Respiratory syncytial virus (RSV)

10 mins read

A coughing and wheezing baby or child is always a worry, but even more so if your child already has a health condition or complex medical needs. 

RSV (respiratory syncytial virus) is one of the most common viral causes of coughs and colds in winter. It’s highly infectious, and the main cause of breathing difficulties (bronchiolitis) in young children. Most babies and children infected with RSV get mild symptoms of bronchiolitis, but some can become unwell with breathing difficulties and need to be admitted to hospital.

In 2021, doctors predict more children than ever in the UK will contract RSV. Over the past year there have been few respiratory viral infections, other than Covid-19. But right now, rates are unusually high for this time of year. This is because since the easing of Covid restrictions, more people are mixing, and there are many young children who have never been exposed to RSV.

Our health lead Amanda Elliot has compiled the following questions and answers to help you protect your child from the virus, better understand the symptoms of bronchiolitis and know what to do if you baby or child becomes very unwell with breathing difficulties. 

And if you are a parent caring for a child aged 5 and under please join our new baby and toddler email group and get our latest advice to help you and your child stay well this winter.

In this article

What is RSV?

RSV (respiratory syncytial virus) is one of the most common viruses that cause coughs and colds. It circulates widely in the UK in the autumn and winter months, peaking in December. Almost all children are infected with the virus by the time they’re two years old.

RSV may cause a cough or cold in children and adults, but in young children it is the main cause of bronchiolitis. In fact, it’s the most common cause of bronchiolitis in children aged under two. 

Is RSV serious?

Most cases of bronchiolitis are mild, and children recover without treatment within two to three weeks. Some children are more vulnerable to the virus and breathing problems, so it is important to look out for more serious problems.

How does the virus make children ill?

The virus enters the windpipe and makes its way down to the smallest airways in the lungs (bronchioles). The infection causes inflammation or swelling in the small airways and excess mucous.

Swelling can narrow and block the child’s airways so it is harder for them to breathe. Babies and young children have small, underdeveloped airways, so they are more likely to get bronchiolitis. 

What are signs my baby/child has bronchiolitis?  

Early symptoms usually appear a few days after becoming infected and are like a common cold, such as a blocked or runny nose, cough or slightly high temperature. Symptoms can appear worrying and usually get worse between the third and fifth day before gradually improving. Symptoms may include: 

  • Dry, rasping and persistent dry cough.
  • Difficulty feeding.
  • Rapid or noisy breathing (wheeze).
  • Brief pauses in breathing. 
  • Fewer wet nappies and smaller appetite/taking fewer feeds.
  • Vomiting after feeding.
  • Irritability.

Which children are most likely to get very unwell with bronchiolitis? 

Parents need to be especially vigilant if their child or baby:

  • Is under three months old. 
  • Has chronic lung disease, including bronchopulmonary dysplasia.
  • Has significant congenital heart problems.
  • Was born prematurely (under 32 weeks).
  • Has a neuromuscular disorder.
  • Is immunodeficient.

How does the virus spread? 

The virus spreads through coughing and sneezing.  Children can breathe in tiny droplets of liquid in directly from the air or pick it up from an infected surface, like toys or a table. 

Your child can become infected after touching a toy that has the virus on it and then touching their eyes, mouth, or nose. The virus can survive on a surface for up to 24 hours. A child can remain infected with RSV for up to three weeks even after the symptoms have vanished. 

How can I stop my baby or child being infected with RSV in the first place? 

RSV is easily spread, so it’s impossible to completely prevent it. But there are ways to reduce the risk:

  • Wash your and your child’s hand often and ask people in contact with your child to wash their hands first.
  • Use disposable tissues rather than handkerchiefs, and throw them away as soon as they have been used.
  • Cover your child’s nose and mouth when they cough or sneeze.
  • Wash and dry eating utensils after use.
  • Wash or wipe toys and surfaces regularly.
  • Keep infected children at home until their symptoms improve.
  • Keep newborn babies away from people with colds and flu.
  • Never smoke around your child.

My baby/child has an underlying health condition. Will they be admitted to hospital if they develop bronchiolitis? 

Some children with bronchiolitis need to be admitted to hospital. Babies and children born prematurely (before 37 weeks) are more likely to need to go to hospital. If you are worried, do not hesitate to contact your GP or call NHS 111. Keep these contact numbers handy.

Doctors will refer your baby or child hospital if they are not getting enough oxygen into their blood because they’re having difficulty breathing, or if they are not eating or drinking enough.  

