All About RSV in Babies: Symptoms, Complications, Management, & Home Care

RSV, or respiratory syncytial virus, is a contagious viral pathogen that can cause illness in humans by infecting the respiratory tract. RSV in newborns and babies is very common, with most babies experiencing at least one bout of RSV by the time they’re two years of age. It is a self-limiting infection that often resolves in a span of one to two weeks in most babies, however, in newborns and other high-risk children, RSV can lead to life-threatening complications that require urgent medical attention. 

RSV in newborns can cause bronchiolitis and pneumonia, two severe complications that lead to labored breathing and reduced oxygen supply. Parents need to be watchful of their baby’s symptoms and make sure the child’s mucus is cleared from time to time to allow easy breathing. Unlike adults and older children, neonates and babies below the age of two cannot clear out their mucus. This makes RSV and other flu-like illnesses a cause for concern. We discuss the symptoms, complications, treatment options, and home care strategies for infant RSV in the upcoming sections. 

how do babies get rsv

What is RSV?

  • RSV is a contagious, mostly airborne virus that infects the respiratory tract and causes a cold-like illness. 
  • The progression of this infection in the upper respiratory tract can end up involving the bronchioles placed lower in the lungs. RSV can also lead to the build-up of fluid and cause pneumonia in vulnerable children. 
  • The virus is one of the prime causes of hospital visits and hospital admissions in newborns and infants, making the disease significant for parents and pediatricians alike. 
  • RSV spreads through contaminated air in poorly ventilated spaces and hospital settings. 
  • The virus infects the superficial epithelial cells in the upper and lower respiratory pathway. This infection often triggers an immune response, causing inflammation while leading to the build-up of mucus and fluid in the tissues. 
  • The virus can enter through the eyes, nose, or mouth of the baby and make its way to the respiratory pathways. 
  • RSV is more prevalent in the cold winter months and during early spring. 
  • Immunocompromised infants, babies with congenital abnormalities, and premature neonates are at high risk of developing severe RSV infections that can lead to bronchiolitis and pneumonia. 

How do Babies Get RSV? 

  • RSV in newborns and babies occurs when they breathe in or come in contact with droplets containing RSV. 
  • The virus can spread from child to child, so it’s important to keep children away from each other in case one of them has the sniffles. 
  • The droplets get into the air when someone coughs or sneezes. These droplets can even contaminate surfaces of objects where the virus can survive for long periods and infect a child that comes in contact. 
  • Babies can infect others for up to one week after they have fallen sick. However, infants with weak immunity continue to transmit the virus for longer durations. 

Symptoms of RSV in Newborns & Babies

  • The symptoms of RSV begin like that of the common cold. In newborns and infants, however, the symptoms become severe due to the lack of flowing mucus and its natural expulsion. 
  • Symptoms often appear between five days to a week after the child’s exposure to the virus. 
  • The most common symptoms of RSV in newborns and babies include: 
    • Fever: RSV is accompanied by high fever often above 100.4 F. Watch out for spikes in body temperature. Rectal temperature is considered for newborns and infants below the age of 3 months. 
    • Fast-paced Breathing: While the breathing rate of infants and newborns is higher than in adults, a sick baby’s breathing will be faster and shallower than the usual pattern. 
    • Dehydration: Illness makes it very easy for babies to get dehydrated. Look for a sunken fontanelle (the soft spot at the top portion of the head) to see if they’re dehydrated. Try frequent feeding, and if the child is over the age of 6 months, hydrating them regularly will go a long way in aiding quick recovery. 
    • Lethargy: The buildup of mucus in the airways and the nose caused by RSV makes it difficult for newborns to breathe. A decrease in oxygen uptake and labored breathing can make babies lethargic and fatigued. 
    • Cough: Both dry and wet cough are common symptoms when your newborn is down with RSV. 
    • Congestion & Wheezing: Wheezing accompanied by cough is a matter of concern. Listen for sounds between each breath to know if your child has wheezing. They're usually heard after exhalation and indicate a build-up of phlegm in the respiratory tract.  
    • Lack of Appetite: Newborns and babies feed poorly when they’re down with RSV. However, ensure the child is fed regularly to prevent dehydration. 
    • Runny nose: A runny nose is another common symptom noted during RSV. Mucus is capable of clogging your child’s nostrils, making it important to clear them out to help the baby breathe better. 
    • Sneezing: Like cold, RSV too, causes sneezing. This is a classic symptom of an upper respiratory tract infection.  
    • Increased Fussing: RSV’s obstruction of the respiratory tract can lead to irritability and increased fussiness in the newborn. 
  • Severe symptoms of the illness include: 
    • Difficulty Breathing: Thick mucus buildup can seriously impede breathing when RSV infects babies. An important sign includes the ribcage getting depressed and curved between breaths. You might also notice the ribcage becoming more visible during breathing - a symptom that indicates the child is expending more effort to breathe by involving the chest muscles. Symptoms such as this demand immediate medical attention. 
    • Severe Cough: A cough that does not resolve despite home care and symptomatic relief indicates a severe infection in the lower respiratory tract. A severe cough requires medication to address and relieve. 
    • Bluish Discoloration in the Extremities: One of the most serious symptoms of RSV in newborns is a bluish color appearing in the nails and the lips of the child, denoting a lack of oxygen. Known as cyanosis, this symptom demands urgent medical attention. 

