally, RSV can be managed at home. RSV is a viral illness, therefore antibiotics do not help symptoms. The only cure for a viral illness is time. 

There are two major things to watch for at home as far as RSV.

1. Dehydration

Babies are largely nose breathers when they eat. While sucking on a bottle or breast, they are using their mouths to suck and swallow, so breathing is largely taken over by the nose. When their noses are filled with snot, they stop eating as well because it is difficult to breathe and eat at the same time. This leads to dehydration. Signs to look for when it comes to dehydration include:

-dry lips/mouth

-decrease in wet diapers: babies should be wetting a diaper every 8 hours as a minimum!

-no longer crying real tears

2. Wheezing or Breathing Difficulty

Babies are largely belly breathers, meaning their bellies move a lot when they normally breathe. As a provider, when assessing breathing effort, I look for if an infant is using extra muscles to breathe. It is not normal for infants to grunt when they breathe or use muscles in their necks or between their ribs. When infants are working hard to breathe, you will see their muscles pulling in those areas. This is a reason to take your child to the office immediately. When babies use extra muscles to breathe, they get tired faster. Eventually, their bodies will tire of using extra muscles and their oxygen levels will drop. 

Treatment

As I said above, there is no cure for RSV, however, there are treatments for symptoms that can make your baby more comfortable.

If your baby seems uncomfortable, treat the fever with an anti-pyretic aka fever reducing medication. Ibuprofen can only be given once your infant is older than 6 months. Fever contributes to dehydration. The hotter the body, the faster it is using its fluids. 

Provide small amounts of water if your baby is greater than 6 months old. If under 6 months, water is not recommended. If you note your infant isn’t wetting diapers normally, take them in to be seen.

Nasal congestion can be improved with suctioning. Products like the nose freida, or similar electric options can be helpful to provide clear nasal passages, especially before feedings to ensure your infant can breathe and eat at the same time. This is typically the number one intervention provided in the emergency room for babies with RSV, however hospital grade suction is far superior to home devices. 

If your infant is wheezing or showing signs of extra muscle use, you should consult a provider. Oftentimes wheezing medications are ineffective with RSV, however your infant may need oxygen monitoring to ensure safe oxygen levels. Sometimes, in severe RSV infections, infants need to be given extra oxygen to keep levels in a safe range. 

When in doubt, consult your pediatrician for an evaluation. As a parent, no one knows your child better than you. If your gut is telling you something is wrong, you are probably right. 

Check out my reel on instagram @nuanced_newborns to see my journey with RSV when my son (middle child) was just 10 weeks old. It was easily one of the most terrifying days in my parenting history.