RSV vs. Cold Symptoms and Severity in Adults and Kids

Respiratory syncytial virus (RSV) causes cold-like symptoms in most people but can cause more serious problems in some, especially babies and older adults. Almost all children get RSV at least once by the time they turn 2 years old.

The common cold is an upper respiratory tract infection caused by different viruses, most commonly rhinovirus. Adults get a cold an average of two to three times a year, and children tend to have more than that. A cold shares many symptoms with RSV but is less likely to cause severe illness.

Both colds and RSV have symptoms such as sneezing, runny nose, cough, sore throat, and decrease in appetite. Babies with RSV may be irritable, fatigued, and have breathing difficulties.

A barking or wheezing cough could be a sign that the RSV virus has spread to the lower respiratory tract, possibly leading to pneumonia or bronchiolitis. While RSV is mild for most people, it can lead to hospitalization for some. Up to 10,000 older adults in the United States die from RSV complications each year.

How to Tell RSV and Cold Symptoms Apart

RSV and cold symptoms overlap quite a bit, but there are some distinctions.

Similarities

RSV and colds can cause symptoms such as:

• Cough
• Congestion (stuffy nose)
• Runny nose
• Temperature of 100.4 F or more
• Sneezing
• Fussiness and poor feeding (in babies)
• Sore throat
• Headache

Both RSV and colds can lead to illnesses such as pneumonia (an infection of the lungs) and bronchiolitis (inflammation of the small airways in the lungs), particularly in those with risk factors such as a weakened immune system and respiratory conditions. RSV is the most common virus associated with bronchiolitis.

Differences

RSV can cause cold symptoms and additional symptoms such as:

• Fast breathing
• Wheezing
• Shortness of breath
• Conjunctivitis
• Worsening of asthma, chronic obstructive pulmonary disease (COPD), other respiratory conditions, and congestive heart failure
• Development of bronchiolitis or pneumonia
  

In babies with RSV (particularly if severe), there may be:

• Flaring of the nostrils and head bobbing when breathing
• Short, shallow, and rapid breathing
• Rhythmic grunting during breathing
• "Caving in" of the chest in between and under the ribs
• Belly breathing (tugging between the ribs and/or the lower neck)
• Bluish mouth, lips, and/or fingernails
• Fever
• Cough
• Wheezing
• Poor feeding
• Sleepiness

Vaccines are available for people who are at risk of serious RSV.

There are no vaccines for colds because so many different viruses cause them.

RSV vs. Cold Viral Causes 

RSV is a virus that affects the respiratory system.

Colds are the result of an infection from a virus. More than 200 different viruses can cause a cold, but colds are most commonly caused by rhinoviruses.

RSV and colds are spread in a similar way:

• Virus-containing droplets from an infected person's cough or sneeze enter another person's eyes, nose, or mouth.
• You have direct contact with secretions or fluids containing the virus (such as by kissing).
• You touch a surface contaminated with the virus (like a doorknob) and touch your face before washing your hands.
  

Having RSV or a cold does not prevent you from getting it again.

Groups Prone to Severe Symptoms

There is a higher risk for severe illness from RSV in adults who:

• Are 65 and older
• Have a weakened immune system
• Have chronic heart or lung disease, such as asthma, COPD, congenital (present at birth) heart disease, or cystic fibrosis
• Are living at high altitudes (8,500 feet or higher)
• Have certain underlying medical conditions such as severe diabetes or severe obesity
• Live in nursing homes or long-term care facilities

Infants and children who are at a higher risk of severe illness from RSV include:

• Premature infants
• Infants up to 12 months, especially 6 months and younger
• Children younger than 2 years with chronic lung disease (such as asthma) or heart disease
  
• Children with neuromuscular disorders (including those who have difficulty swallowing or clearing mucus)
• Children with Down syndrome
• Children with weakened immune systems
  

RSV can lead to or worsen conditions such as:

• Pneumonia
• Bronchiolitis
• Congestive heart failure
• Worsening of asthma or COPD symptoms
  

Testing to Diagnose RSV and Cold

Healthcare providers typically diagnose a cold by discussing symptoms and doing a physical exam. There is no test for the common cold, but the healthcare provider may run tests to rule out other causes for the symptoms.

A nasal swab, or a sample collected by inserting a saltwater solution into the nose and gently suctioning it out, may be used to test for RSV.

