Parenting Advice From Your Physicians at Kaiser Permanente

The news is full of stories about sick kids this fall – indeed, this is shaping up to be quite a cold and flu season! Two years of masking and social distancing worked well to prevent our kids from getting sick. Without these preventive measures, our kids seem to be constantly ill – and to be passing viruses to each other. One of these is called respiratory syncytial virus (RSV) and we as pediatricians, want to help answer your questions about it.

What is RSV?

RSV is a common contagious respiratory virus that typically causes illness during the winter months. This year RSV is starting earlier than usual and spreading faster. Children who were protected from getting RSV by masking and distancing the last two winters now have little immunity to the virus. This makes a greater number of kids susceptible to getting ill from RSV, and it is spreading quickly. There is no evidence that we are facing a new, more dangerous strain of RSV.

RSV causes illness in the nose, throat, and lungs. For most children, it is like a bad cold, with LOTS of nasal discharge and a cough that can last 2 to 3 weeks (the runny nose from RSV is remarkable and can last for ages!) Other children, especially those under 6 months, premature infants, and children with underlying heart or lung disease, have more than just a bad cold and can get very ill.

Who gets RSV? 

Everyone, regardless of age, can get RSV, and it’s typical to get reinfected several times throughout your life. The illness from RSV is most severe the first time you get it. Usually, children have had their first infection by the time they’re age 2. Previous infections help build up some immunity. Over time, infections tend to be less severe.

Is there a test for RSV?

There is a test for RSV, much like a COVID-19 PCR test, but it’s usually only used for infants or children under age 6 months -1 year who are very sick. A positive test for RSV does not change how a child is treated, so a test is generally unnecessary. There’s no medication to treat RSV directly.

What can I do to help my child if they get sick?

Humidity and suction are the best ways to support your child during an RSV infection. Start with saline nose drops followed by suctioning can help lots! Even though children often fight the process, squirting saline nose drops into the nostrils and then using suction to remove mucus can help them breathe. Doing this makes it easier for them to eat and sleep.

Steam from a humidifier, warm bath, or shower also keeps the mucous in the nose and lungs moist and makes it easier for children to clear it out better.

It is important to ensure children with RSV drink lots of fluids and stay well hydrated. A breast- or bottle-fed baby may find it hard to suck because of all the nasal mucus. To help them use suction before each feed and offer feeds more often than you usually would.

In children over one, honey can also help control their cough. It is very important to never use honey for a baby under one year of age! If your child has a fever, ibuprofen and acetaminophen can help them feel better.

When should I worry?

Children usually do well with RSV, and while they can have symptoms for some time, they successfully fight off the virus without medical support. Red flags that it is time to bring your child in for evaluation include difficulty breathing and feeding. Seek medical attention right away if your child is:

• Breathing much faster than usual.
• Working hard to breathe with flaring nostrils, sucking in between ribs, moving their tummy and shoulders up and down to help them breathe.
• Wheezing or grunting.
• Having bluish discoloration of lips or fingertips.
• Struggling to take the bottle or breast because of difficulty breathing.
• Looking very tired.
• Urinating infrequently.
• Under 3 months old and has a fever over 100.4.

What can I do to prevent RSV?

Many of the same preventive measures we’ve followed during the past 2 years of the pandemic work well to prevent the transmission of RSV. Distancing, masking, washing hands, and disinfecting surfaces are all helpful. However, many of these are more challenging to carry out with small children in preschool or daycare. There is no vaccine for RSV yet, but one is being developed and may be available as soon as next year. Children 6 months and older are eligible for flu and COVID-19 vaccines, and we highly recommend both. This protection can help prevent the dreaded “tripledemic” of RSV, influenza, and COVID-19.

Resources for Parents

American Academy of Pediatrics

RSV: When It’s More Than Just a Cold

Centers for Disease Control and Prevention

RSV