Published on July 15, 2021

RSV: The New Old Kid on the Block

child holding parent's hand

Respiratory Syncytial Virus (RSV) is typically seen in the fall and winter with disease activity almost gone by April.

However, during this past winter, the incidence remained very low—most likely because people were masking and social distancing to combat COVID-19, which like RSV, is spread through respiratory droplets (coughing and sneezing) and through direct contact with contaminated surfaces.

Since we have relaxed public health measures for COVID-19, RSV is now presenting with this atypical time circulation pattern, particularly in southern states. The Centers for Disease Control have issued a health advisory to this effect.

Respiratory Syncytial Virus is an RNA virus, which is the most common cause of bronchiolitis (inflammation of the smaller lung airways) and pneumonia in children under a year old. Infants under 6 months old, especially preemies, children with heart conditions, children and older adults who are immunocompromised and those with chronic medical conditions are at risk for severe disease.

If your child is in day care or has been exposed to anyone with cold symptoms, suspect RSV as the possible cause of your child’s cold symptoms—which may include cough, nasal congestion, runny nose, fever, fussiness and poor feeding. Symptoms may or may not progress to bronchiolitis or pneumonia, which manifest as rapid breathing, nostril flaring, grunting, tugging between ribs and lower neck when breathing, belly breathing, wheezing or apnea (stopping breathing), particularly in newborns.

Course of Illness

Symptoms are at their worst on Days 2-5 of illness. Fortunately, almost all kids recover on their own. High risk groups mentioned above are more prone to being hospitalized or even die from RSV. Symptoms occur within about a week from exposure and an infected person is contagious for three to eight days. Cough may linger for two to three weeks.

Diagnosis and Treatment

Pediatricians will obtain medical history and perform a physical exam as well as a nasal swab test. If there are lung symptoms, a chest X-ray is usually done. Your pediatrician will check your child’s oxygen saturation using a pulse oximeter; this will let your doctor know how severe the disease is and whether your child needs to be hospitalized.

There is no definite cure for RSV. Mild to moderate symptoms are treated with nasal saline and gentle nose suctioning; use of a cool mist humidifier; and keeping well hydrated. Acetaminophen or Ibuprofen can be given to reduce fever.

About 3% of RSV cases require hospitalization—including those children who require oxygen and IV fluids and those who may need care in a Pediatric Intensive Care Unit.


  • Wash hands with soap and water for 20 seconds.
  • Limit crowd exposure and keep children out of day care and away from other kids if they have obvious cold symptoms, especially if they test positive for RSV.
  • Teach older children to cover their coughs and sneezes.
  • Disinfect objects and surfaces in your home frequently and avoid tobacco exposure.
  • Mask and social distance if you have respiratory symptoms.

Typically seen in the fall and winter, RSV is on the rise this summer, especially in the South.