So, your little one is under the weather. Maybe they’re fussier than normal, not sleeping well or eating less than they should be. Symptoms like a fever, coughing, sleep issues and a decreased appetite can be caused by a variety of conditions. But if your child’s symptoms seem to appear in phases – rather than all at once – it may be that they’re being caused by the respiratory syncytial virus, or RSV.

Keep reading to learn about possible symptoms of RSV in babies and kids, when to see a doctor, and how to treat mild, moderate and severe symptoms.

RSV is a common seasonal respiratory virus, but it can be serious for young kids

RSV generally appears in the fall and winter, and it has recently started to show up in early summer. It mostly causes cold-like symptoms that last less than a week, and it doesn’t typically require medical treatment. Most people fully recover within 1-2 weeks. However, RSV can be more serious for certain groups, especially babies and young children.

A telltale sign of RSV in kids is how the symptoms appear

If your baby or young child has RSV, symptoms will generally appear 2-8 days after exposure to a sick person. You can sometimes distinguish it from other cold and flu-like conditions by how the symptoms appear: RSV symptoms may appear in phases, while symptoms of other conditions often show up all at once.

Signs of RSV in babies include irritability, poor feeding and more

Babies can’t tell us they’re not feeling good with their words, so we have to look for it in their behavior. Some of the RSV signs to watch for include:

  • Fever
  • Increased irritability
  • Pauses in breathing (apnea)
  • Poor feeding due to decreased appetite
  • Unusual fatigue
  • Noisy breathing

Because babies' immune systems are so new, they haven't developed the strength or immunity to fight off many illnesses. For that reason, infants under 6 months old are at a much higher risk for experiencing a more severe case of RSV. Immunizations and healthy habits can help prevent severe RSV in babies.

Other common RSV symptoms in babies and young children

Babies and young children with RSV generally experience similar symptoms – children are simply able to communicate more of them. The full list of possible RSV symptoms in children includes:

  • Cough
  • Decreased appetite
  • Fatigue
  • Fever
  • Headache
  • Runny nose
  • Sneezing
  • Sore throat
  • Wheezing

Signs of severe RSV in babies and young children

According to the Centers for Disease Control and Prevention (CDC), RSV is the number one cause of bronchiolitis and pneumonia in children under age 1 in the U.S.

If your child is sick, watch for signs of severe RSV and seek medical attention right away if you notice any of the following:

  • Difficulty breathing, such as short, shallow or rapid breaths
  • Noticeable pulling in of the chest wall and stomach to breathe (chest retractions)
  • Nostrils flaring or head bobbing with each breath
  • Short pauses in breathing (apnea)
  • Wheezing (a high-pitched sound during inhales can be a sign of bronchiolitis or pneumonia)
  • Decreased activity or alertness
  • Severe cough
  • Bluish coloring of the skin, lips or fingernails

Treating mild to moderate RSV in babies and kids

Most children with a mild or moderate case of RSV recover on their own within a week or two. And while there is no treatment to cure RSV, there are home remedies that can help relieve symptoms and keep your child more comfortable while they recover:

  • Keep your child well hydrated. If you have a baby under 12 months old, talk to their doctor before giving them water.
  • If your child’s doctor approves, give your child over-the-counter pain medication like ibuprofen or acetaminophen as needed to reduce their fever. Follow the doctor’s recommendations, and never give aspirin to children, as it can lead to a condition called Reye’s syndrome.
  • To help babies breathe easier, use a bulb syringe to remove mucus from their nose.
  • Ask your child’s pediatrician if you can safely use saline nasal drops or spray to help loosen a stuffy nose.
  • Try using steam to improve breathing. To ease dry or stuffy breathing passages, your child's doctor may recommend using a cool mist humidifier in their bedroom at night. If you don't have a humidifier, you can turn on a hot shower with the bathroom door closed to create a steam room effect that can make breathing easier.

How long does a child with RSV have to stay home?

Some schools and childcare centers across the country may ask parents for a doctor’s note or a negative test before their child can return after having RSV, but the American Academy of Pediatrics (AAP) does not advise this. In Minnesota, where we serve many of our patients, the AAP Minnesota chapter explains that RSV tests can remain positive for several weeks after infection, so they shouldn’t be used to test whether someone has recovered.

Instead, the AAP recommends following community standard guidelines for returning to school. This includes the child being fever-free for at least 24 hours without the help of fever reducers, having no signs of shortness of breath, and general improvement of symptoms. And like other respiratory illnesses, wearing a mask for a while after returning to a group setting can help prevent transmission to others.

Not sure what your child has or think they have a severe case? Talk with an expert.

When your child is sick, it’s important to know what you can do to help. A diagnosis can help you understand what you can do to relieve their symptoms, how long they need to stay home from daycare or school, and whether there are treatments available to help them get better, faster.

If your child has symptoms of severe illness, contact your pediatric clinic as soon as possible. Your child's care team can guide you toward the best next steps based on your child's symptoms. If you call during business hours, they may advise you to make a same-day appointment or visit your local urgent care. If it's after business hours and your child is having trouble breathing, take them to an emergency room for immediate care.