If needed, lung function testing may be performed, such as a chest X-ray, oxygen saturation test, or computed tomography (CT) scan. Blood and urinary cultures may also be performed (bronchiolitis related to RSV can occur with a urinary tract infection in newborns).

It can be hard to know whether or not to contact a healthcare provider or to wait out what might be a cold. If you aren't sure, or you are concerned, call a healthcare provider, particularly if you or your child have risks for more serious illness with RSV or other respiratory conditions such as COVID-19 (in some cases, antiviral medications may be used early into the illness).

Get immediate medical care if you or your child are having trouble breathing. In an infant or child, this may look like:

• Rapid breathing
• Using their stomach or shoulders to breathe
• The skin between the ribs being sucked in, "caving in," and forming an upside-down "Y" with each breath
• Nostrils flaring with breathing
• Inability to breathe and drink at the same time
• Grunting at the end of each breath
• Pale, grey, or blue skin, lips, or nail beds (depending on skin tone)
• Pauses in breathing
• Wheezing

Also, get immediate medical attention if your child has symptoms such as:

• Signs of dehydration, such as fewer than one wet diaper every six hours, urinating less frequently than normal, dry mouth, lethargy, and lack of tears when crying
• Ear, chest, or sinus pain or pressure, ear tugging or drainage, poor sleep, fussiness, or thick mucus from the nose or mouth that is yellow, green, or grey (symptoms that could indicate an infection such as pneumonia, sinus infection, or ear infection)
• Significantly decreased activity and alertness
• Fever above 100.4 F in a child under 3 months old
• Fever above 104 F in any child
• Fever above 103 F for more than 24 hours
• Fever above 102 F that lasts more than two days
  
• Vomiting for more than 24 hours
  
• Bloody diarrhea
• Poor feeding
• Seems very sick or lethargic (very drowsy, difficulty staying awake)
• Shows signs of RSV and is high risk or less than 6 months old
• Seems to be getting worse
• Bad headache
• Severe belly pain
  
• Seems confused
  
• Has asthma or other illnesses and has symptoms that could be RSV, the flu, or COVID-19
• You think urgent care is needed
  

Call your healthcare provider for symptoms such as:

• Cough that lasts more than four days
• Symptoms, such as fever or cough that improve, then return or worsen
• Symptoms that do not improve within 10 days (or sooner if they are severe)
• Sore throat
• Worsening of chronic conditions
  
• You have questions or concerns

Evidence-Based Home Remedies and Self-Care

There is no specific treatment for colds and RSV. Treatment of minor symptoms involves managing comfort while the virus runs its course. More serious symptoms may need medical treatment.

For adults, over-the-counter (OTC) medications for pain, fever, or cold symptoms may help you feel more comfortable. Check with your healthcare provider or pharmacist before taking any medications. If you are taking more than one medication, check the ingredients as they can overlap, and taking them together may result in taking too much.

Children over 6 months old can be given Tylenol (acetaminophen) or Advil/Motrin (ibuprofen) as directed for fever. Children under 6 years old should not have OTC cough or cold medications as this can lead to serious and possibly life-threatening side effects. Do not give aspirin or aspirin-containing medications to any child or teen due to the risk of Reye syndrome.

Some ways to help manage symptoms and feel more comfortable include:

• Get lots of rest.
• Drink plenty of fluids.
• Use honey to relieve cough (not for babies under 1 year old).
• Use a cool mist vaporizer (clean it often to avoid bacterial and mold growth).
• Use saline nasal spray or drops (for young children, suction out the mucus after the saline using a rubber suction bulb).
• Breathe in steam from a shower or bowl of hot water (be careful to avoid burns).
• Use throat lozenges or cough drops (do not give to children under 4 years, as they are a choking hazard).
• Help babies stay hydrated with frequent feedings (suctioning their nose before feeding may help them feed better. Shorter feedings more often may also be more tolerable).
• Gargle with salt water (adults and older children who won't swallow it).
• Keep the room warm but not overheat.
• Drink warm fluids, such as soup.
• Avoid smoking, and do not smoke near children.

Prescribed Treatments

Antibiotics do not help with viral infections. They would only be beneficial if a secondary bacterial infection develops.

