RSV cough: when to worry

RSV can begin like a cold and then cause a persistent cough, noisy breathing or wheeze as the small airways become inflamed. A cough by itself does not show how seriously a child is affected. Look at the work of breathing, skin colour, alertness and ability to drink. Babies may show illness through shorter feeds, tiring during feeds or fewer wet nappies rather than describing chest symptoms.

Other causes of cough include the common cold, acute bronchitis, asthma, allergic rhinitis and acid reflux. A cough’s duration and pattern help a clinician distinguish these possibilities, but an examination is needed when breathing or hydration is affected.

Keep the child away from smoke and offer small, frequent drinks or feeds. Keep the nose clear with measures recommended by a clinician, and observe breathing while the child is calm. Record changes in feeding, wet nappies, temperature and activity. Do not use over-the-counter cough medicines for a young child unless a clinician specifically recommends one. Arrange medical advice if the cough is worsening or you cannot judge the breathing comfortably.

Call emergency services for blue or grey lips, repeated pauses in breathing, severe chest retractions, grunting, collapse or a child who cannot be woken normally. Seek same-day medical assessment for struggling to breathe, markedly reduced drinking, repeated vomiting, signs of dehydration, or unusual limpness. A very young infant with fever needs prompt medical advice. A cough that persists, recurs or comes with blood also merits clinician review.

Ask how to count breathing effort, which feeding and urine changes matter, how long monitoring should continue, and whether another condition such as asthma or bronchiectasis needs consideration.