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RSV: Three Little Letters Can Mean Big Trouble for Wee Ones

June 08, 2016

By Sam Smith, MD, Surgeon in Chief, Arkansas Children's Hospital

To hear a baby struggling to breathe is one of the worst sounds a parent can hear. It breaks your heart to see your child experiencing troubled breathing; I know it saddens me to see a little one with these issues in clinic.

The telltale signs of breathing difficulty in babies and children – flaring nostrils, the muscles surrounding the ribcage appearing to cave in – can be very unsettling, and could signal respiratory syncytial virus, or RSV.

RSV is a virus that can cause bronchiolitis, an infection that affects a part of the lungs called the bronchioles. These "tubes" in our lungs carry air in and out, and when infected, they can become swollen and can fill with mucus. When this happens, it makes it hard for your child to breathe.

Other symptoms that can accompany breathing trouble include a congested or runny nose, a mild cough, a fever and decreased appetite. If the virus progresses, it can lead to fast or troubled breathing, wheezing or whistling when breathing, a severe cough and trouble eating and drinking. In infants, one of the initial signs of a more severe problem is a pause in breathing that lasts more than 15 or 20 seconds.

If your child is grunting, seems to get tired when breathing, stops breathing or has blue-colored skin, seek medical attention quickly; these are signs of a severe case that would require immediate medical treatment to stop the progression of the virus.

RSV is particularly troublesome in infants with weakened immune systems. The most severe cases that I've seen in our intensive care units are in patients who have already fought hard battles with prematurity, cancer or heart conditions. Parents of babies with any immunity issues should be as careful as possible to protect their child from RSV and other viruses, as their weakened immune systems can lead to a more severe case, oftentimes requiring a hospital stay.

Obviously, this is something parents want to avoid if possible. Like the common cold, RSV is transmitted both through indirect contact with an infected person via a cough or sneeze, or contact with a surface the infected person has touched, and through direct contact like kissing the face of a child infected with RSV.

As is the case with most viruses, the key to prevention is a mix of proper hand hygiene (washing those hands faithfully) and avoiding contact with those who are sick. It's also important for children six months and above, as well as their caretakers, to be vaccinated against the flu. Exposure to cigarette smoke has also been shown to increase a child's likelihood of respiratory problems, so it's important for parents to protect their children from secondhand smoke.

If your child presents the symptoms listed above, and particularly if you have a baby exhibiting these symptoms, call your family care provider. Bronchiolitis, the infection caused by RSV, is typically diagnosed by discussing your child's medical history and by examination.

RSV is usually not a condition that would require extensive care or treatment, and typically passes much like a cold. Keep your eye on your little one's symptoms, and if they continue to worsen and your child is obviously having trouble breathing, it's time to call your doctor.

While RSV isn't typically something for parents to fret over, for a certain population of kiddos with weakened immune symptoms and very young babies, those three little letters could mean big problems.

Sam Smith, MD, is surgeon in chief at Arkansas Children's Hospital and a professor of Surgery at the University of Arkansas for Medical Sciences. He writes a column each week covering a variety of kids' medical concerns. If you have a topic you'd like him to consider addressing, email

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