Introduction
Respiratory syncytial virus (RSV) is an incredibly common virus that infects the respiratory tract. It is spread from person to person via contact with infected saliva, nasal discharge or mucus. Most children will have been infected with RSV by the age of two.
Usually, the virus causes mild symptoms similar to those associated with a cold. Mild cases of RSV can be treated at home using self-care methods to relieve any discomfort. However, in a few cases, RSV can become severe and life-threatening. Severe cases of RSV should be assessed by a healthcare professional.
Understanding and differentiating between the mild common symptoms and the severe RSV symptoms is vital in ensuring the health and well-being of your toddler.
Overview of RSV
Globally, RSV has an annual rate of incidence of 30 million cases in children aged 5 years and below, with severe cases requiring hospitalisation <10%.1 However, complications associated with RSV are the second most frequent cause of death amongst toddlers and infants.2
Outbreaks of RSV are seasonal. In regions with 4 distinct seasons, there is an increase in prevalence around late autumn, winter and early spring when the temperature is generally cooler.1 Whilst in tropical regions cases occur year-round, but with a general increase when there is a lot of rainfall or a drop in temperature.1 Researchers have speculated that the rise in RSV cases during colder and wetter months is due to increased indoor crowding allowing easier viral transmission.1
In the UK, peak transmission occurs during the winter months with approximately 20,000 hospital admissions of infants under 1.2 It is responsible for the vast majority of lower respiratory tract infections in infants and toddlers. Maternal immunoglobulins do not protect against the RSV virus so infants and young children have to develop their immunity against it.1
Common symptoms of RSV in toddlers
Symptoms typically reach their worst between days 3 and 5, but overall symptoms can last about one to two weeks.
Respiratory symptoms
There are a range of symptoms ranging from mild to severe that will affect the respiratory system of your toddler, these include:
- Coughing
- Wheezing: A high-pitched whistling noise upon exhalation. It is caused by inflammation or narrowing of the airways.
- Congested or runny nose
- Rapid or difficulty breathing
Severe respiratory symptoms can affect your child's ability to acquire sufficient oxygen and can lead to hypoxia. Therefore, monitoring your toddler's symptoms and seeking medical advice as needed is vital.
Fever
- Low-grade fever: A temperature slightly higher than normal. Between 37.5 ºC and 38.3 ºC
- High-grade fever: More severe. A consistent temperature above 38 ºC is considered a high-grade fever. A persistent high temperature is dangerous and may result in febrile seizures in your toddler.
Other symptoms
- Irritability
- Tiredness
- Difficulty feeding
When to seek medical attention
It is vital to be aware of any changes in the condition of your toddler and contact the doctor when necessary. You must contact the doctor if you notice:
- That your child is in respiratory distress
- Blue-coloured skin (This is a sign of a lack of oxygen)
- A persistent high-temperature
- Dehydration
- Noticeable changes in cognition (confusion and lack of alertness)
- Symptoms are worsening or not improving after 7 days
Treatments
Mild cases of RSV
For mild cases of RSV, adequate treatment can be provided at home to try and relieve the discomfort caused by the RSV symptoms in your child. Treatments can include:
- Paracetamol or Ibuprofen to reduce the fever
- Nasal saline drops and gentle suctioning to help reduce the congestion caused by the buildup of mucus
- Lots of fluids to prevent your toddler from becoming dehydrated
- Cool mist humidifiers add moisture to the air and help to ease coughing and congestion associated with RSV
Severe cases of RSV
Severe cases of RSV may require hospital interventions. Treatment will depend on the age, health and severity of their condition.3 Treatment can include:
- IV fluids to treat and prevent dehydration
- Supplementary oxygen if your child is not receiving enough oxygen (hypoxia)
- Medicine that opens your airways (bronchodilators), such as salbutamol
- Mechanical ventilation. In very severe cases a ventilation machine can be used to assist with breathing
Future direction
Inhaled NO has been suggested as a future direction to combat the symptoms associated with RSV.4 Studies have demonstrated the antibacterial, antiviral, anti-inflammatory and bronchodilator properties of NO.4
Prevention
Vaccination
Passive immunisation can be achieved via maternal vaccination during pregnancy, whilst active immunisation involves direct immunisation of your child.4 Expectant mothers to children due during the RSV season will be offered the vaccine.
