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 (RSV) Respiratory Tract Infection

This standard is undergoing a complete revision as of 11/2022.


For additional information on RSV see:


Respiratory syncytial virus (RSV) is a common cause of respiratory tract infection in infants and young children, although infection in all ages may occur. Most children are infected at least once with RSV by two years of age and reinfection is common 1.


RSV causes mild symptoms in most people, usually lasting 5-7 days. However, 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. This may be followed by more serious respiratory symptoms in the lungs or the lower respiratory tract.Young children who are becoming more severely ill may also feed poorly, have fever wet diapers, be less active, or be difficult to soothe1-2.


RSV Symptoms in Children
Upper Respiratory Tract InfectionLower Respiratory Tract Infection
  • Runny nose
  • Poor feeding
  • Coughing
  • Sneezing
  • Fever
  • Fussiness
  • Fast breathing
  • Flaring nostrils
  • Grunting noise with breathing
  • Head bobbing with breathing
  • Belly moving with breathing
  • Ribs pulling in with breathing
  • Wheezing

Outbreaks of RSV are common in Early Care and Education Programs.  Children with known RSV infection may return to programs when 2:

  • The child can participate in all the program’s activities
  • The child’s care does not result in more care than the staff can provide without putting the health and safety of other children at risk

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

Early Care and Education 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
  • Throw used facial tissues away after one use
  • Clean and sanitize 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 (fever, cough, wheezing, and increased respiratory rate) or pneumonia in infants and young children less than two years of age. Infants with prematurity, chronic heart and lung problems, and immunocompromised children may be at high risk for more severe illness. Parents/guardians with higher risk children should be notified of RSV infection on their program.

RSV is spread 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 shed and spread infection to others in nasal secretions and saliva for three to four weeks or longer1.

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. Preventive measures may include limiting, where feasible, exposure to contagious settings, hand hygiene and avoidance of contact with people with respiratory tract infections.


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. American Academy of Pediatrics; 2021; 628-638.

  2. Aronson, S. S., T. R. Shope, eds. 2020. Managing infectious diseases in child care and schools: A quick reference guide, 5th Edition. Elk Grove Village, IL: American Academy of Pediatrics.