Caring for Our Children (CFOC)

Chapter 7: Infectious Diseases

7.3 Respiratory Tract Infections

7.3.8 Respiratory Syncytial Virus (RSV) Attendance of Children with Respiratory Syncytial Virus Infection (RSV)

Content was modified on 3/30/2023.

Respiratory syncytial virus (RSV) is a common cause of respiratory tract infection in infants and young children, but all ages can be infected. RSV infects most children at least once by the age of 2, and reinfection is common.1

RSV causes mild symptoms in most people, usually for 5-7 days. But, RSV can lead to serious breathing problems in some children. RSV causes cold symptoms in the upper respiratory tract, which includes the nose, mouth, and throat. More serious respiratory symptoms may follow in the lungs. Young children who are sicker may also have trouble feeding (i.e., breastfeeding/chestfeeding, bottle feeding), have fewer wet diapers, be less active, or be more difficult to soothe.1,2

RSV Symptoms in Young Children 
Upper Respiratory Tract Infection Lower Respiratory Tract Infection
Cold symptoms may include: 
  • Runny nose 
  • Poor feeding
  • Decrease in appetite 
  • Coughing 
  • Sneezing 
  • Fever 
  • Fussiness 
Symptoms may include cold symptoms plus: 
  • Fast breathing 
  • Flaring nostrils 
  • Grunting noise with breathing 
  • Head bobbing with breathing 
  • Belly moving with breathing 
  • Ribs pulling in while breathing 
  • Wheezing 

Outbreaks of RSV are common in early childhood programs. Children with diagnosed RSV infection may return to programs when:2

  • The child can take part in all program activities.
  • The child does not need more care than the staff can offer without putting the health and safety of other children at risk.
  • Other exclusion criteria no longer apply.

For more information on inclusion and exclusion criteria for ill children, see Standard Inclusion/Exclusion/Dismissal of Ill Children.

Early childhood programs can limit the spread of RSV by:2

  • Using good hand hygiene practices
  • Not allowing children to share food, bottles, toothbrushes, or mouthed toys
  • Teaching children and staff to cover their coughs and sneezes
  • Throwing away facial tissues after one use
  • Cleaning and sanitizing surfaces regularly, and more often during outbreaks



RSV is a well-known cause of respiratory tract illness in children and is more common in the winter and early spring.2 RSV often causes cold-like symptoms in older children, and adults. In most younger children, RSV causes upper respiratory symptoms but can also cause lower respiratory tract infections including bronchiolitis and/or pneumonia in infants and young children under 2. Premature infants, infants or children with chronic heart and lung problems (i.e., asthma) and immunocompromised children may be at a higher risk for more severe illness. When a child has an RSV infection, programs should tell the parents or guardians of children who have a higher risk.

RSV spreads by droplets in the air from coughing and sneezing, contact with nose and mouth secretions, or contact with the virus on surfaces or objects such as tables.1,2 The RSV virus can spread infection through nasal secretions and saliva for 3-4 weeks or longer.1

It is important to prevent and reduce RSV infection in high-risk infants by educating parents, guardians, and staff about the importance of decreasing exposure to and transmission of RSV. Prevention may include limiting (when possible) exposure to contagious settings, using good hand hygiene, and avoiding contact with people with respiratory tract infections.


For more information on RSV, see:

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Handwashing Procedure Cough and Sneeze Etiquette Inclusion/Exclusion/Dismissal of Ill Children
Appendix J: Selection and Use of a Cleaning, Sanitizing or Disinfecting Product
Appendix K: Routine Schedule for Cleaning, Sanitizing, and Disinfecting
  1. American Academy of Pediatrics. Section 3: Summaries of infectious disease, Respiratory Syncytial Virus. In: Kimberlin DW, Barnett, ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. Itasca, IL: American Academy of Pediatrics; 2021:628-638

  2. American Academy of Pediatrics. Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide. Aronson SS, Shope TR, eds. 5th ed. Itasca, IL: American Academy of Pediatrics; 2020


Content was modified on 3/30/2023.