Masked adult holding sick infant

Respiratory Syncytial Virus (RSV) in the Child Care Setting

What is it?
RSV is a virus that infects the respiratory system. The respiratory system is made up of parts of the body involved in breathing. This includes your lungs, nose, and throat.  RSV is the most frequent cause of respiratory infections in infants and children under 2 years old. The illness causes cold-like symptoms in most people, but it can be very serious for:

•    Infants, especially those 6 months and younger
•    People with heart or lung diseases (including asthma)
•    People with weakened immune systems
•    Older adults, especially those 65 years and older 

What are the symptoms?
For most people, RSV causes mild symptoms that last one to two weeks. Symptoms of RSV infection often include:

•    Runny nose
•    Decrease in appetite
•    Coughing
•    Sneezing
•    Fever
•    Wheezing

In very young infants, the only symptoms may be irritability, decreased activity, and breathing difficulties. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in infants. Severe cases of RSV may lead to hospitalization.

Health care providers usually diagnose RSV based on symptoms and a physical exam. Lab tests are also available to diagnose RSV. Tests for RSV are most accurate if done within the first few days after symptoms begin. To do the test, a sample of fluid from the nose is collected using a swab. The symptoms of RSV are similar to symptoms of COVID-19 and influenza, so testing for these illnesses may be done at the same time.

Who gets it and how?
Almost all children have had RSV at least once by the time they are 2 years old. Young children with the infection can shed the virus before symptoms appear and for days or weeks after they become sick.  Infants often get RSV from older children.

RSV is highly contagious and spreads easily from person to person through:

•    Droplets from a cough or sneeze in the air
•    Direct contact with nose and mouth secretions
•    Contact with the virus on hands, surfaces, toys, and other objects

RSV infections occur throughout the year.  Most outbreaks occur during the winter months, but the timing of RSV circulation can vary from year to year. Child care providers are frequently exposed to children with RSV and may get repeated RSV infections.

Adults who have undergone chemotherapy or organ transplants, as well as those with weak immune systems are most vulnerable to complications from an RSV infection.

When should children with RSV stay home?
Children with RSV should stay home if:

•    They are too sick to participate in activities or
•    They require more care than staff can provide without taking time away from the care and education of the other children

Take a child to a health care provider immediately if they are: 
•    having trouble breathing
•    breathing fast
•    wheezing
•    turning blue when coughing. 
These are symptoms of severe RSV illness.
Where should we report it?
Let families in your program know of cases of RSV so they can watch for symptoms and practice infection control measures at home. Remember, health information is confidential, so don’t share the name of the child who is sick.

How can we limit the spread?

•    Pregnant mothers, infants and toddlers should get an RSV vaccine/ immunization if eligible
•    Conduct Daily Health Checks on every child each day.
•    Wash your hands often with soap and water for at least 20 seconds throughout the day
•    Don’t allow children to share mouthed toys, cups, or eating utensils.
•    Clean and disinfect surfaces that are soiled with body fluids.
•    Cover coughs and sneezes by coughing in your sleeve or with a tissue. 
•    Dispose of used tissues and wash hands. 
•    Change clothing soiled with mucous.
•    Provide fresh air.
•    Promote breastfeeding as it protects infants from RSV.

What about vaccines?
There are vaccines available to protect infants, toddlers and older adults from getting very sick with RSV.

  • Pregnant women who get the RSV vaccine during week 32-36 of pregnancy can help protect their baby from getting very sick with RSV after they are born. In most cases, the baby will not need another immunization later.
  • Ask your health care provider about RSV immunization for:
    • infants younger than 8 months   
    • children ages 8 to 19 months who:
    • have chronic lung disease because they were born prematurely  
    • are severely immunocompromised 
    • have severe cystic fibrosis 

People of American Indian or Alaska Native descent are at higher risk and should also contact their health care provider about RSV immunization.

Ask your health care provider for more information and about cost.

Resources and References

Aronson, S. and Shope, T. (Eds.) (2020) Managing Infectious Diseases in Child Care and Schools 5th Edition, American Academy of Pediatrics
Respiratory Syncytial Virus Infection at 
Respiratory Syncytial Virus (RSV) Tests at         

October 2023, UCSF California Childcare Health Program

This article was made possible with funding from the Heising-Simons Foundation.