RSV: When A Cold is Actually Something to Worry About

RSV is a common virus that’s usually harmless. But for some, it can lead to serious complications.

Children and the elderly are especially vulnerable to RSV-related complications.

Medically reviewed in February 2022

Millions of people catch colds each year. For kids, it’s a practically endless cycle, since most will have between six and eight of these upper respiratory infections over the course of 12 months. Sometimes, however, especially among young children, the culprit behind the sniffling and coughing is actually RSV.

Though you may never have heard of it, respiratory syncytial virus (RSV), is a near-universal rite of passage, affecting almost every child before their second birthday. Much like the flu, it’s highly contagious and most active in the fall, winter, and spring in the United States and other parts of the Northern Hemisphere. Cases begin to rise in October or November, peaking in January or February and dwindling by April or May.

“We see a pretty seasonal surge, which is very classic,” says Purva Grover, MD, medical director of the pediatric emergency departments at the Cleveland Clinic in Ohio. “With the winters come a lot of holidays, and with the holidays come a lot of large crowds gathered together.”

Most RSV-infected children experience a simple cold, while otherwise healthy adults with an RSV infection often don’t show any symptoms at all. But for some, the virus can trigger serious complications, including bronchiolitis (inflammation of the lung’s small airways), pneumonia and respiratory failure.

Children and the elderly are especially vulnerable to RSV-related complications. Among children younger than 5 years old, the virus accounts for 57,000 hospitalizations in the U.S. every year. Among older adults, RSV results in more than177,000 hospitalizations and 14,000 deaths annually. 

Isn’t this just a cold?
RSV is one of many viruses that cause the group of upper respiratory-tract symptoms typically associated with the common cold—runny nose, cough, loss of appetite and sometimes fever. It usually lasts a week or two.

“A kid with a runny nose versus a kid with a runny nose and RSV could look no different,” Dr. Grover says. “It doesn’t really matter until they have complications of RSV.”

So, what could happen? RSV can do serious harm if it descends, killing cells that line the lower respiratory tract and triggering a fierce immune response. As immune cells crowd in, the airways can become obstructed. This can result in pneumonia or RSV bronchiolitis—inflammation of the small airways—which is a particular menace to children younger than 2 years old. In extreme cases, lower respiratory tract RSV infection can lead to respiratory failure and the need for mechanical ventilation.

Know the warning signs
When it comes to kids and older people with cold symptoms, Grover says two things especially worry her: respiratory distress and dehydration. These issues could indicate a serious RSV infection.

Early signs of respiratory distress may include wheezing and breathing that is too fast or labored. As the condition worsens, it can lead to more serious symptoms, including:  

  • Flaring nostrils
  • Belly breathing, or sucking in between or below the ribs or at the base of the neck with each breath
  • Pauses in breathing
  • Blue or gray-tinged skin tone, particularly on the lips and tongue
  • Listlessness and reduced alertness

Among infants and toddlers, head bobbing or grunting are other possible warning signs that should not be ignored. Parents should call their pediatrician if their child is having any trouble breathing. If any of these severe symptoms of respiratory distress develop, they should seek immediate medical attention.

Children who wet fewer than two diapers in 24 hours, are lethargic and don’t make tears when they cry are likely dehydrated, Grover says. Such signs also require medical attention—at least a phone call to the doctor.

Who’s at risk for complications?
Aside from age, the risk for RSV complications depend on several factors, including medical history. Premature or low-birth weight infants, especially those born before 29 weeks’ gestation, and babies younger than 6 months old are more vulnerable.

Other high-risk groups include children younger than 2 years old who have chronic lung or heart disease, certain heart defects, those with immune system problems and those with neuromuscular disorders that affect their ability to swallow or cough up phlegm.

Babies who are bottle-fed, exposed to secondhand smoke or have siblings or are around other children at home or in a daycare setting are also at higher risk for a serious RSV infection.  

“Parents who have kids who belong in those special high-risk categories just need to be a little bit more aware,” Grover says.

For people with asthma or another lung condition, such as chronic obstructive pulmonary disease (COPD), RSV can also lead to a flare up of their symptoms and result in respiratory distress. Older people—particularly those with chronic immune, heart or lung problems—are also more vulnerable to the virus. 

How is RSV diagnosed?
Frequently, children and adults who are infected with RSV never know it—they aren’t tested for the virus because they experience cold-like symptoms they ride out at home.

But a doctor can diagnose likely RSV based on typical symptoms and signs. There are also nasal-swab tests. To decide whether or not to test, Grover uses a rule of thumb: if a child with possible RSV requires suctioning of the nose and throat, and if that child is sick enough that hospital admission might be necessary, it’s appropriate to test for both RSV and influenza.

How is RSV infection treated?
There is no specific medication for RSV, according to Grover. Since RSV is a virus, antibiotics won’t help, as these drugs only target and kill bacteria.

RSV treatment consists mainly of supportive care, such as drinking plenty of fluids, taking a non-aspirin pain reliever and using a cool-mist humidifier to help ease congestion and make breathing easier. For babies, more frequent feedings and suctioning their upper airway can also help manage the infection. Remedies used to treat some other respiratory illnesses, including inhaled saline or bronchodilators and steroids, are generally not used to treat RSV.

RSV infections rarely require hospitalization. But in these cases, intravenous fluids, oxygen and respiratory support may be given.

Can RSV be prevented?
RSV typically enters the body through the eyes, mouth or nose, following direct contact with infected saliva or mucus. Droplets containing the virus can be spread through the air when a person coughs or sneezes.

The virus can also survive for 30 minutes or longer on unclean hands and for up to six hours on hard surfaces. Even bedclothes with dried secretions are a possible source of contamination. So, touching commonly used surfaces, like toys, doorknobs or utensils, then touching your or someone else’s hands, eyes, mouth or nose can also spread the infection.

Unlike the seasonal flu, measles or other vaccine-preventable diseases, there are currently no immunizations that help protect against RSV. Some babies at higher risk for severe problems from RSV infection are eligible to receive a protective drug called palivizumab.

For everyone else, proper hand hygiene is often the best way to avoid RSV infection. Steps you can take to help reduce the risk include:

  • Washing your hands well and often with soap and water for at least 20 seconds
  • Not touching any part of your face—including your eyes, nose or mouth—with unwashed hands
  • Keeping surfaces clean and disinfected 
  • Avoiding people with suspected or confirmed infection

Ideally, caregivers should limit the exposure of high-risk children to groups of other children, such as in childcare settings during RSV season. Children should also never be exposed to second and third-hand cigarette smoke.

Article sources open article sources

Stanford Children’s Health. “Common Cold in Children.”
Centers for Disease Control and Prevention. “RSV in Infants and Young Children.” “Respiratory syncytial virus infection: Clinical features and diagnosis.”
Centers for Disease Control and Prevention. “RSV in Older Adults and Adults with Chronic Medical Conditions.”
Centers for Disease Control and Prevention. “Respiratory Syncytial Virus Infection (RSV).” “Bronchiolitis in infants and children: Treatment, outcome, and prevention.” “Acute respiratory distress in children: Emergency evaluation and initial stabilization.”
American Academy of Pediatrics. “RSV: When It's More Than Just a Cold.” “Respiratory syncytial virus infection: Treatment.”
National Library of Medicine. “Respiratory Syncytial Virus Infections.”
NY State Department of Health. “Respiratory Syncytial Virus Infection (RSV).”
Centers for Disease Control and Prevention. “Protect Against Respiratory Syncytial Virus.” “Respiratory syncytial virus infection: Prevention.”

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