What does beginning stages of RSV look like?

RSV, or respiratory syncytial virus, is a common respiratory virus that usually causes mild, cold-like symptoms. However, RSV can be serious, especially for infants and older adults. The beginning stages of RSV often look like a common cold with symptoms like runny nose, cough, and fever. However, RSV symptoms can rapidly progress to breathing difficulties like wheezing, rapid breathing, and decreased appetite. Knowing the early signs of RSV can help parents seek medical care quickly for infants.

What are the first symptoms of RSV?

The very first symptoms of RSV often resemble a mild cold. Early symptoms may include:

  • Runny nose
  • Congestion
  • Sneezing
  • Cough
  • Sore throat
  • Mild fever under 101°F (38.3°C)
  • Decreased appetite

These early symptoms of RSV tend to be mild at first. However, RSV can rapidly progress to lower respiratory infection within 1-2 days. Parents of young infants should closely monitor even mild cold symptoms, as they can quickly worsen with RSV.

How rapidly do RSV symptoms progress?

RSV symptoms tend to worsen very rapidly. Early mild RSV symptoms will usually intensify over the course of 1-3 days. The cough often becomes more persistent and severe. Breathing may become rapid and shallow. Symptoms often peak within 3-5 days.

RSV symptoms in infants can progress very quickly from sniffles to significant breathing difficulties. Seek medical attention right away if an infant has any trouble breathing. Call 911 if an infant’s breathing efforts become very rapid, if they are breathing shallowly, or if the skin around nostrils, mouth or ribs pulls in with breathing.

What are other early signs of RSV?

In addition to cold-like symptoms, other early signs of RSV may include:

  • Decreased appetite – Infants may nurse or eat less than normal.
  • Fussiness or irritability – Young infants may become more irritable or restless.
  • Tiredness or fatigue – RSV makes infants more tired or sluggish.
  • Wheezing – A whistling noise may be heard when breathing out.
  • Crackly cough – The cough may sound wet or gurgly.

These signs indicate RSV is affecting breathing. Seek medical advice if an infant exhibits these other symptoms along with congestion, cough, and fever. Call 911 if breathing becomes very rapid, shallow, or struggles for air.

What is the incubation period for RSV?

The incubation period for RSV refers to the time between exposure to the virus and when the first symptoms appear. For RSV, the incubation period ranges from 2-8 days. However, most people will develop symptoms 4-6 days after getting infected.

So if an infant is exposed to RSV, symptoms like runny nose and cough would usually show up within 4-6 days. However, some infants may develop symptoms as soon as 2 days or as long as 8 days after exposure. This wide incubation period makes RSV hard to control.

Knowing about the 2-8 day incubation period is useful for parents. If an infant develops early cold symptoms within 2-8 days after contact with a sick person, they are more likely to have RSV versus a common cold.

How long do RSV symptoms last?

In otherwise healthy infants, RSV symptoms usually last about 1-2 weeks. The most severe symptoms tend to occur around day 3-5, then gradually improve. However, cough often lingers for up to 3-4 weeks.

Premature infants, those under 6 months, and infants with lung disease or heart disease may have more severe and prolonged RSV illness lasting over 2-3 weeks.

Adults tend to recover faster than infants. RSV symptoms in healthy adults usually clear up within 1-2 weeks. However, RSV can lead to exacerbations of asthma or COPD that may require several weeks to fully recover.

When to seek medical care

While RSV often causes mild cold-like symptoms, it can lead to pneumonia or bronchiolitis. Parents should contact the doctor if an infant under 3 months old develops possible RSV symptoms. Seek medical care right away if infants have any of the following:

  • Difficult, rapid, or wheezy breathing
  • Nostrils flaring with breathing
  • Skin tugging in around ribs with breathing
  • Blue tinged lips or skin
  • Dehydration – no wet diapers for 8+ hours
  • Inconsolable irritability or lethargy

Adults should contact their doctor if RSV symptoms worsen, especially people with heart or lung disease. Get emergency care for any trouble breathing, persistent chest pain, or bluish lips.

How can parents help soothe early RSV symptoms?

