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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Respiratory Syncytial Virus (RSV)

RespiratorySyncytialVirus smlRespiratory Syncytial Virus (RSV) is a highly contagious viral infection that tends to occur more frequently during winter and early spring. The virus was discovered in 1956 and is capable of causing a wide variety of illnesses. Older children and adults commonly experience a "bad cold", lasting 1-2 weeks. In babies and toddlers, RSV may produce more severe pulmonary diseases such as bronchiolitis and pneumonia. Premature infants, children with compromised immune systems, as well as those with chronic pulmonary disease or congenital/acquired cardiac disease (such as asthma or cystic fibrosis) are at higher risk.


RSV has an incubation period of 2-8 days. RSV disease is transmitted through respiratory secretions (coughing or sneezing), close contact with infected persons (especially between the first 3-8 days of illness), or contact with contaminated surfaces and objects. RSV infection occurs when infectious particles come into contact with the nose, mouth and eyes or through the inhalation of droplets produced from coughing or sneezing.


Most infants and children with RSV infection, display the symptoms of a bad cold, including:

  • Sore throat
  • Headache
  • Fever
  • Nasal congestion
  • Nasal discharge (runny nose)
  • Coughing

If the infection progresses:
Within 2-3 days, the cough may become worse.
This may result in rapid, more difficult breathing and wheezing on exhalation.
If your child is struggling to breathe, they may find drinking and swallowing difficult.
Due to strained breathing and the resultant lack of oxygen in the bloodstream, you may notice a bluish tinge around your child's mouth and fingertips (cyanosis).
Other signs of breathing difficulties include grunting, flaring of the nostrils, or chest retractions (sucking in of the skin around the ribs and base of the throat).

In more severe cases there may be:
Inflammation of the terminal airways, which restricts airflow and causes wheezing (bronchiolitis); or
Infection of the terminal airways (pneumonia)

Contact your pediatrician immediately if:

Your child is experiencing breathing difficulties (including rapid breathing: 60-80 times per minute)
Has a cough that gets worse over time; or produces yellow, green, or grey mucous
Is younger than 2-3 months and has a fever
Shows signs of dehydration (crying without tears, dry mouth, less frequent urination)
Your infant is unusually irritable or inactive, or refuses to breast or bottle-feed.


RSV infections are generally diagnosed on the basis of a physical examination. Your doctor may suspect RSV infection based on symptoms and during certain times of year when RSV infection is common. In healthy children, it is unnecessary to distinguish between RSV and the common cold. In high-risk children, a number of laboratory tests are available to isolate or detect the virus. Nasal swab tests are a reliable means of detecting RSV antigens. Newer, more accurate, RT-PCR tests can also be done to accurately diagnose the virus.


In otherwise healthy infants and children, RSV infection typically lasts 1-2 weeks. Respiratory symptoms such as wheezing may last a month or more.


There is no medication available to treat the virus itself. Treatment therefore focuses on symptomatic relief. Most babies and children can be treated at home. Give your child small amounts of fluids at frequent intervals to prevent dehydration. Use a bulb syringe to remove sticky nasal fluids. Saline solution can be placed in the nose to ease breathing. A cool-mist vaporizer/humidifier moistens the air and helps with respiration. If your child is older than 1 year, prop them up in bed with an extra pillow. Keeping their head elevated may help them to breathe more easily. If your child has a fever, give them appropriate doses of a non-aspirin based fever reduction medication. If your child is experiencing breathing difficulties, suffers from asthma, or has reactive airways; your doctor may prescribe bronchodilators to help open the airways. This medication is usually given every 4-6 hours.

If the viral infection is severe, hospitalization may be required. Most infants hospitalized for RSV infection are younger than 6 months of age. Treatment may include IV fluids to prevent or treat dehydration, and to ensure that your child has enough fluids and nutrients if they refuse or are unable to eat. Supplemental oxygen may be given to children who are unable to get sufficient oxygen from room air. This is given by placing a tube (nasal cannula) under the nose, or a facemask over the nose and mouth. In infants, an oxygen head box may be used. The aim of treatment is to slowly reduce and discontinue supplemental oxygen. This is done by periodically monitoring the child's blood oxygen levels, when the oxygen is turned off. On rare occasions, RSV infected babies may need a respirator to help them breathe. This involves inserting a breathing tube into the child's mouth and throat. The tube is connected to a ventilator, which breathes for the child at a regular rate. Treatment is discontinued when the child improves.


For high-risk infants and children, preventative therapy is available. Palivizumab (Synagis) is a monoclonal antibody designed to prevent the growth of RSV. Palivizumab is used to prevent infections of the breathing tubes and lungs, caused by viruses such as RSV. Children undergoing preventative treatment receive a Synagis injection once a month during the RSV season.

In general, RSV disease transmission can be reduced through frequent hand washing and by not sharing items such as cups, glasses and eating utensils. Children should avoid touching their face and eyes unnecessarily. Infants should be kept away from anyone who has symptoms of a respiratory illness, even if it is just a slight cold.

It is unnecessary to exclude children with colds or respiratory illness from school or day care, if they are well enough to attend. The disease is usually spread during the early stages of illness before the development of more severe symptoms.

In a hospital setting, strict contact precautions need to be adhered to prevent the transmission of the RSV virus. This includes hand washing and the wearing of gloves, masks and gowns.


Most people's immune systems lose their protective ability a few months after being exposed to RSV. As a result, RSV causes repeated infections throughout life. More than half of all infants will be exposed to the virus by their first birthday. Many will have few or mild symptoms. Approximately 25-40% of babies and young children will experience the signs and symptoms of bronchiolitis and pneumonia. 75, 000-125, 000 infants will require hospitalization for severe RSV infection on an annual basis.

Annual community outbreaks of RSV tend to last for 4-5 months. For unknown reasons, disease patterns tend alternate on an annual basis. For example, a "bad year" (a large number of patients with moderately severe disease) may be followed by a "good year" (fewer patients with milder symptoms).


There is currently no vaccine for RSV. Most children tolerate an RSV infection well, unless they require supplemental oxygen or are at risk for dehydration. Wheezing and respiratory symptoms can often be treated at home, using portable nebulizers. Children commonly respond well to inhaled bronchodilators. With prompt and appropriate treatment, children with more severe respiratory illness caused by RSV infection recover completely with no lasting side effects. Deaths from RSV infection are relatively rare.

There is a greater concern for RSV in premature infants because they lack the necessary maturity and protective antibodies to fight the infection. There is a similar concern for people of all ages with RSV infection with immunodeficiency. There seems to be a connection between RSV bronchiolitis during infancy and recurrent wheezing later in life. It is uncertain whether the RSV virus triggers the wheezing episodes, or whether children prone to asthma are more likely to become ill with RSV exposure during infancy.


RSV is one of the most common diseases of childhood and although incurable, symptoms are generally self-limited to the common cold in most patients. Although the disease may never be eradicated, its scope can be decreased through simple public health measures such as hand washing.

References Respiratory Syncytial Virus Infection (RSV). American Academy of Pediatrics. . Updated May 11, 2013. Accessed January 8, 2014. Infections: Respiratory Syncytial Virus. The Nemours Foundation. . Reviewed September 2012. Accessed January 10, 2014.

Mersch, J. Respiratory Syncytial Virus (RSV) Infection. MedicineNet, Inc. Reviewed March 31, 2010. Accessed January 3, 2014. Respiratory Syncytial Virus. CDC. Reviewed December 2, 2013. Modified December 2, 2013. Accessed January 9, 2014.