RSV (respiratory syncytial virus) has no cure or antiviral medication, so treatment focuses on managing symptoms while the virus runs its course. Most cases resolve at home within one to two weeks with basic supportive care: keeping airways clear, staying hydrated, and controlling fever. Severe cases, particularly in young infants and older adults, sometimes require hospital support with supplemental oxygen or IV fluids.
Managing RSV Symptoms at Home
The cornerstone of RSV treatment is comfort care. The virus typically peaks around days four and five, when congestion and coughing are at their worst, then gradually improves. Here’s what actually helps during that stretch.
Clear congestion: For babies who can’t blow their own noses, place one or two drops of saline in each nostril, then use a bulb syringe to gently suction out mucus. Don’t overdo the suctioning, as it can irritate nasal passages and make swelling worse. Sometimes the saline drops alone trigger a sneeze that clears things out. For older children and adults, saline spray and gentle nose-blowing work fine.
Stay hydrated: For infants, breast milk or formula are the best options because they provide both fluids and nutrients. Older children and adults should drink water, broth, or electrolyte solutions frequently. Small, frequent sips work better than large amounts at once, especially if breathing is labored.
Use a cool-mist humidifier: Moist air loosens mucus and soothes irritated airways. Clean the humidifier daily to prevent mold and bacteria buildup.
Control fever: Acetaminophen can be given every four to six hours (up to five doses in 24 hours), dosed by your child’s weight rather than age. Ibuprofen is an option every six to eight hours but should not be given to infants under six months, children with chickenpox, or children who are vomiting or dehydrated. Neither acetaminophen nor ibuprofen should be given to infants younger than eight weeks without guidance from a pediatrician.
Signs That Need Emergency Care
Most children and adults recover from RSV without medical intervention, but the virus can cause serious breathing problems, especially in infants under six months, premature babies, and adults over 65. Watch for these specific warning signs:
- Chest retractions: skin pulling inward between or below the ribs with each breath
- Nasal flaring: nostrils spreading wide open during breathing
- Fast, shallow breathing or pauses in breathing
- Wheezing or noisy breathing that worsens
- Bluish or grayish color on the skin, lips, or fingernails
Any of these signals that the body is struggling to get enough oxygen and warrants an emergency room visit.
What Happens in the Hospital
Hospital treatment for RSV is still supportive, just at a higher intensity. The two main interventions are supplemental oxygen and IV fluids.
When a child’s blood oxygen saturation drops persistently below 90 to 92%, doctors typically start high-flow nasal cannula therapy, which delivers warm, humidified oxygen through small prongs in the nose. This approach helps keep airways open without intubation. It’s discontinued once oxygen levels hold steady above 94%, breathing effort has normalized, and the child can feed adequately again.
If a child isn’t drinking enough to stay hydrated (common when breathing is labored), IV fluids replace what they’re missing. In severe cases where high-flow oxygen isn’t enough, doctors may escalate to CPAP (continuous positive airway pressure) or, rarely, mechanical ventilation. Hospital stays for RSV bronchiolitis typically last a few days, though premature infants or children with underlying heart or lung conditions may need longer.
Preventing RSV Before It Starts
While not a “treatment” in the traditional sense, several newer preventive options can stop severe RSV illness before it happens. These have changed the landscape significantly in the past two years.
Protection for Infants
A preventive antibody called nirsevimab (brand name Beyfortus) is recommended for infants younger than eight months entering their first RSV season, typically October through March in most of the U.S. It’s a single injection, not a vaccine, that gives babies ready-made antibodies against the virus. Babies born during RSV season should ideally receive it within the first week of life, during their birth hospitalization. Babies born outside of RSV season (April through September) get it in October or November, just before the season begins.
The antibody is specifically recommended when the mother did not receive an RSV vaccine during pregnancy, her vaccination status is unknown, or the baby was born within 14 days of the mother’s RSV vaccination (not enough time for antibodies to transfer). Certain higher-risk children between 8 and 19 months, including those with chronic lung disease, severe immune deficiency, cystic fibrosis with lung complications, and American Indian or Alaska Native children, are eligible for protection heading into their second RSV season as well.
Vaccination During Pregnancy
Pregnant women can receive the Abrysvo vaccine between 32 and 36 weeks of pregnancy. The vaccine prompts the mother’s immune system to produce antibodies that cross the placenta and protect the newborn during their most vulnerable first months. Women past 36 weeks and 6 days should not receive the vaccine because there isn’t enough time for antibodies to develop and transfer before delivery. This maternal vaccine and the infant antibody injection are meant to be complementary options, not used together.
Vaccines for Older Adults
RSV isn’t just a childhood illness. It causes tens of thousands of hospitalizations in adults over 60 each year. Three vaccines are now available for older adults. Arexvy reduced RSV-related hospitalizations by 60 to 65% in clinical trials and was first approved for adults 60 and older, with eligibility later expanded to include adults 50 to 59 at increased risk. Abrysvo showed 58 to 63% efficacy, and a newer mRNA-based option, mResvia, demonstrated 55 to 58% efficacy. All three are single-dose injections.
What RSV Treatment Does Not Include
Antibiotics do not work against RSV because it’s a virus, not a bacterial infection. Doctors may prescribe antibiotics only if a secondary bacterial infection develops, such as an ear infection or bacterial pneumonia. Over-the-counter cough and cold medications are not recommended for children under four, and studies have not shown them to be effective for RSV-related coughs in any age group. Steroids and bronchodilators (the inhaled medications used for asthma) are sometimes tried but have not shown consistent benefit for RSV bronchiolitis in otherwise healthy children.