While there is no medication that specifically treats RSV, parents can help soothe an infant’s early symptoms:

  • Use saline drops and gentle suctioning to unclog a stuffy nose
  • Run a cool mist vaporizer to loosen congestion
  • Keep infant hydrated with frequent feeding
  • Hold infant upright with some head elevation to ease breathing
  • Gently suction out thick nasal secretions
  • Give acetaminophen or ibuprofen for fevers over 100.4°F (38°C)

Make sure to contact the doctor if symptoms worsen or breathing becomes difficult. Home remedies do not treat RSV, but can provide some comfort.

How is RSV diagnosed?

Doctors can use several methods to diagnose RSV:

  • Rapid RSV test – A nasal swab is taken and tested for RSV. Results are available in 1-2 days.
  • Chest x-ray – Can show bronchial thickening and inflammation consistent with RSV.
  • Complete blood count – RSV often causes a high white blood cell count.
  • Viral culture – Takes 3-5 days but confirms RSV by growing the virus in a lab.

RSV testing helps doctors rule out other viruses and bacteria. Tests can confirm RSV infection so appropriate treatment can begin.

Rapid RSV Tests

Rapid RSV tests are the most common method used to diagnose RSV. A nasal swab is taken by inserting a long Q-tip into the nasal passage and rotating it. The sample is then tested for RSV using an immunoassay. Results are available within 1-2 days.

Rapid RSV tests have a sensitivity of 80-90%, meaning they correctly identify RSV infection 80-90% of the time. Rapid RSV tests are fast, inexpensive, and fairly accurate for diagnosing RSV.

Chest X-Rays

Chest x-rays are not used to definitively diagnose RSV. However, they can support an RSV diagnosis. RSV infection often causes inflammation and thickening of the bronchial tubes, which may show up on a chest x-ray. Chest congestion and pneumonia related to RSV can also appear.

However, many respiratory conditions can cause similar x-ray findings. So chest x-rays give helpful supportive information but do not confirm RSV.

Complete Blood Count

A complete blood count measures different types of blood cells. With RSV, doctors often see a high white blood cell count, indicating infection and inflammation. There may also be anemia or low red blood cell count.

Again, a complete blood count cannot definitively diagnose RSV. But certain patterns of blood cell abnormalities can provide helpful supporting evidence of RSV.

Viral Culture

Viral cultures involve taking a nasal swab specimen and growing the virus in a lab over 3-5 days. RSV can be confirmed by seeing growth of the virus. Viral cultures are accurate for diagnosing RSV. However, the process takes too long to help guide initial treatment decisions.

In summary, rapid RSV tests provide a quick, fairly accurate way for doctors to diagnose RSV infection. Other testing methods like chest x-rays and blood work act as supplemental information.

What treatments are available for RSV?

Unfortunately, there are no medications that specifically target the RSV virus. Treatment focuses on managing symptoms:

  • Oxygen – For significant breathing troubles, oxygen is given through a nasal cannula or face mask.
  • Fluids – Infants may need intravenous fluids if they are too sick to hydrate orally.
  • Suctioning – Nasal suctioning helps remove mucus plugs obstructing breathing.
  • Bronchodilators – Albuterol nebulizer treatments can help relax airways.
  • Steroids – Oral steroids like prednisolone may reduce inflammation.
  • Antibiotics – Given for suspected secondary bacterial infections.

The above treatments focus on supporting breathing, hydration, and controlling symptoms. Most infants fully recover within 1-2 weeks with supportive medical care.


Ribavirin is an anti-viral drug sometimes used for RSV. It can be given orally, by inhalation, or intravenously. Some data suggests ribavirin may shorten duration of RSV symptoms. However, its benefits are controversial.

Ribavirin also has risks of side effects like bronchospasm. It’s very expensive. As a result, ribavirin is not routinely used for RSV. It may occasionally be given to immunocompromised patients.

RSV Immunoglobulin

RSV immunoglobulin is an antibody treatment made from donated human blood. It can help neutralize RSV virus particles. RSV immunoglobulin is given as a monthly injection during RSV season to help prevent severe RSV infections. It is only used in high-risk infants.

For regular infants with acute RSV infections, RSV immunoglobulin infusion does not provide significant benefit. It’s generally not used to treat active RSV illness in otherwise healthy infants.

In summary, no antiviral medications effectively treat RSV. Supportive treatments, close monitoring, and immunoprophylaxis in high-risk infants remain the standard of care. Development of new antiviral medications for RSV is an active area of research.

