Spotting the Symptoms of RSV in Babies Before You Panic

"Just put sliced raw onions in his socks," my neighbor Brenda texted me at 11 PM on a Tuesday, which is honestly unhinged behavior but I was too tired to block her. Meanwhile, my mother-in-law had already called twice to insist I slather him in menthol rub and wrap him in three layers of wool, and my husband Dave was literally standing in the doorway of the nursery holding a half-eaten turkey sandwich saying, "Babe, it's just a little cold, look at him, he's fine."

He wasn't fine.

Leo was four months old, and he was making this sound in his crib. Like a tiny, congested pug mixed with a squeaky toy that had been dropped in a puddle. I was sitting on the floor in my milk-stained sweatpants, aggressively googling every possible sign of respiratory distress while chugging cold coffee from a mug I had found on the nightstand that may or may not have been from yesterday. Dave texted me from the hallway asking if the "babi" was asleep—his phone's autocorrect is perpetually broken, so now we just ironically call the children "babi" sometimes—and I just wanted to scream.

Because the thing about respiratory syncytial virus is that everyone has an opinion, but nobody tells you what it actually looks like in your own living room at 2 AM.

The timeline is an absolute joke

I always thought a virus just hit you, you got really sick, and then you got better. But my pediatrician, Dr. Aris, who's basically my therapist at this point, told me that RSV in babies is like a terrible houseguest. They show up, they seem totally fine and mild for a couple of days, and then on day four they completely trash your living room and set the couch on fire.

Days three through five are the absolute pits. That's when the soreness really kicks in. I remember on day one, Leo just had a little clear runny nose. I was like, oh, whatever, babies get snotty. By day four, he was a miserable, floppy little puddle of a human who refused to nurse and just looked at me with these glassy, betrayed eyes. If you're on day four right now, just know that I see you, and I validate your decision to eat stale graham crackers for dinner while crying in the shower.

What the breathing actually looks like

So thing is that nobody really explains properly until you're living it. When they tell you to watch their breathing, they don't mean just listen to it, they mean you've to basically rip off their clothes and stare at their bare chest like a total creep.

Dr. Aris called it "chest retractions" and it's the most terrifying thing I've ever witnessed. Basically, Leo was working so incredibly hard to pull air into his tiny lungs that the skin under his ribcage was sucking all the way in, making this deep hollow bowl shape in his stomach with every single breath. It's called belly breathing, and it looks horribly unnatural. Then there's the part where the skin at the base of their neck, right above the collarbone, caves in. His little head was bobbing forward every time he inhaled, like a tiny pigeon, and his nostrils were flaring out wide. I remember sitting there in the dark, my heart hammering in my ears, just watching his ribs outline themselves under his skin, trying to decide if I was overreacting or if we needed to go to the emergency room right that second.

I must have recorded ten different videos of his chest to send to the after-hours nurse line, completely panicked because the rhythmic grunting sound he was making at the end of every breath sounded like he was lifting weights.

Oh god, and their temperature might spike to like 101, but whatever, fevers are super normal and honestly the least of my worries when the kid is breathing like a marathon runner.

The clothing situation when they feel like garbage

When your kid is sick and struggling to breathe, they sweat. A lot. And then they get the chills, and then they sweat again. I had Leo in these thick synthetic fleece footies because it was November and my mother-in-law had me completely paranoid about him being cold, but he just ended up smelling like sour milk and damp misery.

I ended up stripping him down and putting him in this Organic Cotton Baby Bodysuit Sleeveless Infant Onesie from Kianao. I had originally bought it just because the sage green color looked nice for family photos, but it ended up being my absolute favorite piece of clothing during that awful week. It’s made of this super breathable organic cotton, so it didn't trap the heat against his feverish little body, and because it was sleeveless, I could easily see his chest to monitor his breathing without having to constantly unzip him and wake him up. Plus, there's no scratchy tags, which is a big deal when your infant is already incredibly irritated by literally everything in the universe.

Honestly, having the right gear when they're sick doesn't cure them, but it makes managing the misery slightly more tolerable for everyone involved. You can browse around Kianao's organic clothing line here if you want to stock up before the daycare plagues hit.

Dealing with the snot factor

Dr. Aris loves to use the phrase "obligate nose breathers," which is just fancy medical speak for "babies don't know how to breathe through their mouths." Which is a massive design flaw in human biology, if you ask me.

