RSV In My Child: Should I Be Concerned?

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I heard that a new virus called R.S.V. is spreading among children. As a parent, should I be worried?

Respiratory syncytial virus, better known as R.S.V., is an upper respiratory illness that’s very common in children. By the age of 2, nearly all children have had it. In most cases the virus causes mild, cold- and flu-like symptoms such as a runny nose, congestion or fever.

But in some children, especially infants, it can lead to more serious complications like pneumonia and bronchiolitis, a condition in which the small airways in the lungs become inflamed. Some 58,000 children under 5 years of age are hospitalized with R.S.V. every year in the United States. For those younger than a year, it’s the No. 1 cause of hospitalizations, said Dr. Ethan Wiener, the chief of pediatric emergency medicine at N.Y.U. Langone Health.

The virus usually circulates in the fall and winter months, peaking in February. But the pandemic disrupted R.S.V.’s usual patterns: This past winter, many hospitals saw almost no cases of R.S.V., as people wore masks and physically distanced from one another during the lockdowns, and the Centers for Disease Control and Prevention reported that positive test results for R.S.V. (as well as influenza and other seasonal infections) reached historically low levels. Once states began to reopen and people eased up on masking and social distancing in the early summer, cases of R.S.V. in infants and toddlers skyrocketed across the country.

At the Children’s Hospital of Philadelphia, doctors began to see a surge in cases in May, which accelerated in the past eight weeks, said Dr. Audrey John, the chief of the hospital’s Division of Pediatric Infectious Diseases. “To put that in perspective, none of the children who were tested for R.S.V. through the winter were positive,” she said. “But in the last couple weeks we’re up to one in four children who are getting tested are positive for R.S.V. That’s a lot of virus out there.”

The spread of R.S.V. appears to have started in the northeast and then spread to other parts of the country, where children’s hospitals in states like Texas, Florida and Louisiana reported seeing spikes in June. The virus is quite contagious and can survive on hard surfaces for many hours. Experts say that it’s much more likely to be transmitted through infected surfaces than SARS-CoV-2, the virus that causes Covid-19.

But experts say that parents of school aged children should not be overly worried. While older children can get infected, severe cases of R.S.V. are mainly a concern for children under 2 years, said Dr. Jennifer Lighter, a pediatric infectious disease specialist and hospital epidemiologist with Hassenfeld Children’s Hospital at N.Y.U. Langone Health. Infants are most at risk, she said, especially those who were born prematurely or have heart, lung or neuromuscular diseases.


Aug. 29, 2021, 12:56 p.m. ET

One way that doctors prevent severe cases of R.S.V. is by giving children who are at high risk a drug called Palivizumab, which is administered through five monthly injections during the winter season. But because of the unusual surge in cases this summer, the American Academy of Pediatrics issued a statement this month calling on pediatricians to consider administering the drug right away to infants who may be eligible for it.

Older children are less likely to get severely sick, but they can still pass the virus to children who are more vulnerable. In general, doctors recommend following common sense precautions like frequent hand washing or sanitizing, avoiding crowded indoor places, and — for children over 2 — wearing masks. Children and adults who have cold or flu symptoms should avoid coming into close contact with babies. And parents should keep their children home from school or day care if they’re sick and experiencing symptoms like a cough, runny nose or sore throat, said Dr. John at the Children’s Hospital of Philadelphia.

“A child who has two out of those three symptoms would be the sort of thing that triggers my concern,” she said. “But if a kid is running around outside and comes in with a runny nose and it goes away quickly, that would not be concerning.”

Dr. John said that keeping a sick child home is partly a matter of social responsibility, since one sick child can inconvenience many other families. “If your kid goes to day care and gets five other kids infected, then those five kids’ parents have to stay home when their kid gets sick,” she said.

There’s a nasal swab test that doctors can do to check for R.S.V. But the American Academy of Pediatrics generally doesn’t recommend routine testing for it in children older than 6 weeks. Parents who are worried about whether their child has R.S.V. or Covid-19, however, can ask their pediatrician if it makes sense to get tested.

R.S.V. in infants and high-risk children requires immediate medical attention. In rare cases, otherwise healthy older children with R.S.V. can become dehydrated and develop breathing problems, which can be a sign of pneumonia. In those cases, you should seek medical help. But in general, experts said, most children fully recover from R.S.V. in one to two weeks at home.

“The vast majority of kids who get R.S.V. are not going to get seriously ill — they’re going to get a cold,” said Dr. Wiener. “In the vast majority of cases, it’s really a matter of keeping the kid comfortable, much as you would with a cold, and watching for any progression of symptoms.”