Respiratory syncytial virus (RSV) symptoms, preventative measures and its connection to COVID-19

Respiratory syncytial virus (RSV) is a respiratory virus with a large range of symptoms. It can affect all ages but usually acts like a common cold for healthy, older children and adults. However, for premature infants and immunocompromised babies, RSV can make them very sick.

With the effects of RSV ranging drastically, with additional concerns about COVID-19 viruses on top of that, parents may worry about their child developing RSV. In this Q&A, Dr. Jenna Timboe, a pediatrician in CHOC’s primary care network, explains the signs and symptoms of RSV, how RSV and COVID-19 may relate and what to do to prevent them both.

What is respiratory syncytial virus (RSV)?

Respiratory syncytial virus (RSV) is common, and one of the many viruses that cause respiratory illness ― illnesses of the nose, throat, and lungs. For healthy children, RSV symptoms resemble a common cold, but it may lead some immunosuppressed and young babies to develop lower respiratory illnesses like bronchiolitis and pneumonia.

RSV is spread from respiratory secretions through close contact with infected people or contact with contaminated surfaces or objects. Its typical peak season of transmission is from October to March. However, RSV cases in children slowed during 2020 with COVID-19 closures and precautions and picked up in summer 2021 with the relaxed COVID-19 precautions ― causing cases of RSV to rise exponentially during its typical off season. 

What are the symptoms of respiratory syncytial virus (RSV)?

The early phase of RSV in infants and young children is often mild, like a cold. In children younger than 3 years, the disease may progress into the lower airways and cause coughing and wheezing. In some, the infection progresses to a severe respiratory disease requiring hospitalization to help the child breathe.

RSV is so common that most children will be infected by the time they are 2 years old. This will give them protection against that specific strain of the virus, but they are able to be reinfected by a different strain anytime throughout life.

The following are the most common symptoms of RSV, which likely appear two to five days after exposure to the virus. However, each baby may experience symptoms differently. Symptoms may include:

  • Runny nose
  • Fever
  • Cough
  • Apnea (periods without breathing)
  • Trouble eating, drinking, or swallowing
  • Wheezing
  • Flaring of the nostrils or straining of the chest or stomach while breathing
  • Breathing faster than usual, or trouble breathing
  • Turning blue around the lips and fingertips

The symptoms of RSV may resemble other conditions or medical problems. Always consult your child’s pediatrician for a diagnosis.

Are some children more at risk for contracting respiratory syncytial virus (RSV)?

Yes. A child is more at risk to develop RSV if they are around others with the virus. There are typically outbreaks in the winter and early spring months in communities, classrooms and childcare centers.

RSV can affect both children and adults, but is most dangerous for young babies and older people. For older, healthy children and adults, RSV may act like the common cold. Infants (especially premature infants), older adults, people with heart and lung disease or anyone with a weak immune system are at increased risk for developing severe illness from RSV.

This these cases, the infection can spread to the lower respiratory tract, causing pneumonia or bronchiolitis — inflammation of the small airway passages entering the lungs, which can be life threatening. RSV in infancy may also be related to the development of asthma later in childhood.

When should I seek treatment for respiratory syncytial virus (RSV) for my child?

Specific treatment for RSV will be determined by your baby’s pediatrician based on:

  • Your child’s age, overall health, and medical history
  • The extent of the condition
  • Your child’s tolerance for specific medications, procedures, or therapies

There are no medications used to treat the virus itself. Care of a baby with RSV involves treating the effects of the virus on the respiratory system. Because a virus causes the illness, antibiotics are not useful, unless there is also a bacterial infection. If your child is having severe illness and trouble breathing, treatment may also include:

  • Supplemental oxygen
  • Breathing treatments
  • Suctioning of mucus
  • Intravenous fluids (to prevent dehydration)
  • Tube feedings (if the baby has difficulty sucking)

Children with very serious breathing problems are intubated and put on ventilators, or breathing tubes are inserted and attached to machines that assist with breathing.

Read about how Alexandria and her son’s journey with RSV changed the way she parents.

Is COVID-19 a respiratory syncytial virus?

No. RSV and COVID-19 are both highly contagious respiratory illnesses caused by different viruses; RSV is caused by respiratory syncytial virus and COVID-19 is caused by the SARS-CoV-2 virus.

RSV and COVID-19 may be hard to tell apart due to their shared symptoms: fevers, coughing, shortness of breath, a runny nose, sore throat and headache.

The best way to determine if your child has RSV or COVID-19 is to have them tested for both, if possible, by a health care provider.

Can my child have respiratory syncytial virus (RSV) and COVID-19 at the same time?

Yes. It is not uncommon for children to contract two viruses at once. With COVID-19 variants on the rise, it’s possible that there may be more and more children developing RSV and COVID-19 at the same time.

The best way to prevent both RSV and COVID-19 is to have all eligible children get vaccinated for COVID-19, wear a mask, social distance and wash their hands frequently.

How can respiratory syncytial virus (RSV) be prevented?

The U.S. Center for Disease and Control (CDC) recommends that children at high risk for RSV should avoid people with cold-like symptoms. Because RSV is spread through contact with infected people or contaminated surfaces, familes should avoid sharing cups eating utensils and close contact like hugging and kissing with anyone with cold-like symptoms. In addition, practice frequent hand washing and disinfect frequently-touched surfaces like doorknobs, counters and phone screens.

The American Academy of Pediatrics (AAP) recommends that babies at high risk for RSV get a medicine called palivizumab. This is given to prevent RSV in babies at high risk. Ask your child’s healthcare provider if your child is at high risk for RSV. If so, ask about monthly injections during RSV season to help prevent infection.

To reduce the risk for RSV, the AAP recommends all babies, especially preterm infants:

  • Be breastfed
  • Be protected from contact with smoke
  • Not go to childcare with lots of children during their first winter season
  • Not have contact with sick people

Also, make sure that household members wash their hands or use an alcohol-based hand cleaner before and after touching your baby. Don’t allow people to smoke in your home or in your car. Remove your baby from any area where people are smoking.

We are excited to offer the Pfizer BioNTech pediatric COVID-19 vaccine for children and teens. To receive a vaccine, contact your CHOC primary care pediatrician to make an appointment.


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