Respiratory syncytial virus (RSV) in babies and children

Every winter, hundreds of viruses cause coughs and colds in people of all ages. One of the most common culprits is a virus called respiratory syncytial virus – or RSV. Most people recover from an RSV infection within a week or two. But the virus can be more serious for some, particularly certain children and babies under a year old.      
 

What is RSV?

Sometimes called, human orthopneumovirus, RSV causes infection of the lungs and respiratory tract. It belongs to the same family of viruses as the human parainfluenza viruses (these also cause respiratory infections but – despite their name – they aren’t related to the influenza, or flu, virus) as well as the mumps and measles viruses.
 

Is RSV a coronavirus? 

 
While RSV and COVID-19 are both respiratory illnesses with some overlapping symptoms, they are not caused by the same virus. RSV is more prevalent in children than adults, unlike Coronavirus, where adults experience the worse symptoms in infected cases.
 

How common is RSV in babies? 

 
According to the UK Health Security Agency more than 60 percent of children have been infected by RSV by the time they reach their first birthday, with more than 80 percent infected by the time they’re two years of age (i).
 
But while it causes a mild respiratory illness in most, RSV is responsible for around 29,000 children and adolescents needing hospital care every year in the UK, along with 83 deaths (the majority in young babies) (ii). RSV can be very serious for elderly people too, with 8,000 dying from the infection every year (ii). It’s not clear, however, how many younger adults are affected by RSV.
 

How does RSV spread?

 
RSV is transmitted from one person to the other much like any other virus that causes coughs and colds – in other words via droplets and secretions containing the virus from contact with an infected person. You can come into contact with the virus when:
 

• An infected person coughs or sneezes and virus droplets get into your eyes, nose or mouth

• You have direct contact with the virus (if you kiss someone who’s infected, for instance)

• You touch a surface that has virus droplets on it and then touch your face before washing your hands

 
The virus can survive on surfaces for around four to seven hours, so you can become infected long after someone sneezes or coughs over a surface or touches a surface with infected hands. Children, for example, can become infected after touching a toy that has the virus on its surface, and then touching their face.
 
According to the Centers for Disease Control and Prevention (CDC) in the US, children are often exposed to and infected with RSV at school, childcare centres and other places rather than in their own home (iii). Then after the initial infection it typically takes three to five days before they will start to experience any symptoms.
 
Most adults and children will be contagious for three to eight days, including a day or two before their symptoms start. Some babies, however, as well as people with weakened immune systems, may still be contagious for up to four weeks after their symptoms stop. Meanwhile RSV isn’t a one-off infection, with repeat infections usually happening throughout life.
 

Is RSV a seasonal virus?

 
While RSV is active throughout the year, there is a distinct season when the virus circulates far more than at other times. This season typically begins in the autumn – usually earlier than the flu season – and runs throughout winter. According to the UK Health Security Agency, the virus is in circulation from October for four to five months and peaks in December (i).
 
During the Covid-19 pandemic, however, the pattern of RSV transmission in the UK changed, with a dramatic decline in the number of cases seen during the winter of 2020-2021. This meant that many children were left without any natural immunity to RSV and other winter viruses, particularly those born during the pandemic when lockdowns and social distancing measures helped to largely stop viruses spreading.
 
Then when the lockdowns and social distancing measures were relaxed towards the latter half of the pandemic, the number      of RSV cases      rose dramatically. Even the seasonal pattern changed during this time, with far higher-than-normal numbers of cases seen during the summer of 2021 – a result of many children not developing any immunity to the virus the previous winter.
 
Again during the autumn of 2022, numbers of children in the UK hospitalised with RSV surged with infections shooting up by more than eight percent during the last week of October (iv).
 

Do most babies recover from RSV?

 
For many people, RSV causes a mild illness that lasts a week or two. But some are more likely than others to develop a more severe infection such as bronchiolitis (inflammation of the small airways in the lung that affects young children) or pneumonia. Those who have the greatest risk of developing a more serious RSV infection include babies and young children, particularly:      
 

• Premature babies

• Babies aged six months or younger

• Children aged two years or younger who have a chronic lung disease or congenital heart disease

• Children who have weakened immune systems

• Children with neuromuscular conditions

 
Some adults have a high risk of developing severe RSV too, including:
 

• Older people aged 65 plus

• People with a weakened immune system

• People with chronic heart or lung disease

 
Meanwhile RSV can also make certain health problems worse. Someone with asthma, for instance, may be at risk of having an asthma attack as a result of having an RSV infection. People with congestive heart failure may also have more severe symptoms if they catch RSV.
 
