Respiratory Syncytial Virus (RSV)

What Every Parent Should Know Before Respiratory Season

October is just around the corner.

For many families, that means cooler weather, Halloween costumes, pumpkin patches, school parties, and all the fun that comes with fall.

For pediatricians, October also means something else:

Respiratory virus season.

And if you have a baby or young child in daycare, you probably already know what that means. The runny noses begin. Then the coughs. Then someone sends a message saying, “RSV is going around.”

One virus that has always gotten the attention of parents of babies and young children is RSV—respiratory syncytial virus.

RSV is incredibly common. Most children will have been infected by the time they are 2 years old, and for most children it looks like a fairly ordinary cold. But in young babies, particularly infants, RSV can sometimes move beyond the nose and throat and cause inflammation in the small airways of the lungs.

That inflammation is called bronchiolitis.

And this is where knowing what to watch for can make a big difference.

What actually happens with RSV?

RSV often starts innocently enough.

Your baby may develop:

• A very runny nose

• Nasal congestion

• Sneezing

• A cough

• Decreased appetite

• Fussiness or irritability

• Sometimes a fever

At first, it may look like every other daycare cold—which, honestly, can make it difficult for parents to know what is coming next.

But over the next few days, the virus can begin affecting the smaller airways in the lungs.

These tiny airways are called the bronchioles.

When the bronchioles become inflamed and swollen, there is less room for air to move through them. Mucus can also build up.

That combination can make breathing much harder.

This is what we call bronchiolitis.

And when a baby has to work significantly harder than normal to breathe, we call that respiratory distress.

When is RSV usually the worst?

One of the things I want parents to know about RSV is that the first day of illness does not necessarily tell you how sick your child will become.

RSV symptoms commonly become more significant around days 3–5 of illness.

So you may have a baby who starts with nothing more than a runny nose and then, a couple of days later, you notice:

“Wait. He's breathing really fast.”

Or:

“She's having a harder time eating.”

Or:

“I can see her ribs when she breathes.”

Those changes matter.

A baby who is working harder to breathe is using more energy simply to get air in and out.

And that creates a difficult cycle:

Breathing becomes harder → feeding becomes harder → baby drinks less → baby becomes dehydrated → baby becomes tired → breathing can become even harder.

This is one of the reasons young babies with bronchiolitis sometimes need to be hospitalized.

It isn't simply because they tested positive for RSV.

It is because they are having difficulty breathing, difficulty staying hydrated, or both.

So what can daycare parents actually do?

This is the part I really want parents to know.

You cannot completely prevent your child from encountering RSV.

If your child attends daycare, they are going to be exposed to germs. That's part of being around other children.

But there are things we can do to reduce transmission and recognize problems early.

1. Be thoughtful about hand hygiene

RSV spreads through respiratory secretions such as mucus and saliva and can also spread through contaminated surfaces.

This makes handwashing particularly important in settings where adults are caring for multiple babies.

Wash hands after:

• Wiping a baby's nose

• Wiping drool

• Cleaning up saliva

• Changing diapers

• Coughing or sneezing

• Caring for a child who is sick

And especially before touching another baby.

This sounds simple, but during respiratory season, those simple habits matter.

2. Daycare workers: think about what is touching each baby

This is one of those things that parents—and even adults caring for babies—may not think about.

Imagine a baby drooling all over the shoulder of a caregiver's shirt.

Now imagine another baby being held against that same shoulder.

Respiratory viruses can spread through mucus and saliva, so reducing opportunities for secretions to move from one child to another is important.

For childcare providers, having individual cloths or burp cloths designated for each baby can be one practical way to reduce cross-contamination.

While I would love to create a germ-free daycare, the bigger goal is to be intentional about breaking the chain of transmission wherever we can.

3. Don't share cups, utensils, or pacifiers

Again, easier said than done—especially when you have a toddler who thinks everything belongs in their mouth.

But avoiding shared cups, utensils, and pacifiers can help reduce exposure to saliva and respiratory secretions, particularly when someone in the household is sick.

What if your baby is already sick?

This is where I want parents to shift their focus.

Once your baby has a respiratory virus, the question becomes less:

“Is this RSV?”

and more:

“How is my baby doing?”

A positive RSV test doesn't tell you how sick your child is going to become.

Your baby's breathing, hydration, activity level, and ability to feed are much more important things to watch.

1. Watch how your baby is drinking

Babies with stuffy noses have a surprisingly difficult time eating.

Think about trying to drink through a straw while someone is holding your nose shut.

