12 things parents need to know about RSV

We’re entering the holiday season, which is also, unfortunately, the season of viruses. Namely, RSV season 2023 has officially begun, and heralded by an increase in RSV cases in the southeastern part of the country.

While RSV can present as a mild upper respiratory cold, it can be especially severe for children under 2, babies born prematurely, those with chronic health conditions or weakened immune systems and older adults. Serious cases are marked by a lower respiratory illness, such as bronchiolitis or pneumonia.

Here’s what to look out for and what to do if your child tests positive for RSV.

12 things parents need to know about RSV 2023

1. RSV stands for respiratory syncytial virus

In healthy adults and older kids, RSV usually presents as a common cold. Symptoms may often start out as mild, with just a clear runny nose and reduced appetite for a couple of days, and then progress to cough and wheezing.

Common RSV symptoms in babies and kids

• Clear, runny nose
• Decreased appetite
• Coughing
• Wheezing
• Sneezing

In very young babies, the only symptoms may be decreased activity, irritability and some difficulty breathing. RSV may sometimes present with a fever, but not always. Most healthy people are over the illness in about two weeks, but it can have serious health implications for some infants, especially those who are premature or have other health conditions.

Related: Does breastfeeding protect against RSV?

2.  We’re in the early stages of RSV season 2023

The virus is common in late fall through spring. According to the CDC, in recent years, RSV season has started in mid-September to mid-November, with the season peaking in late December to mid-February, and tapering off in the spring (except in Florida, which has an earlier RSV season onset and longer duration than most states).

3. RSV and other respiratory illnesses were worse last year

While the virus itself doesn’t seem to be more severe, we saw higher case numbers than was typical last year. Experts suggest that during the pandemic, kids who typically would have had more general exposure to RSV in their daily lives and built up some resistance might now be underexposed, leaving a larger subset of the population more vulnerable to RSV infection. This phenomenon is not due to a weakened immune system as a result of public health measures such as lockdowns, masking and social distancing, but those same public health measures intended to slow the spread of Covid also reduced the spread of many common viruses, RSV and flu included.

Recently, CDC experts noted that we could be in for a worse flu season, too, making it a good time to get your flu shot.

Related: Health officials urge pregnant women to get vaccinated against flu, Covid and RSV

4. RSV is super common

According to the Mayo Clinic, most kids will have been infected with RSV by age 2. That doesn’t mean it’s not serious though. RSV can come on like a cold, but because the virus can cause constricted airways, it can make breathing difficult in some. The CDC notes RSV is the most common cause of bronchiolitis and pneumonia in children younger under 12 months old, and it results in 2.1 million outpatient visits in kids under 5 every year.

5. Some babies require hospitalization

More than 58,000 kids under 5 require hospitalization due to RSV each year. Bronchiolitis and pneumonia can of course put a child in the hospital, but RSV doesn’t have to cause either of those for an infant to require round the clock medical treatment. Sometimes a severe RSV infection without those complications means a baby will require hospitalization so that their breathing can be monitored and IV fluids can be administered.

Related: Amy Schumer’s son was hospitalized for RSV: ‘Hardest week of my life’

6. A baby’s chest muscles and skin pulling inward is a sign of severe RSV

If you notice your baby’s skin and chest are pulling in with every breath they take, you should seek medical attention right away. Short, shallow or rapid breathing, coughing, lethargy and not eating as they usually do are also red flags for parents during RSV season.

Severe RSV symptoms in babies

If RSV progresses, the second stage may be marked by more serious symptoms.

• High fever
• Fast breathing rate
• Difficulty breathing
• Persistent cough
• Decreased activity
• Pauses in breathing (apnea)

Be sure to head to the nearest hospital if your child is having trouble breathing or experiencing severe symptoms.

7. There is no medication for RSV

Because it’s a virus and not a bacterial infection, RSV is primarily treated through symptom management. Most cases tend to clear up within a week or two, but the following can be helpful as your child recovers:

• Increased fluids: Be sure to offer plenty of water and fluids to avoid dehydration.
• Extra rest: Encourage your little one to get lots of rest and sleep.
• Managing fever: Talk to your doctor about using appropriate fever-reducing medications that are safe for your child.
• Use a humidifier at night: Because colds often get worse around bedtime, try using a humidifier in your child’s room while they’re sleeping.
• Saline spray: Using saline spray or a mist inhaler can help break up mucus in little noses.

Mom @jordmariee on TikTok shows how much of a game-changer a saline mist inhaler can be for babies and toddlers as nasal sprays can often cause tears.

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8. There is a new RSV vaccine-like product for infants, and a maternal RSV vaccine

There is a new RSV shot for infants available for the first time this fall, the monoclonal antibody therapy Beyfortus (nirsevimab), to be offered to babies going through their first or second RSV season. The approval marks one of the first protections for healthy infants against a virus that can be severe or even life-threatening in babies under 12 months.

The FDA also recently approved Abrysvo, the first vaccine approved for pregnancy to prevent lower respiratory tract disease caused by RSV in babies from birth through 6 months. US health officials urge pregnant women to protect themselves and their developing babies against severe respiratory illnesses. 

Related: Pfizer’s RSV vaccine for pregnancy can protect newborns against severe illness

9. There is another preventative medication for those at the highest risk

Babies who were born prematurely and those who are immunocompromised, have heart defects or other health conditions are sometimes eligible for a monthly injection of Synagis (palivizumab) during peak RSV season to prevent severe RSV. The drug is expensive, and only recommended for when babies meet certain high-risk criteria.

10. RSV is unfortunately very contagious

RSV has a long incubation period—symptoms may not appear for up to three to five days after the initial infection, which is how it’s so easily passed around daycares and schools, and why it’s so contagious.

A child with RSV might be contagious for up to four weeks, even after they stop showing symptoms. If you have multiple children and one has been sick, it’s a good idea to clean shared toys and have them sleep in separate rooms if possible.

11. Prevention is key

If more people were able to stay home when they are sick, RSV transmission could be lowered. If you’re sick and you can take time off, do it. It will help you recover faster and prevent the possible spread of RSV to other families.

Frequent hand-washing, teaching kids to cover coughs and sneezes and wiping down surfaces and shared toys can go along way in preventing the spread.

Related: Is it a cold, flu, Covid or allergies?

12. Protecting your family isn’t bad manners

People love to hug and kiss babies, but when somebody is sick, it’s OK to say “no thanks” to affection for your little one.

It can be tricky to navigate in public when you’re trying to protect your baby and everyone in line at the grocery store wants to squish their cheeks, so some parents are putting it in writing—adding little “do not touch” signs to their carts, carseats, onesies and strollers that let strangers know it’s not OK to touch the little one.

A note from Motherly

RSV can be serious, and as we head into the holidays it’s important to remember that it’s OK to say no to an invitation if you’re not feeling well, or to reschedule if a prospective guest tells you they’ve got a little cold. Sometimes, little colds can turn into big problems for little babies, but if we all work together we can make everyone safer during RSV season.

A version of this story was originally published on Nov. 14,. 2018. It has been updated.