Everything Parents Need To Know About RSV

While the virus normally circulates in the fall and winter, doctors and hospitals began seeing an alarming rise in cases beginning in the spring of 2021 that continued into summer.To find out what RSV is, why it’s on the rise, and what warning signs parents need to look for, we talked to Northwell Health pediatrician Allison Mangini, DO.

RSV is a type of virus that primarily attacks the respiratory tract—including the nose, throat, and lungs. While most cases are mild with cold- and flu-like symptoms, there is the potential for more serious infection in certain populations (including infants, the chronically ill, and the elderly). This is, in part, because the virus causes the body to produce thick mucus that lines the respiratory tract, which can be difficult for the body to clear. This can lead to air trapping—or what’s called hyperinflation of the lungs—as well as tiny collapses in a child’s lungs.

In older kids, RSV is unpleasant but easier to deal with since airways are bigger, and the muscles involved in coughing and ridding the body of mucus are stronger. In infants, especially babies who are premature or have low muscle tone or other lung diseases, this thick mucus can become deadly.

In this region, we typically see RSV circulating in the winter months, which coincides with flu season. But because of mask-wearing and social distancing due to COVID-19, we saw very little RSV and other common respiratory illness during the winter of 2020 and 2021. Once people began taking off their masks and easing social distancing practices, the opportunity to pass all manner of viral and bacterial infections to each other resurfaced—including RSV.

The symptoms of RSV are similar to any other respiratory illness: Congestion, cough, fever, and fatigue are the most common. The cough may sound “wet” or “dry” and can alternate between the two.Usually symptoms start mildly and peak within five to seven days, when the body is dealing with the most thickened mucus and inflammation. Appetite may be affected in some cases because there’s so much mucus. For babies, who breathe only through their noses, any nasal congestion at all can make feeding very difficult.The amount of mucus may even make babies vomit, especially after a coughing fit that causes them to gag. Respiratory distress can be a symptom, so parents should watch their children very closely for signs of labored breathing (see below for details).

If your child is having symptoms of cough and congestion with or without a known exposure to RSV, it’s always appropriate to have them examined by their pediatrician.Children should definitely be seen by their doctor if they’re coughing, vomiting from coughing, or if they’re having trouble staying hydrated or showing any signs of dehydration. Look for decreased tears, decreased urination, or less moisture than usual on their lips or tongue.

The best treatments are what we call “supportive care,” which is exactly what it sounds like. Basically, we’re trying to support the child and make them feel comfortable while keeping them hydrated and safe until they’re able to fight off the infection on their own. But when babies under 3 months old get RSV, we often admit them to the hospital for observation and supportive care.When providing care at home, here are some tips to keep in mind:

• Nasal saline and suction are very important in young children, especially before feeding time so they have an easier time feeding
• Keeping them well hydrated with breast milk, formula, water or Pedialyte (as directed by your pediatrician) is also important
• If they have a fever, medicines like acetaminophen or ibuprofen can be used—as approved by your pediatrician
• Warm, steamy shower rooms or a cool-mist humidifier can also help children feel a little better when they have congestion

A baby under 3 months old who has had a known exposure to RSV should be seen by a pediatrician as soon as possible—even if they only have mild symptoms.These are the signs that a baby or child needs to be seen urgently, either by bringing them to the emergency room or calling 911:

• The child isn’t breathing comfortably or is showing signs of increased effort in breathing (such as fast breathing, pausing in breathing, grunting with breathing, or using belly muscles to help them breathe)
• The child is unable to tolerate feeding
• The child appears lethargic or excessively tired

Close monitoring for respiratory distress is essential. I like to tell my patients that there’s a fine line between having the skills and equipment to do this at home by yourself and needing help in a medical facility or hospital. If you’re concerned or feel that your child is distressed, don’t hesitate to seek immediate medical attention.