That's a little bit of what a congested baby is dealing with.

If your baby is having trouble nursing or taking a bottle:

• Clear the nose with saline and gentle suction before feeding.

• Give your baby more breaks while eating.

• Allow extra time to catch their breath.

• Consider smaller, more frequent feeds.

You may find that your baby can't take their normal volume all at once but can manage smaller amounts more frequently.

2. Pay attention to wet diapers

One of the easiest ways to monitor hydration at home is to pay attention to urine output (the wet diapers).

If your baby is drinking significantly less than normal and you notice that wet diapers are becoming less frequent, that is something to take seriously.

Don't wait until your baby has gone an unusually long time without urinating before you start paying attention.

A baby who isn't drinking well deserves a closer look—especially a young infant.

3. Sometimes the nose is the problem

For young babies, congestion can make feeding much harder.

Saline drops followed by gentle suction with a tool like the NoseFrida can help clear mucus before feeding.

You don't need to suction constantly. In fact, too much suctioning can irritate the inside of the nose (causing more inflammation/congestion).

But clearing the nose before a feed can sometimes make the difference between:

“I can't eat!”

and

“Okay, I can manage this.”

4. If your baby can't feed normally, call your pediatrician

Sometimes babies are simply too congested or too tired to breastfeed or take a bottle effectively.

If that happens, don't feel like you have to figure it out alone.

Your pediatrician can help you determine whether your baby is still adequately hydrated and whether the breathing is safe to monitor at home.

For some babies, expressed breast milk or formula may be offered in smaller amounts by an alternative feeding method—but if your baby is struggling to coordinate sucking, swallowing, and breathing, this is something I would want you to discuss with your child's pediatrician rather than trying to force-feed.

The most important thing: watch the breathing

This is the part I wish every parent of a young child knew how to recognize.

Look at your baby—not just the thermometer.

You want to see whether your baby is working harder to breathe.

Signs of respiratory distress can include:

• Breathing rate is much faster than usual

• Ribs pulling inward with each breath (seeing the gaps between ribs more) - we call that retractions

• Flaring of the nostrils

• Grunting

• Head bobbing with breathing in a young infant

• Difficulty feeding because your baby is too short of breath

• Pauses in breathing

• A baby who is becoming unusually sleepy or difficult to wake

• Blue, gray, or pale coloring around the lips or face

These are not “wait and see until tomorrow” symptoms. They are reasons to seek medical evaluation, and severe difficulty breathing, pauses in breathing, or blue/gray coloring warrant emergency care.

And remember:

You know your baby.

If something about their breathing, feeding, or behavior looks significantly different from normal, it is okay to call.

One more way we can protect babies from severe RSV

There is now another important tool parents should know about: RSV immunization.

For babies entering their first RSV season, protection may come from an RSV vaccine given during pregnancy or an RSV antibody given to the baby. Most babies need one or the other, not both. Current 2026–2027 AAP recommendations continue to recommend RSV immunization for infants under 8 months entering their first RSV season who do not already have protection from maternal vaccination, with additional recommendations for certain higher-risk children entering a second season.

If you have a baby or young child and aren't sure whether they should receive RSV protection this season, talk with your pediatrician.

RSV is common. Knowing what to watch for matters.

I don't want parents to walk away from this article terrified of RSV.

Your child will probably get RSV—or one of the many other respiratory viruses circulating through daycare—at some point.

That's childhood.

What I want you to have is a plan.

Know what your child's normal breathing looks like.

Know how much they typically drink.

Pay attention to wet diapers.

Know how to clear a congested nose.

And most importantly, know the difference between a baby who has a miserable cold and a baby who is working too hard to breathe or becoming dehydrated.

Those are the babies I want you to call about.

At Anchor in Tide, I want parents to have somewhere to turn when they're wondering:

“Is this something I can watch at home, or does my baby need to be seen?”

That's one of the reasons I built this practice.

Pediatric care shouldn't be about waiting until your child is sick enough to need an emergency room.

It should be about prevention and follow-up—having a pediatrician who knows your child, knows what is normal for them, and can help you navigate those gray areas before you end up in the middle of a crisis.

Because when your baby is sick, you don't need another number to call.

You need someone who knows your child.

That's the kind of pediatric care I'm building at Anchor in Tide.

This article is for educational purposes and is not a substitute for individualized medical advice. If your child is having difficulty breathing, is not drinking enough, has significantly decreased urine output, is unusually difficult to wake, or you are concerned about their condition, contact your child's pediatrician or seek urgent/emergency medical care as appropriate.