RSV (respiratory syncytial virus) is one of the viruses that cause the common cold. It’s not a new disease, but a growing number of kids and adults are coming down with the virus earlier this year. Many will not need treatment other than rest and fluids, but some are being hospitalized due to severe breathing issues.
Walter Rosenfeld, MD, chair of Pediatrics at Goryeb Children’s Hospital and medical director of Children’s Health for Atlantic Health System, discusses which children are at the highest risk, how you can take care of your kids, and the differences between RSV, COVID and the flu.
New Jersey Family: Cases of RSV seem to be appearing earlier this year and in higher numbers. Is there an explanation?
Dr. Rosenfeld: Almost all children will develop RSV infection before the age of 2. But it is true that this year we are seeing higher numbers earlier in the year. Many of the experts in immunology and infectious disease think that because of the isolation that was necessary due to the COVID pandemic with people masking and staying separated from one another, there is a greater pool of people who are what we call “immune naïve.” They’ve not seen this virus and other viruses for the past few years and so they are highly susceptible to getting it now.
NJF: What symptoms should parents watch out for in their children?
Dr. Rosenfeld: RSV is a virus that can cause the same symptoms we associate with the common cold in older children and adults. Symptoms include a runny nose, coughing, sneezing and fever. However, young infants, especially less than 2 years old, are prone to an inflammatory condition of the lungs, called bronchiolitis and may present quite differently. They often have irritability, seeming more tired than usual, wheezing and breathing problems. Some also progress to pneumonia. . Most children do well with mild symptoms but this year we’ve seen a steep rise in the number of children with more severe problems, sometimes requiring hospitalization.
NJF: Is there a certain age or category of children that RSV affects more?
Dr. Rosenfeld: Infants up until about 5 years of age are the most susceptible with as many as 80,000 in that age group being hospitalized for RSV each year. Children who have complex medical conditions, and those with prematurity, a history of chronic respiratory disease, neuromuscular disorders, and those where their immune system is compromised, such as a child being treated for cancer on chemotherapy, are more likely to be sick.
NJF: At what point should you consult your pediatrician or go to the ER?
Dr. Rosenfeld: Children with mild illness should stay home and rest. For some children, the illness begins with mild symptoms and becomes more severe over several days. When a parent has a question about their child being more seriously ill, we definitely want to see them. If a child is not getting better, is having trouble breathing, or is not taking fluids or food, they should call their pediatrician or come to the emergency room..
NJF: How is RSV diagnosed?
Dr. Rosenfeld: A nasal swab is typically used to diagnose RSV. We test for RSV on children who need hospitalization, but there really is no reason for testing a child who has mild illness.
NJF: What is the treatment for RSV?
Dr. Rosenfeld: Antibiotics and corticosteroids are only used in more complicated situations and will not be of use with straightforward RSV. Getting plenty of fluids, taking ibuprofen or acetaminophen and rest is what we suggest. For a young infant, expect them to be a little bit more tired. Treating the milder symptoms of RSV is similar to the way you’d treat a cold. If a child is sick enough to require hospitalization, usually that means that supplemental oxygen and intravenous fluids are needed.
NJF: If your child is feeling sick, how long does it take for them to recover?
Dr. Rosenfeld: It takes at least five to seven days for the symptoms to subside, with most children back to good health within 1-2 weeks. While a child is symptomatic, they should not be exposed to others. I encourage people to mask if they have symptoms when they’re out in public. All of the guidelines we learned during the Covid-19 pandemic hold true for this as well, where good handwashing, masking and social distancing can be very helpful.
NJF: What are the differences between RSV and other illnesses such as COVID or the flu?
Dr. Rosenfeld: Influenza can start the same way as RSV: runny nose, nasal congestion, feeling like you are achy all over and low-grade fever. Right now we are seeing few cases of COVID in children, but it can also present with some of the same findings. Also, children can have more than one infection with overlap in symptoms, so if there is a question that will influence treatment, laboratory testing will be helpful.
NJF: Do you have any other advice for parents?
Dr. Rosenfeld: It’s understandable that parents who are worried about their children may get alarmed by all of this. We have placed a number of important educational resources on our website atlantichealth.org that we hope helps families have a better understanding of RSV and what to look for. In the meantime, parents can help with prevention by washing your hands, keeping your child up to date on their other vaccines (including Tdap, flu and COVID-19), limiting your child’s exposure to crowds, and disinfecting objects and surfaces in your home regularly. If a parent has a question about any of this, general pediatricians and family medicine physicians are a great source of information and counseling.