Clearing mucus from your baby's nose is important. This can be done with saline and a suction bulb. In some areas, respiratory outpatient clinics may be able to do a deep suctioning with a tube down the baby's nose to help get the mucus out. Your healthcare provider may give you a prescription for this service.

Hospitalization may be necessary in more severe cases of RSV. Hospitalization is most common in infants younger than 6 months and older adults. Hospitalization happens in about 2 to 3 out of every 100 infants with RSV.

Treatment at a hospital may include:

• Intravenous (IV) fluids
• Suctioning of mucus
• Oxygen
• Tube feeding
• Mechanical ventilation
  

How Long Virus Lasts in RSV and Cold

Cold symptoms typically start within a few days of becoming infected and can last up to 10 to 14 days.

Symptoms of RSV are typically worse on days three through five of illness. On average, symptoms last seven to 14 days.

Recovery may take longer in older adults or in more serious cases.

RSV is typically contagious for three to eight days, and those infected may become contagious one or two days before developing symptoms. Some infants and people with weakened immune systems may continue to transmit the virus for up to four weeks, even after they stop having symptoms.

RSV can survive for many hours on hard surfaces (such as tables and crib rails) but typically lives on soft surfaces for a shorter amount of time.

How to Limit Infection Exposure

To help limit the spread of RSV and cold viruses:

• Frequently wash your hands with soap and water for at least 20 seconds.
• Avoid close contact, such as kissing or shaking hands, with people who are sick.
• Avoid touching your face with unwashed hands.
• Clean and disinfect frequently touched surfaces.
• Cover coughs and sneezes with a tissue, throw away the used tissue, and wash your hands.
• Stay home when you are sick, and keep your children home when they are.
• Limit your baby's exposure to crowds, other children, and people who are sick.
• Consider nursing your baby, which gives the baby unique antibodies that can help fight and prevent infections.
• Don't share items such as toothbrushes, pacifiers, utensils, washcloths, towels, and drinking cups.
• Wash your baby's toys and clothes often.
• Wash your hands before touching your baby, and insist others do too.
• Wash your hands before handling food and after sneezing, coughing, or changing diapers.
• Promote cleaner air by opening windows, purifying indoor air, and gathering outdoors.
• Use tools such as masks, physical distancing, and testing.

RSV Vaccines

The Food and Drug Administration has approved three RSV vaccines for the prevention of lower respiratory tract disease: Arexvy for those aged 50 and older, and Abrysvo and mResvia for those aged 60 and older. Abrysvo is also approved for individuals aged 18 to 59 at increased risk. Arexvy and Abrysvo may increase the risk of developing Guillain-Barré Syndrome (GBS) after the vaccine has been administered.

The Centers for Disease Control and Prevention recommends RSV vaccines for all adults 75 years and older and for adults aged 60 to 74 who:

• Have a weakened immune system
• Have chronic heart or lung disease
• Have certain other medical conditions, such as severe diabetes or severe obesity
• Live in a nursing home or long-term care facility
  

The RSV vaccine can be given to eligible adults at any time, but it is recommended to get it in late summer or early fall before RSV typically starts to spread seasonally. One of the vaccines, Abrysvo, is also approved for adults aged 18 to 59 who are at increased risk of lower respiratory tract disease.

Pregnant people whose babies will be born during RSV season can receive the RSV vaccine at weeks 32 through 36 of pregnancy. This reduces the risk of hospitalization from RSV for babies by 57% in their first six months after birth.

Infants and some toddlers may receive an injected RSV immunization called Beyfortus (nirsevimab), which provides antibodies to protect against RSV and has been shown to reduce the risk of RSV-related hospitalizations and healthcare visits in infants by about 80%). It may be included in the baby's routine immunizations.

Most infants only need protection from either the maternal RSV vaccine or infant immunization, but not both.

Children under 24 months old with certain conditions that put them at high risk for severe RSV may receive a product called Synagis (palivizumab), given as an injection once a month during RSV season.

Summary

RSV and colds share similar symptoms in most people. However, some people experience more serious illness, which may require hospitalization. Infants, older adults, and people with certain medical conditions are at a higher risk for serious illness.

There is no specific treatment for RSV or colds; they typically just run their course. However, measures can be taken to help you or your child feel more comfortable as you get better.

RSV vaccinations and inoculations are available for infants, pregnant people, older adults, and others who qualify.