Respiratory syncytial virus (RSV) is one of the most common causes of lung infection in children¹. By the time a child reaches two years old, they will most probably have already been infected. While adults can also become infected, children and infants are usually more commonly infected due to the immaturity of their immune systems.

The sounds of an RSV cough may be similar to the common cold, sounding wet from the mucus. However, in some cases where it can cause severe disease, the RSV cough sound involves labored breathing or wheezing. 

Read on to learn more about respiratory syncytial virus, symptoms to watch out for, and the best treatment for this condition.

RSV Symptoms

Initially, infection with the respiratory syncytial virus may appear like a common cold². The child may have nasal congestion, runny nose, cough, fever, and a sore throat. Irritability, fatigue, and difficulty breathing are possible symptoms in infants. Usually, the symptoms last for just a few days to a week or two. 

However, if the symptoms persist for longer than that or if you observe any of the following symptoms, these may be signs of a potentially more severe infection³:

• High-grade fever
• Worsening cough
• Wheezing
• Barking character of cough
• Labored or rapid breathing
• Irritability
• Bluish lips or fingernails
• Signs of dehydration (e.g. decreased fluid intake, sunken eyeballs, or wetting fewer diapers than usual)

These signs tell us that the infection may have reached the lungs. This is concerning as it can lead to pneumonia or bronchiolitis. In these cases, you should definitely consult your child’s pediatrician. 

Causes of RSV

Respiratory syncytial virus is usually spread through contact with infected fluids from another person⁴. This may happen if they touch a contaminated surface or toy and then touch their eyes, face, or mouth. The virus may also spread if they inhale the droplets from an infected person who sneezes or coughs. It is because of this that outbreaks in daycare and school are very common, as the virus can easily spread in such environments. 

RSV Diagnosis

The symptoms of mild respiratory syncytial virus infection usually mimic that of the common cold. Because of this, and in most cases, your child will not need testing to make the diagnosis⁵. Your doctor will conduct a thorough history and physical examination, also taking into account your child’s age and the time of year. 

When required, the usual tests requested may include a complete blood count or a mouth swab to check for viral infection. For a severe infection requiring hospitalization, additional tests like a chest x-ray or CT scan may be warranted to check for complications of the disease. Urine and blood cultures may also be performed, as urinary tract infections may occur simultaneously with this disease due to the impaired immune system. 

Treatment of RSV

Treatment will depend on your child’s age, symptoms, and overall health status. In mild cases, the best treatment at home is to make your child as comfortable as possible⁶. 

Home Remedies

General measures you can do to hasten your child’s recovery include: 

• Provide plenty of fluids – These can be given in fewer but more frequent amounts if the child is unable to drink a lot at once. 
• Consider a cool mist humidifier – Make sure to clean it regularly to prevent mold and bacterial growth. 
• Use a nasal aspirator or bulb syringe to remove thick nasal fluids if your child is too young to blow their nose – This is especially helpful for younger infants, who are nasal breathers by default. Clearing the airways will also make it easier for them to drink fluids. 
• Reduce fever – Use acetaminophen (paracetamol) for younger children, as well as ibuprofen for children older than 6 months. 

Avoid the following:

• Avoid hot water and steam humidifiers – These can be hazardous and lead to burns⁷.
• Absolutely do not give aspirin to children – This can cause the often-fatal Reye’s syndrome, which causes brain and liver swelling⁸.  

Hospital Treatment

For severe cases needing hospital treatment, treatment is primarily supportive⁹. Management may include:

• Intravenous fluids and electrolytes
• Oxygen support via a mask, nasal cannula, or oxygen tent
• Suctioning of nasal fluids
• Bronchodilators given through a mask or inhaler that will open up the airways
• Tube feeding if the child is unable to suck or tolerate oral feeding
• Mechanical ventilation
• Antiviral medications

Antibiotics are not usually used as they function against bacteria, not viruses.

Regardless of treatment, it is best to have a comprehensive discussion with your physician regarding the most appropriate management. Feel free to ask your doctor any questions you may have regarding the disease, its diagnosis, management, and even future prevention. It is truly difficult to see your child in distress, but taking these steps to educate ourselves will definitely pay off in the long run. 

Risk Factors for RSV

Infants and young children are at greatest risk of respiratory syncytial virus infection¹⁰. An estimated 58,000–80,000 children younger than five years old require hospitalization due to this disease. Specifically, the children we need to watch out for include:

• Premature infants
• Infants younger than six months old
• Children less than two years old with chronic lung disease or congenital heart disease
• Children with compromised immune systems
• Children with neuromuscular conditions with difficulty swallowing or clearing nasal secretions (e.g. cystic fibrosis)

We should keep a closer eye on these children as they are most likely to get sick. By being aware of the signs and symptoms of this disease and knowing who is more likely to get infected, early treatment and the right management can be initiated in a timely manner.

Complications of RSV

While we would want to avoid possible complications of respiratory syncytial virus infection, it is still helpful to know the potential outcomes of this disease¹¹. This includes:

• Pneumonia
• Middle ear infections
• Asthma
• Recurrent infections

These can cause a severe impact on health as well as financial burden down the line. This is why it is important to take note of symptoms early and consult your doctor right away to prevent the development of these complications later on. 

Prevention of RSV

There is no vaccine to combat the respiratory syncytial virus; one is in the works, but it will be some time before it is available to the public¹². Luckily, simple habits like the following can help prevent the spread of this disease¹³:

• Wash hands frequently and thoroughly – Here is a guide on the best way to wash hands
• Avoid exposure by covering your nose and mouth when coughing and sneezing
• Disinfect toys and frequently touched surfaces regularly
• Avoid sharing glasses or utensils with others
• Avoid smoking as this increases the risk of lung disease to everyone who inhales the smoke

The small steps we take everyday can not only promote you and your child’s health, but also the other children they interact with in the school and community. In the bigger scheme of things, prevention will always be better than cure.

Summary

Respiratory syncytial virus infection is a common childhood infection of the lungs. It can manifest with symptoms similar to the common cold including fever, cough, runny nose, and sore throat. While symptoms are expected to last for only a few days to a week or two and may be treated at home, signs of severe infection should be observed. These include difficulty of breathing, flaring of the nostrils, and worsening symptoms. Treatment is generally supportive, with the aim of improving comfort as the child’s immune system battles the virus. 

This disease can be prevented by frequent handwashing, avoiding exposure, and regular disinfection. Consult your doctor if you think your child may be sick with the respiratory syncytial virus.

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Mikaela Millan

Mikaela is a dentistry clinician at the University of the Philippines.