How is respiratory syncytial virus infection different in infants?

An infant may begin with a runny nose, reduced appetite, cough or fever. Breathing may then become faster or harder as the small airways become inflamed. Babies may show illness through shorter feeds, tiring while feeding, fewer wet nappies, irritability or unusual sleepiness rather than describing breathlessness. Very young infants may have little or no fever, so behaviour and breathing matter as much as temperature.

Offer smaller, more frequent feeds if the baby tires easily, and clear nasal mucus gently as advised before feeding. Keep smoke and strong fragrances away from the baby. Check breathing, alertness, feeding and wet nappies regularly. Do not give cough medicines or other treatments unless a clinician recommends them. Wash hands and avoid close contact with people who have cold symptoms.

Get urgent medical help if the baby is struggling to breathe, has pauses in breathing, a blue or grey colour, marked chest pulling-in, cannot feed, is difficult to wake or has clearly fewer wet nappies. A baby who is worsening after an initial cold also needs prompt assessment, especially if very young or born prematurely.

How should I monitor breathing and feeds? Which changes mean we should return immediately? Does my baby's age or medical history increase the need for closer observation?