RSV in Babies: Warning Signs and When to Seek Care

What does the evidence show for RSV in babies?

• The youngest infants face the highest stakes with RSV: symptoms in babies under 6 months may show up only as irritability, decreased activity, eating or drinking less, and apnea, pauses in breathing lasting more than 10 seconds, often without any fever at all, which is why appearance and behavior matter as much as temperature. 1
• RSV symptoms usually appear in stages rather than all at once: runny nose, congestion, and reduced appetite typically come first, with cough following 1 to 3 days later, then sneezing, fever, or wheezing, and an illness that looks mild at first can become more severe several days in. 2
• Clear signs of respiratory distress that call for urgent evaluation include grunting with each breath, flaring nostrils, visible retractions where the skin pulls in around the ribs or breastbone, and rapid breathing over 60 breaths per minute; a tired, pale infant with poor air entry is described as a sign of impending respiratory failure needing emergency airway support. 3
• RSV is common enough among the very young that about 2% to 3% of infants under 6 months of age are hospitalized with it every year in the United States, and severe disease shows up even in infants with no underlying health conditions, not only those considered high-risk. 4
• RSV is the leading cause of infant hospitalization in the United States and the most common cause of bronchiolitis and pneumonia in children younger than 1 year old. Severe cases may need extra oxygen, IV fluids for hydration, or, in the most serious cases, a breathing tube and mechanical ventilation. 5

When should I call my provider about RSV in babies?

Grunting with each breath, flaring nostrils, visible retractions (the skin pulling in around the ribs or breastbone with every breath), or a breathing rate over 60 breaths per minute are signs of significant respiratory distress that need emergency evaluation. A bluish or grayish color to the lips, tongue, or nail beds, or a pause in breathing lasting more than 10 seconds, means call emergency services right away. A baby who is not drinking enough fluids, has gone many hours without a wet diaper, or has become unusually hard to wake or limp also needs prompt medical attention, and a very young infant with RSV may show only irritability and decreased activity without ever running a fever. None of these lists replace your own judgment: if this symptom worries you, that on its own is enough reason to check in with your healthcare provider.