rsv newborn

Complications of RSV in Babies

  • Severe RSV can lead to a variety of complications in vulnerable children. These complications include: 
    • Asthma: Severe bouts of RSV lead to an increased risk of asthma in babies as they grow older. Repeated occurrences of RSV also increase the risk of developing asthma later in life.  
    • Pneumonia: Fluid build-up in the lungs is often not cleared as easily in infants and young babies due to their still-developing organ systems and immunity. The fluid from inflammation in the respiratory tract can cause considerable discomfort and difficulty in breathing for newborns. 
    • Bronchiolitis: RSV that spreads deep inside the lungs and lower respiratory tract can infect the bronchioles - minute tubes in the lungs. The infection of these tubes can lead to widespread inflammation within them, resulting in labored breathing. 
    • Middle Ear Infection: Known as otitis media, middle ear infections arise from the invasion of the space behind the eardrum by pathogens. Since this space is near the oral and respiratory tract, it is common for the virus to enter this space during RSV infections in newborns. 

Testing for RSV in Newborns & Babies

  • Most commonly, RSV is diagnosed by your child’s doctor by noting their clinical symptoms and by checking for other signs of respiratory infections. 
  • The doctor might perform a nasal swab test to send the sample for an RSV PCR test that detects viral DNA to determine the type of virus. 
  • Chest X-rays and oxygen saturation tests might also be performed to confirm the level of congestion and rule out complications such as pneumonia and bronchiolitis. 
  • RSV antigen tests are also common and involve the detection of the RSV antigen in the nasal fluid. The doctor might perform a swab collection on the baby to test for RSV antigens. 

RSV Treatment in Babies

  • If you’re wondering about how long RSV lasts in babies, the illness often resolves between 1 and 2 weeks following the first symptoms. 
  • The illness is often self-limiting and the child’s body fights it off over time. Most treatments are symptomatic. 
  • Don’t medicate the child out of turn, and consult with your baby’s pediatrician before you give them medications such as Tylenol. Medicating children involves giving them only specific drugs based on their body weight. 
  • In babies that have severe RSV, doctors may choose to give them a few doses of antiviral drugs to help their bodies fight the infection better. 
  • Oxygen therapy might be recommended in cases where breathing is severely obstructed due to pneumonia or bronchiolitis. 
  • Intravenous fluids might also be administered to the baby in case the doctor notices signs of dehydration. If not, they might have to place a feeding tube to ensure the child gets its dose of fluids and nutrition. 
  • RSV is a viral disease that does not respond to antibiotics. Most treatments are restricted to resolving the symptoms until the virus is cleared off by the body’s natural defense mechanisms. 

symptoms of rsv in newborn

Home Remedies for RSV

  • A majority of RSV cases are mild and can be managed at home. 
  • Ensure the baby is hydrated regularly. Feed the baby frequently, and keep track of water intake in case the child is over 6 months old. 
  • Use a bulb syringe to clear mucus from the baby’s nostrils followed by cleaning the bulb syringe thoroughly and sterilizing it before subsequent use. 
  • Using a humidifier can help your baby clear out mucus with ease. While steam humidifiers are commonly suggested, they end up posing scalding risks to the baby. Use cold mist humidifiers for risk-free mucus management instead. 
  • Along with home remedies, also make sure you undertake efforts to prevent RSV infection in your baby by regularly washing hands, cleaning potentially vulnerable surfaces, and by keeping the child away from pollutants such as tobacco smoke. 

While RSV might not be an immediately serious illness, the risk it poses to children and their overall health makes it a disease to watch out for. Stay in touch with your baby’s pediatrician and alert them in case of any severe symptoms to ensure your baby beats the RSV infection without complications.