The most important thing first. According to CDC, RSV usually causes only mild, cold-like symptoms and most cases clear up by themselves; but in young children it can turn into bronchiolitis or pneumonia, and two to three in every hundred babies under three months old are admitted to hospital with RSV each year. What to follow is how your child BREATHES and whether they can still feed.
Recognising it: look at the breathing, do not count the coughs
According to CDC, symptoms usually appear four to six days after infection: a runny nose, a blocked nose, poor appetite, coughing, sneezing, fever, wheezing — and these symptoms usually arrive in stages rather than all at once. A baby who today has nothing more than a runny nose can still be struggling to breathe on day three or four.
- THE YOUNGER THE CHILD, THE FEWER CLEAR SIGNS. According to CDC, in very young babies the only symptom may be irritability, reduced activity and difficulty breathing.
- According to CDC, in babies under six months the signs may include irritability, reduced activity, taking less food and drink, and pauses in breathing — a gap lasting more than ten seconds. CDC also says that many children with RSV have no fever.
- LABOURED BREATHING, according to MedlinePlus: the muscles around the ribs drawing in with each breath the child takes in, the nostrils flaring with each breath, fast breathing, and skin or lips turning blue from lack of oxygen.
- According to NHS, bronchiolitis from RSV makes a child breathe faster, breathe with a wheezing or rattling sound, and feed or eat with difficulty; it is usually at its worst around day three to day five.
Easily confused with other illnesses
- Whooping cough also gives young babies pauses in breathing with almost no coughing — there is a separate article on whooping cough on this site.
- Influenza A, influenza B and pneumonia all have their own articles on this site; for the cough itself, see the articles on a dry cough and a cough with phlegm.
- Fever is not the measure in this illness. A child whose fever has gone while the breathing has got heavier is worse.
What to do straight away
- COUNT THE BREATHS while your child is settled or asleep, and look at the belly below the ribs to see whether it draws in. Write it down by the hour: getting faster means getting worse.
- According to NHS, keep your child upright as much as possible while they are awake, and give them plenty to drink.
- Feed or give food in small amounts more often — a child who is struggling to breathe can only take a little at a time. Count the wet nappies each day and write it down.
- According to NHS, if your child is uncomfortable or fretful you can use children's paracetamol (acetaminophen) for a child over two months old, or ibuprofen for a child over three months old. The dose is for a doctor or pharmacist to decide.
- Note the time your child started breathing fast, and tell whoever examines them whether the child was preterm or full term.
What you must NOT do
- Do NOT wait to see whether the coughing increases. In this illness what changes the decision is the breathing, not the cough.
- According to NHS, do NOT smoke around your child.
- According to NHS, do NOT try to bring a fever down by sponging your child with cool water or taking all their clothes off.
- According to NHS, do NOT give aspirin to a child under 16.
- Do NOT buy antibiotics yourself: according to NHS, bronchiolitis has no specific treatment and usually clears up by itself, and antibiotics do not kill viruses. There is a separate article on antibiotics on this site.
- Do NOT let anyone with a cold or a cough hold your child or kiss their face. According to CDC, kissing the face of a child who has RSV is one route of transmission.
Which children become more severely ill
According to CDC, the children at highest risk of severe illness are: the younger the child the higher the risk, children born preterm, children with chronic lung disease or heart disease, children with a weakened immune system, and children with neuromuscular conditions that make swallowing or clearing secretions difficult. If your child is in this group, your threshold for phoning should be lower. According to CDC, call the doctor if your child is having difficulty breathing, is not drinking enough, or the symptoms are getting worse.
When you must go to hospital
GO TO EMERGENCY CARE or call 115 (the emergency number in Vietnam) NOW — do not wait until morning — if your child has ANY of the following; according to NHS and MedlinePlus this group belongs at emergency level: your child is having difficulty breathing; there are pauses in your child's breathing; the skin, tongue or lips turn blue, grey or dusky; your child has to work to breathe at all — the muscles around the ribs drawing in, the nostrils flaring, breathing very fast; your child is clearly exhausted, drowsy, hard to rouse when called; your child cannot feed at all. — BE SEEN THE SAME DAY, do not wait until tomorrow, if: your child's cold is getting steadily worse; your child is feeding or eating markedly less than usual; your child has had no wet nappy for half a day or more; your child is under six months, was born preterm, or has underlying heart or lung disease and has started breathing fast. — If you are unsure, phone and ask before deciding for yourself.
This is an illness in which a young child who becomes severely ill has to go into hospital: according to CDC, children admitted may need oxygen, fluids by drip when they cannot eat or drink, and mechanical ventilation. None of that can be done at home instead. Y Te Xanh does NOT take on home care for infants and newborns, and is not a substitute for your child's paediatric appointment.
There are two things we can do: a remote consultation by video call so you can decide whether to go in now or wait for the appointment, and a doctor coming to the house to take the history, examine, and say clearly which cases must be admitted. With a sign from the box above, go in first and call afterwards.
The symptoms, the signs in babies under six months, the risk groups, the routes of transmission and the in-hospital treatment above follow the public material of CDC in the United States on RSV. The bronchiolitis section, the worst-day mark and what to do and not to do at home follow NHS; the signs of laboured breathing follow MedlinePlus. This article passes that on and does not replace being examined. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.
Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.
Sources
- CDC — About RSV
- NHS — Bronchiolitis
