RSV is a common viral infection that effects people of all ages. In older children (older than 2-3 years) and adults, the symptoms look just like a very bad “head cold” with significant runny nose and coughing. There may or may not be fever. RSV is most common between the months of October through April, although it can occur any time of year.
In younger children and infants, RSV can cause a much more serious illness. This is because in older patients the RSV virus stays in the “upper respiratory” area, that is, the nose and throat. In younger infants and children the virus can go on to infect the “lower respiratory” area, that is, the lungs. When this happens the lungs begin to produce large amounts of mucous and this can cause many problems. Often babies with RSV will present with in a manner similar to babies who have asthma, even If they have no asthma history. In these situations they can have wheezing and rapid breathing. They can even progress to having to use extra muscles to help them be able to breathe and this can be seen by muscles pulling in between the ribs or below the rib cage. Babies may develop difficulty feeding or low oxygen levels. There are no medications that we routinely use to treat RSV. It is a virus and there are very few medications that treat viruses. Most care for RSV is supportive care. Infants who are having trouble eating may need to have an IV placed and be admitted to the hospital to receive IV fluid support. Infants with low oxygen levels will be admitted for oxygen support. Sometimes we can try different nebulized medicine to see if these help an infant, but for many infants these medicines may not make a difference. In some instances we will try the same medicine we use in children with asthma, albuterol, and sometimes we try to use something called racemic epinephrine, which can help reduce the inflammation in the lungs and make breathing easier. Unfortunately, often all we can do is support the infant and see what their natural clinical course will be. Some infants will require transfer to a Pediatric Intensive Care Unit for higher levels of oxygen or breathing support.
Premature infants and infants with underlying chronic lung disease from being premature or children with certain types of congenital heart disease represent special populations. These children are at even higher risk than other infants for complications from RSV. These infants may qualify for a medication called Synagis which is given once monthly as an injection. In infants born after 35 weeks and in otherwise healthy infants, Synagis has not been shown to reduce the risk of illness enough to justify its use.
Some infants who have RSV when they are young will go on to have viral-induced wheezing when they colds in the first few years of life. There is no way to predict which infants will go on to have future wheezing, it is something that you and your doctor can monitor in the months following an RSV infection. Luckily, most children who have recurrent wheezing with illness that occurs after an RSV infection will outgrow their wheezing episodes by the age of 5 or 6 years.