5 RSV Symptoms in Babies Caregivers Should Never Ignore

Prominent during the colder months, respiratory syncytial virus (RSV) can lead to serious complications in babies. Here are five telltale signs that warrant a visit to the doctor.

If you're raising a baby during the fall and winter months, you probably do everything you can to keep your little one healthy. That's partly because colder weather coincides with respiratory syncytial virus (RSV) season. RSV is a virus that mimics a bad cold in toddlers and children, but unlike a cold, it attacks the tiny airways of the lower respiratory system.

In newborns and babies, "the degree of inflammation and mucus production can be substantial," This inflammation and mucus can cause blockage of the smaller airways in the lungs, making it difficult for young infants to breathe," says Alyssa Silver, M.D., an attending physician at Children's Hospital at Montefiore in New York.

Five Serious Signs of RSV in Babies

RSV is much more dangerous in newborns than in older children due to their still-developing airways. In fact, more than 40% of hospitalizations from RSV occur in children under 6 months old, says Jennifer Marshall DNP, FNP-BC, a nurse practitioner at Avista Family Medicine in Erie, Colorado. Even more frightening, the Centers for Disease Control and Prevention (CDC) reports that RSV leads to 58,000 hospitalizations and 100-500 deaths in children under the age of 5 each year.

So how do you know if your little one is infected with RSV? The first step is contacting your doctor for common symptoms like runny nose, cough, fever, and sneezing; they'll be able to diagnose. In the meantime, watch out for these five serious signs of RSV in newborns, which means that the illness might progress. They warrant a trip to a healthcare provider right away.

Retractions and breathing difficulties

Retraction breathing is when a person is not getting enough air, and the area between their ribs and neck appears to sink inward while the person tries to inhale.

Never ignore any signs of breathing difficulty in an infant. This includes very fast breathing, using extra muscles to breathe, pulling at the neck, nostrils flaring in and out, or seeing in between the ribs while breathing—called retractions, says Dr. Silver. These are all signs your baby is struggling to get enough oxygen intake, which is an emergency.

Fewer wet diapers than usual

Any infant who goes more than six or eight hours without a wet diaper should see a physician to ward off dehydration, says Dr. Silver. Unlike other common childhood illnesses, dehydration from RSV isn't caused by high fever or vomiting. Instead, it's a side effect of feeding difficulties caused by the extreme nasal congestion common in RSV sufferers.

Other signs of dehydration in babies include:

  • No tears when your baby cries
  • Dry mouth
  • The fontanelle (soft spot in your baby's head), appears sunken
  • Irritability

Blue tinge around lips and fingernails

According to Dr. Silver, any bluish discoloration of the skin is worrisome. "These are signs that your baby may need oxygen or additional support with breathing and should be seen in the emergency room right away," she warns.

Insufficient oxygen can lead to a condition called central cyanosis, when the body, including lips, mucus membranes, and fingernails, can appear bluish. To treat this, doctors will likely give your child oxygen and, in some cases, may prescribe antibiotics.


Apnea, or a period of time where your baby is not breathing, is critical in an infant under 6 months, says Marshall. Although this is one of the more common—yet terrifying—RSV symptoms in newborns (very young newborns may have pauses in their breathing for more than 20 seconds when they have RSV, according to Dr. Silver), it still should be evaluated promptly.

Apnea is considered a series complication of RSV. According to the American Academy of Pediatrics, 20% of babies younger than 6 months with RSV who require hospitalization will experience apnea. The good news is that apnea appears to be a limited occurrence in premature babies younger than one month and does not tend to reappear in later infections.

Poor feeding

If newborns have RSV, they can become so severely congested that they cannot complete a feeding. "This can progress to the point that babies need either supplementation in their feeding with a nasogastric tube (from their nose to their stomach) or intravenous (IV) fluids," says Dr. Silver.

Monitor their diaper output if you're struggling to feed your baby for more than a few minutes. A lack of wet diapers means they may not receive adequate nutrition, and a visit to the pediatrician is definitely warranted.

My Baby Has RSV—Now What?

What should you do if your infant catches RSV despite your best efforts? "Unfortunately, there is no magic medicine that makes RSV get better faster. The large majority of those with RSV need time and support through this illness," says Dr. Silver.

You can alleviate symptoms with some comfort measures; for example, use a nasal aspirator to ease congestion, encourage hydration, and give over-the-counter medication if a doctor recommends it.

Remember, when in doubt, call your doctor.

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