Once in hospital, your child will be closely monitored and given various treatments, depending on their condition. 

Who should I contact if I am worried about my child’s symptoms? 

See your GP or call NHS 111 if:

  • You’re worried about your child.
  • Your child has taken less than half their usual amount during the last 2 or 3 feeds, or they have had a dry nappy for 12 hours or more.
  • Your child has a persistent high temperature of 38C or above.
  • Your child seems very tired or irritable.

When should I call an ambulance? 

Call an ambulance (999) if: 

  • Your child has severe breathing difficulties or is exhausted from trying to breathe. 
  • You can see the muscles under their ribs sucking in with each breath. 
  • Your child is grunting (making a sound when breathing out) with the effort of trying to breathe.
  • There are long pauses in your child’s breathing.
  • Your child’s lips or tongue are blue.

For more information on breathing difficulties in children and when to call an ambulance, visit the British Lung Foundation website. 

How will doctors treat my child’s bronchiolitis in hospital? 

Babies or children with bronchiolitis will be admitted to hospital if they are not getting enough oxygen into their blood. Most children need to stay there for a few days.

Your child will be able to leave hospital and return home when their condition has stabilised. This will be when they have enough oxygen in their blood without the need medical assistance, and they’re able to take and keep down most of their normal feeds. Nurses will measure your child’s oxygen levels with your child’s using blood pulse oximeter, a small clip or peg that’s attached to your baby’s finger or toe.  

The hospital may also: 

  • Give your child more oxygen through thin tubes in their nose or a mask that goes over their face. 
  • Take a sample of your child’s mucus to test whether RSV is causing the bronchiolitis. If your child has RSV, they’ll need to be kept away from other children in the hospital to stop it spreading. 
  • Give your child fluids or milk through a feeding tube (nasogastric tube), a thin plastic tube that goes into your child’s mouth or nose and down into their stomach. 
  • If your child is at high risk of respiratory failure or cannot use nasogastric fluids, they may be given fluids directly into a vein (intravenously). 
  • Nasal suction is not routinely used in children with bronchiolitis. But it may be recommended if your child’s nose is blocked and they’re having trouble breathing. A small plastic tube will be inserted into your child’s nostrils to suck out the mucus. 

What medications prevent or treat RSV and bronchiolitis? 

There’s no medicine that can kill the virus that causes bronchiolitis, but there are a few things you can do at home to ease mild symptoms and make your child more comfortable (see the section below on how to care for your child at home). 

Most children get better within two-three weeks, while some will still have symptoms after four weeks.  A small number of children will have severe infection and need hospital treatment.  

Antibiotics and corticosteroids are not recommended for treating bronchiolitis. 

Are there any other ways to protect my high-risk child? 

Children at high risk of developing severe bronchiolitis may be able to have monthly antibody injections (Palivizumab) during the winter (November to March). Children considered to be at high risk include: 

  • Children born very prematurely.
  • Children born with a heart or lung condition.
  • Children with an immune deficiency (weakened immune system).

The injections may help limit the severity of bronchiolitis if your child becomes infected. But they can be expensive and are not always available on the NHS. Speak to your GP if you think your child has an increased risk of developing severe bronchiolitis.

How should I care for my baby or young child at home if they have bronchiolitis? 

These care tips can help ease your baby or child’s symptoms. Do not hesitate to contact your GP or out-of-hours service if their condition worsens. 

  • Check on your child regularly including during the night.
  • Avoid sending your child to nursery or childcare until the symptoms have gone – RSV is very infectious.
  • Avoid smoking in the house and anywhere near your child.
  • Keep your child upright. It may make it easier for them to breathe and feed.
  • Try giving babies smaller breast or bottle feeds more often.
  • Supplement breast or bottle feeds with water or diluted fruit juice to prevent them becoming dehydrated.
  • If your child has a high temperature (fever) use paracetamol or ibuprofen, depending on their age.
  • Use saline (salt water) nose drops, available from pharmacies without prescription, before a feed to relieve a blocked nose.

Is it safe to give my baby/child paracetamol and ibuprofen to reduce fever? 

Babies and children can be given paracetamol to treat pain or fever if they’re over two months old. You can give ibuprofen to babies aged three months or over who weigh at least 5kg (11lbs).

Always follow the manufacturer’s instructions. Do not give aspirin to children under the age of 16. Do not try to reduce your child’s high temperature by sponging them with cold water or underdressing them.