 

What are the symptoms of RSV?

 
For people who have a mild RSV infection the symptoms are similar to those of the common cold, including sneezing, coughing, wheezing, a runny nose, a reduced appetite and a temperature. In children, RSV can also cause ear infections and croup, which is a common 48-hour condition in babies and young children that causes symptoms such as a barking cough, a hoarse voice, breathing difficulties and – at the start of the illness – cold-like symptoms. Babies aged six months or younger who have RSV may also become irritable and less active, and experience more serious symptoms such as pauses in their breathing for 10 seconds or longer (apnoea).
 
Meanwhile some babies and children develop bronchiolitis as a result of having RSV. This is a common chest infection that affects children under the age of two years. It isn’t, however, the same as bronchitis, which can affect anyone of any age.
 

What are the symptoms of bronchiolitis?

 
Bronchiolitis is caused by a viral infection, with most cases – up to 80 per cent (v) – caused by RSV. According to Patient UK bronchiolitis is the most common lower respiratory infection in the first year of life in the UK, with around a third of babies developing it before they get to their first birthday.
 
Most cases of bronchiolitis are mild but some children will develop more severe symptoms that can be serious, and they may even need to be hospitalized (between two and three per cent of babies with bronchiolitis need hospital care)-+ (v). Early symptoms are similar to those of having a cold – runny nose, sneezing, cough and a temperature, for example – but if a child has bronchiolitis they may go on to develop further symptoms, including:
 

• Fast breathing (up to 80 breaths per minute (vi))

• Wheezing

• Worsening cough

• Irritability

• Difficulties with feeding or eating/drinking

 

When to see your GP

    
 Make an urgent appointment with your GP or call 111 if your baby or child has any of the following:
 

• A cold that’s getting worse

• A very poor appetite, eating much less than normal

• A dry nappy for 12 hours or longer

• A temperature of 38C (babies three months and younger)

• A temperature of 39C (babies older than three months)

 
Also see your GP if your child feels hotter than usual or if they feel sweaty, or if they have become very tired or irritable.
 

When to go to hospital

 
Meanwhile, call 999 for an ambulance or take your child to A&E if they are having difficulties breathing, if there are pauses when they breathe, if their skin, tongue or lips have turned blue, or if they seem floppy and won’t wake up or stay awake.
 

RSV and pneumonia      

RSV is also among the viruses that can cause pneumonia (this can also be caused by bacterial infections, though in young children it’s most commonly caused by a virus). The symptoms of pneumonia can vary from child to child, depending on their age and what’s causing the infection. The most common symptoms are a temperature and rapid breathing, or difficulty in breathing. Other symptoms can include:
 

• Coughing

• Vomiting

• Chest pain

• Abdominal pain

• Lack of activity

• Poor appetite or feeding

 
If you think your baby or child has the symptoms of pneumonia, contact your GP or call 111.
 
Find out more about the signs and symptoms of pneumonia by reading our guide. 
 

How do you treat RSV in babies and children?

    
Since RSV is a virus it can’t be treated with antibiotics. In fact, there is no specific treatment that kills the virus, instead the infection usually clears up itself within a week or two with treatments simply aimed at relieving the symptoms. So most children with RSV can be cared for at home in much the same way as you’d treat them if they had a cold. This means:
 

• Giving them plenty of fluids to prevent dehydration

• Managing pain and a temperature by giving them over-the-counter pain relief medicines such as paracetamol or ibuprofen (choose the correct product for your child’s age and read the dosage instructions carefully, never give aspirin to children)

• Keeping them upright as much as possible to help them breathe more easily (or if their nose is blocked, try using saline (salt water) drops formulated for children)

 
If your child has bronchiolitis the same advice applies. However, if their symptoms become severe they may need hospital treatment – around three in every 100 babies with bronchiolitis are admitted to hospital, with about two in every 100 babies admitted to hospital needing assisted ventilation to help them breathe (vi). Signs that your child’s symptoms are getting worse include:
 

• Breathing more rapidly

• Struggling to breathe

• Not feeding or drinking well

• Looking paler than usual, or even slightly blue

 

How can you treat a child with pneumonia?