Other methods
Other methods to prevent severe RSV infection include:
- Stay up to date on vaccines
- Wash your hands regularly
- Disinfect and clean the household and toys
- Don’t visit friends or family who are sick
- Limit your child’s exposure to big crowds and lots of children during the RSV season
Conclusion
Young children, including children, are very likely to come into contact with the RSV virus at some point. The virus typically presents itself with cold-like symptoms, such as coughing, congestion and fever. Severe cases can result in difficulty breathing and may require hospital treatment.
At home, treatments aim to relieve the discomfort caused by RSV on your toddler. Treatments include paracetamol or ibuprofen to control the fever, nasal drops to help with congestion, fluid to prevent dehydration and a cool mist humidifier to ease the coughing.
Vaccinations are offered to mothers during their pregnancy if their due date falls within the peak season for RSV infection. Other preventative strategies include regular hand washing, cleaning and disinfecting the home, avoiding large crowds and sick people.
If you are worried about the health of your child, never hesitate to contact a healthcare professional.
FAQs
Q:What is RSV?
A: RSV (respiratory syncytial virus) is a viral infection that affects the respiratory tracts (airways)
Q: Who is at risk of RSV?
A: The most vulnerable groups are infants, young children, the elderly and immunocompromised adults.
Q: Is RSV common?
A: Yes, it is very common. The majority of children will have contracted the virus before their second birthday.
Q: When do the majority of infections take place?
A: In the UK, the peak prevalence of RSV is during the winter months. Global trends indicate cooler temperatures and rainfall are associated with spikes in RSV infection.
Q: What are the common symptoms of RSV?
A: Usually RSV presents with cold-like symptoms, including cough, runny nose, congestion, and fever. Other symptoms include tiredness, irritability and poor feeding/loss of appetite.
Q: What are the symptoms of a severe RSV infection?
A: Difficulty breathing, prolonged high fever, dehydration, changes in cognition (Such as confusion), no improvements in symptoms after a week.
Q: How can I treat RSV?
A: For mild cases of RSV treatment can be provided at home to relieve some of the symptoms. Treatment may include paracetamol or ibuprofen, nasal saline drops, lots of fluids and a cool mist humidifier.
Q: I think my child has a severe case of RSV, what should I do?
A: Please contact a healthcare professional. Your child may require hospital treatment including IV fluids and supplementary oxygen.
Q: What can I do to prevent RSV?
A: Prenatal vaccinations are offered to expectant mothers with the baby due during the peak season of RSV. Avoiding large crowds and sick people is also advised. Washing your hands and cleaning the house regularly may also help minimise the risk of infection.
References
- Kaler J, Hussain A, Patel K, Hernandez T, Ray S. Respiratory syncytial virus: a comprehensive review of transmission, pathophysiology, and manifestation. Cureus. 15(3): e36342. https://doi.org/10.7759/cureus.36342.
- Bardsley M, Morbey RA, Hughes HE, Beck CR, Watson CH, Zhao H, et al. Epidemiology of respiratory syncytial virus in children younger than 5 years in England during the COVID-19 pandemic, measured by laboratory, clinical, and syndromic surveillance: a retrospective observational study. The Lancet. Infectious Diseases. 2023;23(1): 56–66. https://doi.org/10.1016/S1473-3099(22)00525-4.
- Articles. Cedars-Sinai. https://www.cedars-sinai.org/health-library/articles.html [Accessed 13th May 2024].
- Gatt D, Martin I, AlFouzan R, Moraes TJ. Prevention and treatment strategies for respiratory syncytial virus(Rsv). Pathogens. 2023;12(2): 154. https://doi.org/10.3390/pathogens12020154.
