What You Need to Know about RSV in Babies

Respiratory syncytial virus (RSV) is a common respiratory virus that infects the respiratory tract and causes cold-like symptoms. As a matter of fact, it is so common that many children will catch it before their second birthday.

Who is at risk of RSV infection?

RSV enters the body through the eyes, nose or mouth. It can spread easily through the air when someone with RSV coughs or sneezes nearby, or by touching infected people or contaminated surfaces. Now, you may be wondering if such a contagious virus poses a risk to your baby. For most of us, RSV causes nothing more than a cold that lasts less than a week, but it can be dangerous for some infants and young babies. Those at greatest risk of severe RSV infection include:

• Premature infants
• Infants who are 6 months and younger
• Babies with weakened immune systems
• Babies with congenital heart or chronic lung diseases

How do I know if my baby has RSV?

Symptoms of RSV infection generally begin to appear 4 – 6 days after exposure to the virus and vary depending on the disease severity and age group. It is important to note that while the initial symptoms may appear mild at the onset, the disease can become severe 3 – 5 days into the course of the illness. Early symptoms of RSV include:

• Runny nose
• Low-grade fever
• Cough
• Sore throat
• Headache
• Decrease in appetite

In severe cases, the virus can spread to the lower respiratory tract, causing RSV bronchiolitis (inflammation of the small airways in the lungs) or RSV pneumonia (infection of the lungs). Signs and symptoms may include:

• Fever
• Fatigue
• Severe cough
• Wheezing
• Breathlessness
• Cyanosis (bluish colour of the skin and lips)
• Severe decrease in appetite, with decreased urine output/dry diapers

Infants are most severely affected if infected by RSV. In young infants less than 6 months old, some severe cases may also develop apnoeic episodes – periods during which the baby abnormally stops breathing.

When should I take my baby to the Urgent Care Centre (UCC)?

RSV infections typically go away in a week or two, but during this time if you notice your baby having a blue tint to their lips or fingernails, refusing milk feeds persistently, appearing lethargic, or breathing rapidly, please seek urgent medical attention and go to the UCC immediately.

How is RSV diagnosed?

To diagnose RSV, your baby’s paediatrician will first take a medical history and perform a medical examination, including listening to your baby’s lungs. If necessary, and depending on your baby’s condition, the paediatrician may perform some additional tests, such as:

• Blood tests
• Chest X-ray
• A nose or throat swab

What is the treatment for RSV?

There is no specific medication that treats the virus itself. Management of RSV generally involves supportive and symptomatic care of the baby at home in mild cases:

• Use a bulb syringe to gently clear thick secretions from your baby’s nose.
• Give your baby small amounts of fluids throughout the day to keep him/her well-hydrated.
• Use paracetamol (or ibuprofen as required) to help bring down the fever so your child is more comfortable.

For severe cases where your baby requires hospitalisation, the treatment may include:

• Supplemental humidified oxygen
• Intravenous fluids
• Airway suctioning
• Ventilatory support (e.g. positive pressure ventilation or intubation)

What happens if RSV is left untreated?

For most healthy infants or babies, RSV is similar to the common cold. In some susceptible infants, RSV can lead to complications such as RSV bronchiolitis and RSV pneumonia, which may require hospitalisation.

What are the long-term complications of RSV?

There are concerns that severe RSV infection in the first few years of life may be associated with recurrent wheezing, asthma and impaired lung function.

So how can I protect my baby from RSV?

There is currently no vaccine to prevent RSV infections. In specific high-risk populations, healthcare providers may give monthly injections of an RSV-specific monoclonal antibody (palivizumab) before the onset of RSV season to confer some protection.

Since no vaccine exists for RSV, the only prevention is through lifestyle habits:

• Avoid kissing your baby when you are unwell.
• Wash or sanitise your hands frequently, especially before handling your baby.
• Clean and disinfect hard surfaces.
• Keep your baby away from crowded places.
• Keep your baby away from people suffering from cough and cold symptoms.
• Maintain a healthy diet to help keep your baby’s immune system robust and active.

Commonly asked questions by parents

Q: Can a child with RSV go to school or daycare?

A: RSV is contagious. Do keep your child at home and avoid sending him/her to school or daycare. This will also prevent your child from being co-infected by another viral illness, or acquiring a superimposed bacterial infection.

Q: Can adults pass RSV to children?

A: Yes. Parents and other adults can easily pass RSV to infants and young children. Most children acquire the infection after exposure to infected family members, or from other infected children in school or communal play facilities.

Q: Can parents get RSV from their infected child?

A: Children can certainly transmit the virus to their parents or other family members.

Q: Can my baby get an RSV infection more than once?

A: Previous infection with RSV does not convey persistent immunity and reinfection is common, though the severity of infection tends to decrease with increasing age.