Because they can't breathe through their mouths, they can't drink their milk when their nose is completely packed with concrete-level mucus. So you end up having to shoot saline up their tiny nostrils and suck it out with one of those little nasal aspirators right before every single feeding. It's basically a wrestling match. Leo would scream, I'd sweat, Dave would hover uselessly with a burp cloth, and we'd finally get his nose clear enough for him to take maybe two ounces of milk before he got exhausted and fell asleep. You just kind of have to feed them tiny amounts constantly throughout the day and pray they don't get dehydrated instead of trying to force them to eat a full meal and getting frustrated when they inevitably refuse.

Teething and a virus is a special kind of hell

Because the universe has a really sick sense of humor, Leo decided to pop his first tooth right in the middle of his RSV infection. So not only was he coughing up a lung, but he was also drooling everywhere and chewing aggressively on his own hands.

I was so desperate I bought the Panda Teether Silicone Baby Bamboo Chew Toy at like 3 AM on my phone. Look, I'll be totally honest with you: it’s just okay for sick days. It’s super cute, and the bamboo detail is really nice, but when Leo was in the thick of the respiratory stuff, he didn’t have the energy to hold it. He just kind of let it drop on his face. But once we hit day seven and he was starting to perk up, I threw it in the fridge for ten minutes. The cold silicone seemed to really numb his gums, and he finally sat there gnawing on the panda's ear for twenty minutes while I drank a hot cup of coffee for the first time in a week. So, it's a good teether, just maybe temper your expectations when they've a 101 fever.

Now, when my older daughter Maya had a babie cold a few years back, she was completely obsessed with the Bubble Tea Teether. I don't know what it's about the little textured boba pearls on that thing, but she would chomp on it furiously. It actually distracted her from her runny nose for solid chunks of time. Anything that buys you five minutes of silence when you're nursing a sick infant is worth its weight in gold.

The moment you honestly go to the hospital

I'm entirely unqualified to dispense medical advice, I'm just a very tired mom who has lived through this twice. But Dr. Aris grabbed a pen and drew a literal line on a piece of paper for me to explain when to stop Googling and start driving to the ER.

Dehydration is a huge one. If they've fewer than one wet diaper in an eight-hour period, or if they're crying and there are literally no tears coming out of their eyes, you go. If you see cyanosis—which is when their lips, tongue, or fingernails start looking blue or gray because they aren't getting enough oxygen—you don't wait, you go. And if they've apnea, which means they pause their breathing for more than ten seconds at a time, you pack the car immediately. It's so scary, but knowing exactly what the red flags are honestly made me feel a tiny bit more in control of a completely out-of-control situation.

Anyway, the point is, trust your gut. If your baby looks wrong to you, if they're lethargic in a way that scares you, just take them in. The ER nurses are angels and they'll never judge you for bringing in a baby to get their oxygen levels checked.

You're going to get through this. Buy the saline, wash your hands fifty times a day, and maybe order some breathable onesies so you aren't fighting with zippers in the dark. Check out Kianao's full line of sustainable, gentle baby gear right here.

Messy questions I furiously Googled at 4 AM

Why does everyone keep talking about day five?

Because the timeline of this virus is incredibly rude. The mucus production and soreness peak between days three and five. So you might think they're getting better on day two, and then day four hits and they sound like a tractor. It’s normal, it just really sucks. Just hold on until day six or seven.

Is a humidifier genuinely going to fix this?

Fix it? No. Help? Yes. But for the love of everything, NEVER use a warm mist humidifier in a baby's room because it's a massive burn hazard. Get a cool mist one, and you've to genuinely clean the gross pink slime out of it or you're just spraying mold into the air. But yeah, the moisture helps keep the snot from turning into cement in their nose.

Can I just give them honey for the cough?

Oh god, no. If your baby is under one year old, honey is an absolute hard no because of botulism risk. I know your grandma probably told you to rub honey on their gums or something, but don't do it. You just have to ride out the cough with a humidifier and saline, unfortunately. There are no magic medicines for babies under a year.

What are chest retractions, like, in plain English?

It's when your baby is working so hard to breathe that their skin is visibly sucking in around their bones. You'll see the skin under their ribs cave in, or the skin at the base of their neck pull deeply inward with every inhale. If you see this, you don't wait it out, you call your doctor or go to the ER right away.

Should I keep them in their own room or sleep on their floor?

I mean, the official advice is to keep them in a safe sleep space, but I literally dragged a terrible foam mattress into Leo's room and slept on the floor next to his crib for four nights so I could listen to his breathing. Do whatever you've to do to get a tiny bit of sleep while keeping an eye on them. We're all just surviving out here.