T H E  M E D I C I N E  C H E T

RSV Illness in Young Children

RSV, or respiratory syncytial (sin-city-al) virus, is a common, highly contagious seasonal virus that can cause serious respiratory illness in young children. It is a leading cause of serious respiratory illness in children under age 2.

While older children and healthy adults experience minor symptoms and recover within one-two weeks, young infants and very young children can develop bronchial infections and pneumonia. Infants from 2-6 months of age have the highest rates of RSV infection. Premature infants, and those with lung, heart, or immune system problems, are at greatest risk to have serious complications from RSV infection and even death.

Each year, pediatricians begin seeing young children with RSV infection beginning in late fall and lasting through early spring, peaking in January and February. The diagnosis of RSV is usually made through symptoms and time of year.

RSV infections among children lead to more than 125,000 hospitalizations and about 500 deaths in the U.S. annually. Most of those hospitalizations are infants under the age of 6 months.

How It Spreads

RSV is easily spread through contact with nasal and throat secretions from infected persons. It also is spread by sneezing or coughing. RSV can live up to six hours on surfaces such as toys or tables, up to 30 minutes on hands, and for several hours on used tissues.

A child with RSV can be contagious before symptoms appear, and infants with RSV can transmit the virus for up to four weeks. People do not develop full immunity to RSV and reinfection is common. Almost all infants who are in childcare will get RSV during their first year.

Symptoms

Symptoms of RSV in infants and young children usually begin within three-five days of becoming infected. Symptoms mimic the common cold, such as a runny nose and mild cough.

Over the next few days, the symptoms worsen and the child may develop hacking cough, high fever, wheezing, and difficulty breathing. The child experiences these symptoms due to excess mucus production and swelling of the upper and lower airways. Most children recover within one-two weeks.

Currently, there is no vaccine or specific treatment available for RSV. For children with mild cases of RSV, there is no indicated treatment other than using acetaminophen to reduce fever.

Complications

Unfortunately, up to 50 percent of RSV-infected infants and young children will develop pneumonia or bronchiolitis, an inflammation of the bronchial tubes. Some may require hospitalization for oxygen therapy or mechanical ventilation.

A preventive medication called palivizumab (brand name Synagis®) is sometimes given monthly by injection during peak RSV months to premature and certain high-risk infants and young children. Palivizumab prevents the serious complications of RSV. It is costly, but usually is covered by health insurance.

Some studies suggest that children with a history of RSV infection have a higher chance of developing asthma. Asthma is a chronic disease often with recurring episodes of coughing, wheezing, and difficulty breathing when untreated. Infants or young children with RSV often wheeze in the initial phase of the illness as a result of bronchial inflammation.

However, a single episode of wheezing due to RSV infection does not necessarily indicate asthma or that the child may eventually develop asthma.

Implications in Childcare Settings

Children in early childcare and education settings are at a high risk for transmitting RSV. Here are some tips for preventing the spread of RSV and keeping children healthy:

  • Adults and older children with RSV may be unaware that they are infected, and can transmit RSV to infants and very young children without knowing it. Childcare providers and staff with symptoms of the common cold should avoid coming to work, if at all possible, especially during peak RSV season.
  • Make handwashing routine…and fun! There are many songs or jingles that caregivers can use to encourage handwashing in the childcare setting. For example, teach the Henry the Hand theme song, which can be downloaded at www.henrythehand.com.
  • Clean and disinfect toys and all surfaces daily and between uses by different children. Dispose of tissues used to clean children’s noses in closed containers. Avoid sharing of cups, glasses, and utensils.
  • Since RSV is most contagious in the early stages of the infection, excluding children (not infants) with colds or other respiratory illnesses (without fever) who are well enough to attend childcare settings will probably not decrease the transmission of RSV.

However, any adult or school-age child with cold symptoms should be kept away from infants until their symptoms pass. The incubation period for RSV infection is about four-six days.

The American Academy of Pediatrics recommends that “high-risk” infants--those born prior to 32 week gestation, those with chronic lung disease, and those born prematurely between 32-35 weeks who attend childcare--should not attend childcare during RSV season whenever feasible. In addition, infants should never be exposed to tobacco smoke, whether they are high risk or not.

Talk to parents if RSV has been diagnosed in your childcare setting. Share your written policy for excluding children with illnesses. If you suspect a child is sick, suggest that the child see a pediatrician or other health provider. Explain to parents the importance of proper handwashing and hygiene at home, and stress the importance of eliminating exposure to tobacco smoke.

All infants more than 6 months of age and their in- and out-of-home caregivers should receive an annual flu vaccine. Vaccination against the flu by caregivers, children, and parents, reduces the chance of influenza spreading in your early care and education program. Encourage parents to talk to their health care providers about annual flu vaccination for their infant or young child, and themselves.

Elaine Abrams, RN,
Certified Health Education Specialist and Public Health Educator, Statford, CT


Resources

American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098; 847-434-4000; www.aap.org

Internet Resources

Centers for Disease Control National Center for Infectious Diseases Respiratory and Enteric Viruses, www.cdc.gov/ncidod/dvrd/revb/respiratory/rsvfeat.htm

New York State Department of Health, fact sheet in English & Spanish, www.health.state.ny.us/nysdoh/communicable_diseases/en/rsv.htm

Wisconsin Department of Health and Family Services, dhfs.wisconsin.gov/communicable/Communicable/factsheets/RespiratoryRSV.htm

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