Respiratory Syncytial Virus (RSV) in Babies and Small Children

Ann Calandro, MSN, RN, IBCLC

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Does breastfeeding protect infants with RSV?
Research Findings
What do I do if my breastfeeding baby is infected with RSV?
FAQs About RSV
References
In 2019-2021, due to more limited large group gatherings, masking in public areas and frequent handwashing during the COVID-19 pandemic, respiratory viruses including respiratory syncytial virus (RSV) in children and adults declined. However, in 2022, RSV and other viruses have been increasing and many pediatric hospital wards are full of babies and young children suffering from severe RSV infections.

Breastfeeding babies should continue to breastfeed if they become ill with RSV. Research has shown that they will recover faster, they will need less oxygen therapy, and the antibodies in human milk will protect them and aid in healing.1,2,3

Does breastfeeding protect infants with RSV?

Does breastfeeding protect infants or help them recuperate faster if they are infected with RSV? Yes!
The American Academy of Pediatrics recommends breastfeeding because data show that for children who are breastfed, the following acute and chronic pediatric disorders occur less frequently: otitis media, acute diarrheal disease, lower respiratory illnesses, sudden infant death syndrome, inflammatory bowel disease, childhood leukemia, diabetes mellitus, obesity, asthma, and atopic dermatitis.1

RESEARCH FINDINGS

A research study from February 2022 reported that “breastfeeding has shown to have a protective effect for infants with RSV bronchiolitis. The World Health Organization recommends minimum six months of exclusive breastfeeding for maximal immune protection against viral infections in infants. This review shows that exclusive and partial breastfeeding reduces severity of disease, length of hospital stays and supplemental oxygen requirements.”2

“The severity of RSV infection requiring oxygen therapy was lower in the BMF (breast milk feeding) than the AMF (artificial milk formula fed) group. This protective role of human milk on RSV infection might decrease the need for oxygen therapy suggesting less airway damage.” 3

What do I do if my breastfeeding baby is infected with RSV?

It is very important to continue breastfeeding. Is your baby very congested? Try feeding in an upright position to help with drainage. Ask your healthcare provider if saline nose drops and use of a bulb syringe to remove secretions may help with drying nasal passages before nursing.

If your baby is too ill or congested to breastfeed, pump or express your milk frequently to feed your little one, assuring that your baby will continue to receive the antibody protection of human milk. Holding your little one in an upright position on your chest as much as possible throughout the illness will be comforting and will help your baby breathe more easily. Research has shown that recovery is more rapid in breastfed babies and children.

FAQs About RSV

The following information is from the Centers for Disease Control and Prevention (CDC) website.4,5 These frequently asked questions include an explanation of RSV symptoms, prevention, and how the disease spreads.

What is Respiratory Syncytial Virus (RSV)

RSV is a common contagious virus that causes lower respiratory tract infection. Most people infected with RSV experience mild symptoms similar to a common cold. RSV can be contracted at any age, but most children will have experienced an RSV infection by the time they are two years old. It is common in the fall (autumn), winter and spring.

How does it spread?

It can spread through droplets in the air from coughs and sneezes, touching surfaces like doorknobs that are contaminated by RSV, or direct contact such as kissing. The virus can survive for many hours on hard surfaces.

What are the symptoms of RSV?

Symptoms may include coughing, sneezing, runny nose, decrease in appetite, fever, and wheezing. Wheezing is a high-pitched coarse whistling sound. In infants, it may cause 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 lung) in children younger than one year of age in the United States.

Who is at highest risk for complications with RSV?

Premature infants, young children with heart or chronic lung disease, young children with weak immune systems, adults with compromised immune systems and older adults with underlying heart and lung disease are the most at risk. One to two percent of children younger than six months of age with RSV may need hospitalization for treatment.

How can RSV be prevented?

Taking precautions such as frequent hand washing with soap for at least 20 seconds, covering coughs and sneezes with tissues or upper shirt sleeve, avoiding close contact and sharing eating utensils with sick individuals, and cleaning frequently touched surfaces such as doorknobs and mobile devices will help decrease spread of RSV. Young children over the age of two and parents may wish to wear masks for protection in group settings. Children younger than two should not wear a mask. Avoid being around sick people. Research shows that breastfeeding is a preventative measure as well, providing important antibodies for infant protection.

Is there a vaccine to prevent RSV?

Currently there are several vaccines being developed. One RSV vaccine is currently being tested in Europe. None are routinely available to immunize vulnerable populations as of November 2022.

References

1. AAP, Updated AAP guidance recommends longer breastfeeding due to benefits, June 2022, https://publications.aap.org/aapnews/news/20528/Updated-AAP-guidance-recommends-longer (accessed 23 November 2022).

2. Minerva, G. and Philip, R. Pediatrics, Impact of Breastfeeding on the Incidence and Severity of RSV Bronchiolitis in Infants: Systematic Review, February 2022, https://publications.aap.org/pediatrics/article/149/1%20Meeting%20Abstracts%20February%202022/280/185980/Impact-of-Breastfeeding-on-the-Incidence-and (accessed 23 November 2022)

3. Min Jeong Jang, Yong Joo Kim, Shinhye Hong, Jaeyoon Na, Jong Hee Hwang, Son Moon Shin and Young Min Ahn, PubMed Central, Positive Association of Breastfeeding on Respiratory Syncytial Virus Infection in Hospitalized Infants: a Multicenter Retrospective Study, November 2019 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170789/
(accessed 23 November 2022)

4. CDC, Respiratory Syncytial Virus Infection (RSV), last reviewed October 2022, https://www.cdc.gov/rsv/index.html (accessed 23 November 2022)

5. AAP, Mask guidance from the AAP, last updated June 2022, https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/face-masks-and-other-prevention-strategies/ (accessed 23 November 2022)

November 2022