Overview

Respiratory syncytial virus (RSV), like any illness, can temporarily disrupt a child’s sleep as symptoms like coughing, wheezing, fever, and general discomfort can lead to frequent middle-of-the-night wakings, trouble falling asleep, and sleep deprivation. Luckily, the symptoms of RSV are normally mild and short-lived, and sleep patterns can quickly return to normal. However, some children may be at risk for more severe symptoms and long-term health consequences, which may have more profound effects on sleep. Sleep is critical for the healthy growth and development of children. Sleep impacts a child’s memory and learning, affects their emotional regulation and behaviour, and supports immune function and physical growth.¹ 

Understanding RSV in children

What is RSV?

RSV is a common respiratory virus, most active in autumn, winter and early spring.² It usually causes mild, cold-like symptoms, and can affect people of all ages. However, babies and children are at increased risk for developing complications and requiring hospitalisation. 

Worldwide, RSV affects about 64 million people and causes 160,000 deaths each year.³ It is so common that most toddlers will have contracted RSV by the time they reach 2 years of age. While RSV can affect anyone, infants and young children are at increased risk for hospitalisation due to lung infection. 

Symptoms of RSV

In most people, RSV causes mild, cold-like symptoms like a runny nose, decreased appetite, cough, and fever. These symptoms are typically resolved in a week or two, but in some cases, RSV may progress to more severe symptoms like wheezing and difficulty breathing. In young infants, symptoms may include irritability, decreased activity, breathing difficulty, and decreased appetite.⁴ RSV can be particularly dangerous for premature babies, babies younger than 6 months of age, children with chronic lung or heart disease, or children with neuromuscular disorders due to their weakened immune systems.⁴ These children are at increased risk of severe illness caused by RSV, such as bronchiolitis and pneumonia. According to the American Academy of Pediatrics, RSV is the leading cause of hospitalisation for babies under 1 year of age.²

How RSV spreads

RSV is most common during the winter and spring seasons. It is spread through droplets released by the cough or sneeze of an infected person. You can also become infected by coming into direct contact with contaminated surfaces, like touching a doorknob with viral particles on it. Once infected, symptoms usually develop in 4-6 days.² 

Impact of RSV on sleep patterns

Cough, wheezing, fever, and other symptoms can directly affect your child’s sleep by waking them up or keeping them up at night or affecting naps. Since babies under 1-year-old can only breathe through their nose, nasal congestion can make it more difficult for them to breathe and will affect their ability to get good quality sleep. Fever or pain may cause your child to become restless, and they may have difficulty falling asleep or have increased night time awakenings due to discomfort or the need for medication. 

When a child’s sleep is impacted due to RSV, there may be a reduction of time spent in the crucial stages of sleep, such as non-REM sleep, which is vital for memory consolidation, physical growth, and immune function, and REM sleep, which supports cognitive and emotional health.⁵ Missing out on these critical sleep stages means that your child will get less deep, restorative sleep which may cause increased daytime fatigue, mood changes, and the need for more naps.

Short-term effects on sleep

Symptoms of RSV last an average of 7-14 days, but symptoms usually peak on days 3-5.² The severity of the sleep disruption may depend upon your child’s symptoms. Of course, if the RSV causes severe symptoms or requires hospitalisation, your child’s sleep issues may last much longer. 

In the short term, sleep deprivation in children can lead to increased daytime fatigue and impaired cognition, such as decreased attention, concentration, and memory, as well as emotional effects like increased irritability and mood swings. Lack of sleep can also cause appetite changes and decreased immune function.⁶ In the short term, a child with RSV may need more assistance to fall or stay asleep or may wake frequently during the night due to cough, congestion, or other symptoms. 

While it’s completely appropriate to provide support to your sick child, this may cause ongoing problems even after symptoms have resolved if they develop new sleep associations, such as requiring a parent to rock them to sleep every night or needing to fall asleep with a bottle. Other children may quickly return to their sleep schedules once they recover.

Potential long-term sleep problems from RSV

Not all children with RSV will experience long-term sleep problems, but those with pre-existing conditions, severe symptoms, or those who require hospitalisation may be at a higher risk. Studies have shown that children who develop bronchiolitis are at higher risk of developing asthma, which can affect the quality of sleep due to increased nighttime coughing, wheezing, and shortness of breath.⁷ Bronchiolitis in infancy has also been linked to the development of long-term wheezing in children, which can last until school-age.⁸ There is also evidence that viral infections early in life may lead to obstructive sleep apnea (OSA).⁹ Ongoing breathing issues can lead to increased anxiety or stress in children, potentially leading to insomnia or other sleep problems. In addition, exposure to tobacco smoke can worsen breathing problems, lead to severe RSV symptoms, and contribute to long-term complications.¹⁰

Management and prevention of RSV and sleep problems

Prevention of RSV

Prevention of RSV infection includes good hand hygiene, avoidance of sick individuals, especially during the peak viral seasons, and vaccines for at-risk children and adults. Pregnant women can receive an RSV vaccine in pregnancy that provides protective antibodies to the baby after birth, and babies born during RSV season or who are at high risk for complications are eligible to receive a vaccine to prevent severe infection and complications caused by RSV.¹¹ 

Additionally, there is an RSV vaccine available for adults aged 60 and above, which is important for anyone in this age group who may be around your child. Regular medical check-ups for children with severe RSV infections can help manage any developing respiratory issues, thereby mitigating long-term impacts on sleep.

Treatment options for RSV

Mild RSV symptoms should resolve in one to two weeks. Treatment is aimed at alleviating symptoms, through the use of over-the-counter pain and fever reducers, nasal saline, humidifiers, and hydration.

Sleep hygiene practices

When your child is sick, extra comfort may be neccessary to help them sleep. This may lead to new sleep habits, like your child’s dependence on your assistance to sleep. Once symptoms have resolved, you can reinstate your previous sleep routines to get things back on track. Maintain a sleep environment that promotes rest, such as a dark, cool room, and follow safe sleep practices. For infants under one year, always place them on their backs to sleep to reduce the risk of sudden infant death syndrome (SIDS). A consistent bedtime routine, even when unwell, provides comfort and helps reinforce healthy sleep habits.

Summary

RSV is a common respiratory virus that can cause cough, fever, wheezing, and other symptoms. RSV can affect sleep in the short term by disrupting your child’s sleep architecture and reducing their time spent getting restorative sleep. Children may need extra assistance to sleep when they are sick, leading to the development of new sleep associations that may persist even after their symptoms have resolved. Prevention of RSV infection is important to reduce the risk of long-term health consequences that can also adversely affect your child’s sleep. Maintaining good sleep hygiene, even when your child is sick, can help them to transition back to their normal routine once their symptoms have resolved.