Health Notes

The ABCs of RSV

by Dr. Elizabeth Walenz on January 9, 2017

There are three letters in January that can be scary for new parents of an infant – RSV.

RSV stands for Respiratory Syncytial Virus. Why is it so scary? RSV and many other respiratory viruses can cause bronchiolitis, a respiratory illness that can cause difficulty breathing for children under the age of two. The infection plugs up the smaller airways with mucus, making it hard to get air in.

RSV is spread through the air when someone who has the virus coughs or sneezes. They are most contagious during the first few days of illness. The incubation period for RSV is 2 to 8 days. Outbreaks can occur at child care centers and in families. RSV is at its peak during the winter months of January through March.

What are the symptoms of RSV?

Symptoms of RSV start off as a cold with increased nasal congestion or cough for a few days. The symptoms progress after a day or two, with a worsening cough and often wheezing or whistling with breathing. The child may start to breathe more quickly and have difficulty coordinating breathing with drinking from a bottle or breast.

The child may show signs that they’re working harder trying to breathe. They may flare their nostrils or have retractions. Retractions are when the body uses the muscles in their chest or abdomen to help with the work of breathing. It can look like a sucking in of the muscles around the individual ribs, above the sternum or below the rib cage.

What are the dangers of RSV?

With increased work of breathing in a young infant, he can get tired easily, leading to respiratory fatigue. That may require extra respiratory support such as oxygen, in the hospital.

RSV infection in infants can cause apnea or cessation of breathing. With a difficulty of coordination of breathing and drinking, a child can run the risk of dehydration.

Dr. Elizabeth Walenz
Elizabeth Walenz, MD

How should a parent treat a child at home with RSV?

It’s important to thin the mucus. Use saline drops in the nose to help to thin out the mucus to help make it easier for the child to breathe. In children under six months of age, you may also use a bulb syringe to help to remove mucus from the nose.

To use a bulb syringe, parents should expel the air from the bulb before placing the tip in the child’s nostril. Once the tip is in the nostril, the parent should release the bulb which should help to remove the mucus from the nose. A nose frida is also an option. It’s a device where the parent uses their mouth on one end to suck out the mucus from the child’s nose.

It’s also important to keep the air humid. We all have our heat on which makes our houses quite a bit drier. Run a cool mist humidifier in the room your child sleeps in to help to keep the mucus in the nose moist and running.

Prevent dehydration by giving infants clear fluids such as Pedialyte, over milk or formula. I recommend smaller amounts more frequently. A good measure of hydration is urine output. Make sure your child is producing urine or wet diapers at least every 4-6 hours.

What will not help:

  • There are no cough or cold medications recommended for children under the age of 6 years.
  • Antibiotics will not help. RSV is a viral infection and needs to run its course.
  • In the past, we used albuterol to help with the wheezing associated with bronchiolitis. Recent studies show albuterol or steroids do not help with bronchiolitis.

How to prevent RSV:

  • Make sure anyone who wants to hold your child washes their hands well first.
  • Avoid contact with adults or children with cold symptoms.
  • Avoid highly populated areas in the winter time, such as shopping malls or elevators, where there may be increased risk of contact with people with illness.

When to call the doctor:

  • If your child seems to be having a difficulty breathing and has developed retractions.
  • If your child is breathing greater than 40 times per minute
  • If your child is under 3 months of age and develops a fever.
  • If your child is not drinking or showing signs of dehydration including crying without tears, decreased wet diapers or a dry mouth.
  • Your child’s lips appear blue or pale.

If you have any questions or concerns about RSV, talk with your Methodist Physicians Clinic pediatrician.

Dr. Elizabeth Walenz is a pediatrician now seeing patients at
Methodist Physicians Clinic Regency.
Contact Dr. Walenz at
Dr. Elizabeth Walenz


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