 
You may also be able to treat your child at home if they develop pneumonia as a complication of having RSV if their symptoms are mild. Your GP can tell you what you should do to help them recover more quickly, including giving them plenty of fluids and over-the-counter pain medicines to bring down a temperature.
 
They may, however, cough frequently, especially at night. If they find this distressing you can help them by raising the head of their bed or cot at night (place something under their mattress such as a pillow or a rolled-up blanket to make it higher). A warm compress placed on your child’s chest could also help if they have chest pain.
 
However if your child is having breathing difficulties it means they may need help from a doctor or hospital treatment – speak to your GP or call 111 to find out how to get them the help they need.
 
More generally, make sure you don’t smoke around your child (or allow anyone else to do so), as smoking around young children increases their risk of developing a severe RSV infection.
 

Can RSV be prevented?

 
In late 2022 the UK’s Medicines and Healthcare Products Regulatory Agency approved a new treatment that helps protect babies against RSV. Called nirsevimab, the treatment is an antibody injection that provides protection for around six months, with trials showing it’s both effective and safe for use in babies (vii).
 
However the injection isn’t yet available to all babies in the UK as a routine vaccination, as experts are still examining more information on whether or not it prevents babies being admitted to hospital for RSV infection. The injection may also not prevent all RSV infections, just severe infections that require hospital care.
Meanwhile all babies are offered the pneumococcal vaccine, which protects against pneumonia. However this only protects against bacterial pneumonia, rather than the viral pneumonia that’s a potential complication of RSV.
Fortunately there are things you can do yourself to help reduce the chances of RSV affecting your child, including:
 

• Washing your hands and your child’s hands frequently (use soap and water and wash for at least 20 seconds – if soap and water aren’t available you can use an alcohol-based hand sanitiser instead)

• Washing and wiping down toys regularly

• Cleaning and disinfecting surfaces regularly

• Keeping babies aged two months or younger away from anyone who has cold or flu symptoms (this is even more important for babies who were born premature, babies and young children born with a heart or lung condition and babies with weakened immune systems)

• Trying not to touch your face, especially your eyes, nose and mouth if you haven’t just washed your hands

• Using a tissue to cover your mouth or nose if you sneeze or cough, then disposing of the tissue immediately and washing your hands

 
If your child does become infected, it’s a good idea keep them at home until they’ve recovered as this means they’re less likely to pass on the infection to other children.
 
 

How to support your child’s immune system

 
Making sure your child’s immune system is as healthy as possible is important during the autumn and winter months, as RSV is just one of the many viruses they could come into contact with. Having a healthy immune system means their body may be able to cope with viruses and other winter bugs more effectively, including younger children whose immune systems are still developing.
 
Giving them a healthy and balanced diet is one of the best ways to keep your child’s immune system working well, so try to give them at least five portions of fruit and vegetables every day as plant-based foods contain vitamins, minerals and other nutrients their bodies need (including their immune systems). Ask your GP for advice on how to keep your child’s diet healthy if you’re not sure.
 
Many children, however, are fussy eaters and refuse to eat many nutritious foods. If your child is one of them you may want to consider giving them a children’s multivitamin and mineral supplement. Look for a good-quality supplement designed for children that will give them all the important vitamins and minerals their immune system needs. If they don’t like swallowing tablets there are other options, such as effervescent multivitamin and mineral tablets that dissolve in water to make a pleasant-tasting drink, as well as tasty chewable multivitamin and mineral tablets (choose one that’s kind to their teeth).
 
Not sure how to choose a multivitamin for your child? Take a look at our guide to Multivitamins for children to help you decide.
 
Other nutritional supplements may also be helpful, including:
 

Vitamin D 

 
 Children need to get the right amount of vitamin D for their immune systems to work normally. These days, all children from birth to four years old are advised to take a daily vitamin D supplement throughout the year, while those who are four years and older should take it during the autumn and winter months (though there’s a good argument for giving children of any age vitamin D supplements all year round if they don’t spend much time outdoors in the spring and summer months or if they usually wear clothes that cover up most of their skin when they’re outdoors) (viii).
 
A good multivitamin supplement will contain the right amount of vitamin D for your child. Alternatively there are vitamin D supplements available – and if your child doesn’t like taking tablets, you can give them vitamin D drops.
 

