How Do I Know if My Baby Has RSV?

Cold-like symptoms that last 1-2 weeks

• Cough
• Runny nose
• Sneezing
• Reduced appetite
• Decreased activity or more tired than usual
• Yellow, green, or gray mucus
• Signs of dehydration (lack of tears when crying, little or no urine in their diaper for 6 hours and cool, dry skin)
• Fever (temperature above 100 degrees F)
• Fussiness or irritability

Severe symptoms that require emergency medical care

• Short, shallow, rapid breathing
• Flaring (spreading out) of nostrils with every breath
• Belly breathing (look for a “caving in” of the chest in the form of an upside-down “V” starting under the neck)
• Bluish coloring of the lips, mouth, and fingernails
• Wheezing (this can be a sign of pneumonia or bronchiolitis)
• Poor appetite

The following tests may be conducted in babies with RSV to confirm a diagnosis:

• Testing nasal aspirate: Saline solution is injected into the nose to retrieve a sample with gentle suction. The aspirate is tested for viral particles.
• Swab test: The nose or throat is swabbed to obtain a sample that is then tested for the virus. 
• Blood test: Blood is taken from a vein in the arm using a small needle to be tested for viral antibodies.

Your doctor may only advise these tests if your baby’s symptoms are severe, and hospitalization and antiviral medication may be recommended.

RSV is highly contagious, and it spreads through droplet transmission. When a person with the infection coughs or sneezes, secretions from their respiratory tract containing the virus are released into the air. Following transmission through the nose or eyes, RSV infects the lining of the upper and lower airways. RSV continues to multiply within these cells for about 8 days. 

After the first several days, RSV-infected cells slough into the smaller bronchioles of the lower airways. This sloughing mechanism is also believed to be responsible for the spread of virus from the upper to lower respiratory tract. 

Infection causes generalized inflammation within the lungs, including migration and infiltration of the inflammatory cells (such as monocytes and T-cells), death of the cell wall, edema (swelling), and increased mucus production. Together, the sloughed epithelial cells, mucus plugs, and accumulated immune cells obstruct the lower airways.

Children who attend childcare centers or who have siblings who attend school are at a higher risk of exposure and reinfection. People at an increased risk of severe, or sometimes life-threatening, RSV infections include:

• Infants, especially premature infants or babies who are 6 months or younger
• Children who have congenital heart disease or chronic lung disease
• Children or adults with weakened immune systems from diseases such as cancer or undergoing treatment such as chemotherapy
• Children who have neuromuscular disorders such as muscular dystrophy
• Adults with heart disease or lung disease
• Older adults, especially those age 65 and older

Treatment of uncomplicated RSV infection is supportive in nature, which includes adequate hydration, oxygen supplementation, and additional management of symptoms or comorbid conditions such as bronchiolitis.

Ribavirin is the only effective antiviral agent currently available for the treatment of RSV pneumonia. Ribavirin acts by interfering with the step in the viral reproduction process (transcription). This drug is delivered as a small-particle aerosol.

RSV-specific intravenous immunoglobulin such as palivizumab is a monoclonal antibody (artificially made immune protein) directed against RSV. It has also been used with aerosolized and oral ribavirin in people with a high risk of RSV.

• Nasal saline with gentle suctioning to allow easier breathing and feeding.
• Cool-mist humidifier to help break up the mucus and allow easier breathing.
• Fluids and frequent feedings to make sure your child is staying hydrated. 
  • Infants with a cold may feed more slowly or not feel like eating because they are having trouble breathing. Try to suction the baby’s nose before attempting to breastfeed or bottle-feed. 
  • Supplementation with water or formula is unnecessary for breastfed babies. If it is difficult for the baby to feed at the breast, expressing breastmilk into a cup or bottle may be an option.
• Acetaminophen or ibuprofen (if your baby is older than 6 months) to help with low-grade fevers.