How can RSV be prevented?

There is no vaccine currently available for RSV. However, some prevention measures can help reduce risk:

  • Wash hands frequently
  • Disinfect surfaces like cribs, toys, and countertops
  • Avoid close contact with sick individuals
  • Breastfeed infants to pass along protective antibodies
  • RSV immunoglobulin injections for high-risk infants

Good hygiene like handwashing, disinfecting surfaces, and avoiding sick contacts are the main methods for preventing RSV infection. Researchers are working to develop RSV vaccines, but none are ready for clinical use yet.


Frequent handwashing with warm water and soap can help protect against RSV. The virus is easily transmitted through contact with contaminated hands. Make sure to wash hands before touching infants.

Alcohol based hand sanitizers are only partially effective against RSV. They should not replace thorough handwashing. Keeping hands clean is one of the most effective everyday ways to prevent viral spread.

Surface Disinfection

RSV virus particles can live on surfaces like countertops, cribs, and toys for many hours. Regular cleaning of surfaces with soap, followed by disinfection, helps inactivate viruses.

Many common disinfectants like Lysol or bleach solutions work well against RSV. Focus on disinfecting frequently touched baby items like crib railings, bottle nipples, and toys.

Avoid Sick Contacts

RSV spreads readily through direct contact with respiratory droplets from coughing or sneezing. Avoid close interactions with people showing signs of respiratory illness. This can help reduce exposure opportunities.

If contact cannot be avoided, wearing a face mask offers some protection. Sick individuals should practice frequent handwashing, cover coughs, and ideally wear a mask around infants.

RSV Immunoglobulin

Monthly RSV immunoglobulin injections are recommended during RSV season for infants at highest risk. This includes infants born prematurely, those under 12 months with chronic lung disease, or infants with hemodynamically significant heart disease.

RSV immunoglobulin contains protective antibodies that help prevent severe RSV infections requiring hospitalization. Immunoprophylaxis is administered monthly for vulnerable infants during peak RSV season in their community.

What is the long-term outlook for RSV?

Most otherwise healthy infants fully recover from RSV within 1-2 weeks without long term effects. However, research shows early RSV illnesses may influence respiratory health later in childhood.

Association With Asthma

Several studies show a correlation between severe RSV infection in infancy and developing asthma later in childhood. Based on this data, an early RSV illness may increase future asthma risks.

However, it’s unclear whether RSV directly causes asthma. A genetic predisposition toward asthma and allergies may simply make some infants more vulnerable to severe RSV simultaneously. More research is needed to better understand connections between early RSV infection, lung function, and asthma risk.

Association With Allergies

Along with asthma, some research indicates RSV in infancy may be linked to developing allergic conditions like eczema or allergic rhinitis later in childhood. The relationship is likely complex, involving genetics, immune function, and respiratory infections.

More study is required to determine whether RSV illness plays a direct role in allergy development. Or if infants predisposed toward allergies also experience worse RSV infections.

Reinfections With RSV

Recovering from RSV infection does not confer long-term immunity. Reinfections occur throughout life. However, later RSV illnesses usually cause milder cold-like symptoms compared to the severity often seen in infancy.

Adults can get RSV multiple times. But healthy adults will typically experience mild to moderate cold symptoms that resolve on their own. Reinforcement with new RSV strains tends to prevent severe lower respiratory infection in older children and adults.

In summary, RSV infections early in infancy may influence future respiratory health. But additional research is needed to better understand these complex relationships between RSV, asthma, allergies, and the developing immune system.


RSV causes cold-like symptoms that can rapidly worsen into lower respiratory infection. Watch for early symptoms like congestion, cough, and fever in infants, and monitor carefully for any breathing struggles. Call a doctor for evaluation if symptoms persist beyond a few days or if breathing becomes labored.

RSV spreads easily in childcare settings and often causes outbreaks during fall and winter months. Good hygiene measures help reduce transmission. No RSV vaccine is currently available, but research continues to find ways of preventing this common childhood infection.

While severe RSV most often affects infants, it can also create problems like pneumonia or COPD exacerbations in older adults. RSV remains an important cause of respiratory infections across the lifespan. Increased awareness of early symptoms and at-risk groups can help prompt appropriate monitoring and treatment when needed.

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