Vitamin C  

 
This important vitamin is needed for many body processes. Experts also think  not getting enough vitamin C could weaken a child’s immune system (ix). You can find vitamin C in multivitamin and mineral supplements, but it’s also available as a single supplement.
 

Zinc 

 
 People of all ages need zinc for a healthy immune system, but many of us – including children – may not be getting enough of it in our diets. Foods that contain good levels of zinc include meat, shellfish, legumes, nuts, seeds, dairy foods, eggs and whole grains. If your child doesn’t eat many zinc-rich foods, a supplement may be the answer. Most good-quality multivitamin and mineral supplements will contain a decent level of zinc, but you could also try giving them zinc lozenges (these not only taste nice but you can get them with added vitamin C too).
 

Live bacteria  

 
Keeping your child’s digestive system healthy is important too. That’s because the millions of micro-organisms and bacteria that live in the human digestive system are thought to play a key role in immune response, as well as overall health and fitness. Indeed, experts believe around 80 per cent of immune tissue is found within the digestive tract (x).

Acidophilus and other types of live bacteria are thought to help boost the immune system and reduce the risk of viral infections, with some studies suggesting they may help prevent and relieve symptoms of colds and other infections in adults and children (xi). One study also suggests taking certain types of live bacteria may shorten the length of a cold by almost two days as well as reduce the severity of symptoms (xii).

Food sources of live bacteria include yoghurt, kefir, sauerkraut, miso and tempeh, but nutritional supplements that contain live bacteria are also popular.
 

What else can you do?

 
As well as feeding their immune systems with nutritious foods and supplements, some of the other things that could help keep your child’s resistance to bugs healthy include:
 

• Making sure they get plenty of sleep (read our guide to children’s health: sleep for more details)

• Keeping them moving (regular activity can help keep children’s resistance higher)

• Encouraging play and other fun activities (reducing stress in children could help make them less susceptible to infections)

• Keeping their jabs up to date (if you’re not sure ask your GP if your child is eligible for a flu shot, for example)

 
Meanwhile if your child has a medical condition that might make it harder for them to handle viruses and other bugs, your GP can advise you about other precautions you could take to keep them healthy.
 
 

For more information about children’s health

Find details and information about a range of conditions that can affect children, including a guide to children’s coughs, colds and sore throats, in the children’s health section of our pharmacy health library.

 

References:

1. Available online: https://www.gov.uk/government/publications/respiratory-syncytial-virus-rsv-symptoms-transmission-prevention-treatment/respiratory-syncytial-virus-rsv-symptoms-transmission-prevention-treatment

2. Available online: https://www.cdc.gov/rsv/about/transmission.html

3. Available online: https://www.leicestermercury.co.uk/news/health/urgent-warning-number-kids-hospital-7782876

4. Available online: https://patient.info/doctor/bronchiolitis-pro

5. Available online: https://patient.info/chest-lungs/bronchiolitis-leaflet

6. Available online: https://www.bmj.com/content/379/bmj.o2725

7. Available online: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/

8. Maggini S, Wenzlaff S, Hornig S., Essential role of vitamin C and zinc in child immunity and health. J Int Med Res. Mar-Apr 2010;38(2):386-414. Available online: https://journals.sagepub.com/doi/10.1177/147323001003800203

9. Available online: https://patient.info/news-and-features/how-to-boost-your-immune-system

10. Kang EJ, et al., The effect of probiotics on prevention of common cold: a meta-analysis of randomized controlled trial studies. Korean J Fam Med. (2013 Jan). 34(1):2-10. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560336
    
    Rerksuppaphol S, et al., Randomized controlled trial of probiotics to reduce common cold in schoolchildren. P. (2013 Jan). 54(5):682-7. Available online: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1442-200X.2012.03647.x
    
    Keyer GJ, et al., Probiotic Effects on Cold and Influenza-Like Symptom Incidence and Duration in Children. Pediatrics. (2009 Aug). 124(2):e172-9. Available online: https://pediatrics.aappublications.org/content/124/2/e172

11. de Vrese M, et al., Effect of Lactobacillus Gasseri PA 16/8, Bifidobacterium Longum SP 07/3, B. Bifidum MF 20/5 on Common Cold Episodes: A Double Blind, Randomized, Controlled Trial. Clin Nutr. (2005 Aug). 24(4):481-91. Available online: https://www.clinicalnutritionjournal.com/article/S0261-5614(05)00027-0/fulltext

 

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