Most RSV infections are managed at home with basic supportive care: keeping airways clear, staying hydrated, and managing fever. RSV typically runs its course in one to two weeks, and the vast majority of cases never require a hospital visit. What matters most is knowing how to keep the sick person comfortable, recognizing the warning signs that need medical attention, and understanding the prevention tools now available.
How Long RSV Lasts
RSV symptoms usually start like a common cold: runny nose, cough, sneezing, and sometimes a low fever. In most healthy children and adults, the worst symptoms hit around days three through five, then gradually improve. People with RSV are typically contagious for 3 to 8 days and can start spreading the virus a day or two before symptoms appear. Some infants and people with weakened immune systems can shed the virus for four weeks or longer, even after they look and feel better.
The cough can linger for two to three weeks after other symptoms have cleared, which is normal. Wheezing is one of the hallmark RSV symptoms, especially in young children, and it can persist even as the infection resolves.
Managing Symptoms at Home
There is no antiviral medication for RSV. Treatment is entirely about easing symptoms while the body fights off the virus. Here’s what actually helps:
- Fluids. Dehydration is one of the biggest risks, especially for infants and older adults. Small, frequent sips work better than trying to get a sick child to drink a full bottle or cup at once. For breastfed babies, nurse more often. For older children and adults, water, clear broths, and electrolyte solutions all count.
- Fever and pain relief. Over-the-counter fever reducers like acetaminophen or ibuprofen can bring down a fever and ease body aches. Ibuprofen should not be given to babies under six months. Never give aspirin to children.
- Rest. The body needs energy to fight the infection. Limiting activity and encouraging sleep helps recovery.
Clearing a Baby’s Nose
Infants breathe almost exclusively through their noses, so congestion can make feeding and sleeping extremely difficult. Saline drops (not spray, which is too forceful for small nostrils) are the first step. Place a few drops in one nostril to loosen the mucus, then use a bulb syringe or nasal aspirator to gently suction it out.
For a bulb syringe: squeeze the bulb first, place the tip just inside the nostril (not deep, baby nostrils are tiny), then release the bulb to create suction. Repeat on the other side. Clean the syringe with hot, soapy water after every use and let it dry completely to prevent bacteria from growing inside.
Nasal aspirators that use a mouthpiece and filter work the same way. You place saline drops, seal the tip around the nostril, and suck gently through the mouthpiece. The filter keeps mucus from reaching your mouth. Try to suction before feedings so your baby can breathe while eating. Don’t overdo it, though. Suctioning too aggressively or too frequently can irritate and swell the nasal passages, making congestion worse.
Using a Humidifier Safely
A cool-mist humidifier can help ease coughing and congestion by adding moisture to dry indoor air. Always use cool mist rather than warm mist around children. Hot water or steam from a warm-mist humidifier can cause burns if a child gets too close or tips it over.
The key is keeping the humidifier clean. Standing water breeds bacteria and mold, which the machine then sprays into the air your sick child is breathing. Empty the tank and dry all surfaces daily. Use distilled or purified water instead of tap water to reduce mineral buildup. A dirty humidifier can make respiratory symptoms worse, not better.
Warning Signs That Need Medical Attention
Most RSV cases resolve on their own, but some progress to bronchiolitis or pneumonia, particularly in infants under six months, premature babies, and older adults with chronic conditions. In very young infants, the only symptoms of RSV may be irritability, decreased activity, and breathing difficulties, so watch closely.
Get medical help if you notice any of the following:
- Labored breathing. Look for the skin pulling in between or below the ribs with each breath, flaring nostrils, or a breathing rate that looks faster than normal. These are signs the lungs are struggling.
- Significantly reduced fluid intake. If a baby is refusing to feed or a child is barely drinking, dehydration can develop quickly. Fewer wet diapers than usual is a concrete sign.
- Worsening symptoms. A fever that spikes after seeming to improve, or breathing that gets progressively harder rather than better, warrants a call to your doctor.
- Blue or gray color around the lips or fingernails. This signals low oxygen and is a reason to seek emergency care immediately.
If a child’s oxygen levels drop and don’t recover to an acceptable range within about 30 minutes, hospital evaluation is needed. Temporary brief dips in oxygen are normal during an RSV infection, but sustained low levels are not.
Prevention for Infants
A relatively new tool called nirsevimab (sold as Beyfortus) gives infants a dose of ready-made antibodies against RSV. It is not a vaccine in the traditional sense. Instead of training the immune system to make its own antibodies, it provides them directly, offering protection that lasts through an RSV season.
It’s recommended for all infants under 8 months old entering their first RSV season (typically fall through spring) if the mother did not receive an RSV vaccine during pregnancy, if her vaccination status is unknown, or if the baby was born within 14 days of the mother getting the vaccine. In those situations, there hasn’t been enough time for maternal antibodies to transfer to the baby.
For children 8 to 19 months old, a second-season dose is recommended only for those at higher risk: children with chronic lung disease of prematurity, severe immune compromise, cystic fibrosis with significant lung involvement, or American Indian and Alaska Native children, who experience disproportionately high rates of severe RSV.
RSV Vaccine During Pregnancy
Pregnant women can receive a single dose of RSV 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 those vulnerable first months of life. Vaccination after 36 weeks and 6 days is not recommended because there isn’t enough time for antibodies to develop, transfer, and reach protective levels before delivery.
Prevention for Older Adults
RSV is not just a childhood illness. It hospitalizes and kills tens of thousands of older adults each year. A single-dose RSV vaccine is now recommended for all adults 75 and older, and for adults 50 to 74 who have conditions that raise their risk of severe illness. Those conditions include chronic heart disease, chronic lung disease (such as COPD or asthma), diabetes with organ damage, severe obesity (BMI of 40 or higher), moderate to severe immune compromise, chronic liver or kidney disease, neurological conditions that affect breathing or swallowing, and living in a nursing home.
The vaccine is not annual. One dose completes the series. The best time to get it is late summer or early fall, before RSV begins circulating in the community. You do not need medical records to prove you have a qualifying condition. Your own report of a risk factor is sufficient.
Reducing Spread at Home
RSV spreads through respiratory droplets when an infected person coughs or sneezes, and through contact with contaminated surfaces. The virus can survive on hard surfaces like countertops and doorknobs for several hours. Frequent handwashing is the single most effective way to slow transmission. Avoid kissing a baby’s face when you’re sick or have been around someone who is. Keep sick family members away from infants and high-risk household members as much as possible, and clean shared surfaces regularly during illness.