RSV in children

RSV (respiratory syncytial virus) is one of the ordinary respiratory viruses. In an older child or an adult it usually looks like a common cold: a runny nose, a cough, sometimes a modest fever. It has a name of its own not because it always runs more severely, but because in the very youngest children it behaves differently.

Why age matters here, not the name of the virus

The younger the child, the higher the risk of a severe course of RSV infection. A baby's airways are narrow, so even a little swelling and mucus noticeably interfere with breathing, and during feeding the baby depends on breathing through the nose. The same virus that passes as a runny nose and cough in a five-year-old can require a doctor's examination in a baby in the first months of life.

That is why this whole page is built around age. For a preschooler or schoolchild the same benchmarks apply as with any respiratory infection — they are described on the page about respiratory infections (colds). For a baby under one year the assessment is different, and the sections below are devoted to exactly that.

How it appears in a baby: the non-obvious picture

In the first months of life, RSV infection often does not look like a “cold”. There may be no fever at all. Instead, parents notice that the baby has become different: less active, more irritable, feeding less, sleeping differently. Sometimes pauses in breathing appear.

• the baby has become listless or, on the contrary, unusually irritable
• takes noticeably less milk than usual, pulls away from feeds to catch their breath
• breathes faster and with effort; the chest can be seen drawing in
• pauses in breathing have appeared
• and there may be no fever at all

There is no need — and no way — to gauge the depth and duration of breathing pauses at home: the very fact that they have appeared is a reason to seek medical help immediately (in Georgia — 112), not to keep watching.

How it runs in older children

The usual sequence is: first a runny nose and reduced appetite, then a cough that may intensify and become persistent. In some children the breathing becomes wheezy. The condition is often at its most pronounced not on the first day but a few days into the illness — worth knowing in advance: a worsening on day three to five does not mean “something was done wrong”.

By symptoms, RSV cannot be told apart from other respiratory viruses — the picture is non-specific. Neither the runny nose, nor the character of the cough, nor the colour of the discharge names the virus.

RSV and bronchiolitis: how they are connected

Bronchiolitis is an inflammation of the smallest airways in young children. In babies it is most often viral in nature, and RSV is its most common cause; RSV also leads more often than other viruses to inflammation of the lower airways and to pneumonia in children under one year.

The practical conclusion for a parent here is not diagnostic but behavioural: with a respiratory infection in a baby under one year, it is the breathing that is watched, rather than the temperature.

Breathing: what exactly is assessed

The effort of breathing is visible from outside if you undress the child and calmly watch the chest at rest or during sleep — not while they are crying.

• rate: the child is breathing noticeably faster than usual
• effort: drawing-in between and below the ribs, the belly moving, the nostrils flaring
• sound: a grunting out-breath, a wheeze audible without a stethoscope
• colour: paleness, a grey tinge, blueness of the lips and skin
• behaviour: the child does not have enough breath for feeding, talking or crying

Feeding and drinking

In babies, feeding volume is one of the most telling signs, because it reflects a blocked nose, a shortage of breath and general wellbeing all at once. A baby who finds it hard to breathe physically cannot suck for long: they take short bouts, pull away, tire.

• feed more often and in smaller amounts if the baby tires quickly
• clear the nose before a feed so the baby can breathe while eating
• for older children — offer drinks in small amounts, often
• watch urination: passing urine less often is an important sign of fluid shortage

Not drinking enough during a respiratory infection is a reason in its own right to see a doctor, on a par with difficult breathing. The signs of fluid shortage and how it is replaced are covered in detail on the separate dehydration page.

Who is at higher risk

Groups at higher risk of a severe course include babies in the first months of life, children born prematurely, and children with chronic lung or heart disease or a weakened immune system. This is not a prediction for a particular child — it is a reason to see a doctor earlier and with a lower threshold of doubt.

Diagnosis: what an examination gives

With an ordinary course, the diagnosis is made clinically — from the examination and listening to the lungs. The doctor assesses the breathing over time, the child's condition and the feeding volume. At the appointment, the blood's oxygen saturation is measured (pulse oximetry) — this is non-invasive and takes less than a minute.

Laboratory identification of the specific virus in a typical course usually does not change the management: management depends on how the child is breathing and drinking, not on the name of the virus in a report. That is why it is not ordered routinely.

Treatment: what genuinely helps

There is no specific antiviral treatment for RSV infection in ordinary practice. Help consists of support: free nasal breathing, enough drinking and feeding, a calm routine, watching the breathing. In a severe course, hospital care may include oxygen and fluid replacement — that is a doctor's decision, not a home measure.

How this differs from a cold and from flu

From an “ordinary cold”

in an older child — by symptoms, practically not at all. The difference appears with the child's age: in a baby, RSV more often involves the lower airways.

From flu

flu more often starts abruptly, with a high fever and a marked disturbance of wellbeing. RSV in a baby can pass with no fever at all. But these signs do not identify the virus — they only describe the typical pictures.

From bronchiolitis

this is not an alternative but a different level of description: RSV is a cause; bronchiolitis is a condition that this cause can produce in a young child.

This page is for general information only and is not a substitute for a consultation with a doctor. A child's diagnosis and treatment are determined by a doctor during an examination.