RSV Symptoms in Kids: What to Expect From a Childhood RSV Illness

Respiratory syncytial virus or RSV is a common cold virus that’s most active during the winter months. RSV can cause upper respiratory tract infections, like the common cold. But it can also cause more serious illnesses, like bronchiolitis, bronchitis, and pneumonia in adults and children.

Most children only develop a mild illness when they’re sick with RSV. But some children develop more severe symptoms, like trouble breathing and dehydration. 

Babies, especially those born prematurely, and children with underlying heart and lung conditions are at higher risk for developing a severe RSV illness. But even children who develop “mild” RSV illness can feel pretty miserable. Let’s take a look at the most common RSV symptoms in kids and what you can do to help your child feel better.

How can you tell if your child has RSV?

You can often get a sense of whether your child has an RSV infection based on their symptoms. In fact, you’ll find most medical professionals rely on your child’s symptoms and physical exam to diagnose an RSV illness. Quick and readily available RSV tests are relatively new and they’re not always necessary either.

So you can rely on what you see and hear to help you figure out if your child has an RSV illness. The time of year also matters. RSV is most active during winter months. It’s much more likely that your child has RSV if they develop RSV symptoms during the winter.

Also, most children who pick up the RSV virus develop symptoms about 4 to 6 days after exposure. So if your child was around other children with known RSV and then got sick within a few days, it’s likely that they also have an RSV illness.

EXPERT PICKS: WHAT TO READ NEXT

• What is RSV? Our childhood RSV guide breaks down causes, symptoms and treatments.

• Is there a cure for RSV? No, but there are RSV treatments that can ease your child’s symptoms.

• How long does it take for kids to get better? Our experts review how long RSV symptoms last and when you can expect your child to recover.

But what exactly are the symptoms of RSV in kids? It depends on your child’s age. RSV illness looks different in babies, toddlers, and young children. Here’s what to look for.

RSV symptoms in babies

Babies younger than 1 year develop the most severe RSV symptoms because it’s the first time they’re exposed to the RSV virus.

Babies often start off with mild nasal congestion and cough. But symptoms gradually get worse and babies can develop:

• Severe congestion and runny nose

• Dry cough that can keep them from sleeping and eating

• Trouble eating due to congestion and runny nose

• Fast breathing

• Low-grade fever

These symptoms usually are at their worst on days 3 to 5 of an RSV illness. After day 5, symptoms gradually start to get better. 

But babies can develop dehydration during this time because symptoms prevent them from bottle-feeding or nursing. Infants may need treatment for dehydration during the peak of their illness until they feel better and start eating on their own.

Also, about 20% to 30% of infants develop lower respiratory tract infections like bronchiolitis and pneumonia when they get sick with RSV. This can lead to symptoms like:

• Wheezing

• Fast breathing

• Trouble breathing

• Inability to eat because of trouble breathing

• Higher fever

Infants with bronchiolitis or pneumonia caused by RSV often need to be treated in a hospital, especially while symptoms are at their worst. Treatment for RSV includes oxygen and other supports that help children breathe easier. Children may also need treatment for dehydration and help to clear extra mucus so they can breathe and eat comfortably.

RSV symptoms in toddlers

A person gets sick with the RSV virus many times during their lives. But symptoms from RSV illness are less severe each time you get sick with RSV, thanks to your immune system. About 90% of children have been sick with RSV at least once by the time they turn 2. That means most toddlers and preschoolers only develop mild symptoms when they get sick with RSV. 

Children younger than 3 years usually experience:

• Runny nose

• Congestion

• Cough

• Decreased appetite

• Lower energy

Again, these symptoms are usually at their worst on days 3 to 5 of illness and then gradually get better over the next 3 to 5 days. 

Symptoms can make toddlers and preschoolers uncomfortable. But you can usually manage their symptoms at home with over-the-counter (OTC) fever and pain relievers like acetaminophen (Tylenol), ibuprofen (Motrin), and nasal saline. Encouraging them to drink fluids will keep them hydrated, even if they’re not interested in eating. And rest will help them recover from the virus.

Most toddlers and preschoolers don’t need support in a hospital when they are sick with RSV. Children with heart or lung conditions and those with a weakened immune system may develop a more severe RSV illness. These children may need extra support while they are sick. See your child’s primary care provider if your child has a history of one of these conditions and they develop an RSV illness.

RSV symptoms in kids

School-age kids typically develop mild symptoms when they are sick with RSV. In fact, it’s almost impossible to tell the difference between a common cold and RSV illness in children who are over 3 years old. By that point, most children have been sick with RSV at least twice and the immune system is ready to help fight off the virus. 

Older children may develop:

• Runny nose

• Congestion

• Cough

• Sneezing

• Sore throat

• Headache 

Again, symptoms are at their worst on days 3 to 5 of illness. But your child may have such mild symptoms on the days leading up to those 3 days that they might not even notice they are sick. The same is true for the recovery period. They might not even notice mild symptoms as they recover. So they may only “feel” sick for 2 or 3 days. Most children can recover at home with some extra fluids, OTC fever and pain relievers, and rest.

How long should RSV symptoms last?

Symptoms from an RSV illness can last between 7 and 14 days. Again, symptoms usually start off mild and gradually get worse over 48 hours. Symptoms from RSV illness are at their worst between days 3 and 5 of the illness. Then symptoms gradually get better over the next 3 to 5 days. 

Some children recover more quickly than others, especially if they are older or only develop mild symptoms. These children may experience fewer days of illness. 

Other children can take longer to recover, especially if they are younger or have an underlying heart or lung condition. Children who develop severe RSV illness, like pneumonia or bronchiolitis, may also take longer to recover. In fact, it’s not uncommon for a cough from RSV illness to last up to a month in younger children who develop bronchiolitis.

Keep in mind that RSV is contagious. Children can pass the virus to others even if they only have mild symptoms. It’s a good idea to keep your child home until they don’t have a fever and their symptoms are getting better.  

When should you get care if your child has RSV symptoms?

It’s a good idea to see your child’s primary care provider if your child has RSV symptoms and:

• They are younger than 1 year.

• They were born prematurely.

• They have a heart or lung condition or a weakened immune system.

Even if your child only has mild symptoms right now, they are at risk of developing severe RSV illness. So it’s a good idea to work with your child’s primary care provider to make sure your child’s illness isn’t getting worse.

You should also get immediate care if your child develops severe RSV symptoms at any point in their illness. These include:

• Rapid breathing

• Trouble breathing

• Retractions (skin sinking inward between the ribs while breathing)

• Grunting

• Nasal flaring (nostrils moving outwards while breathing)

• Pauses in breathing

• Turning blue around the mouth or fingertips

• Drinking less than normal or refusing to drink at all

• Making less wet diapers than normal

• Increased sleepiness or tiredness

• Irritability

Why trust our experts?

Written by:

Brian Clista, MD

Dr. Clista is a board-certified pediatrician who works in private practice in Pittsburgh, Pennsylvania. He previously served as a National Health Service Corporation Scholar in the inner city of Pittsburgh for 11 years.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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