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What You Should Know about

Respiratory Syncytial Virus (RSV)

Information for Child Care Providers

On October 27, 2022, the PA Department of Health announced via their Health Alert Network that Respiratory syncytial virus (RSV) activity is increasing in Pennsylvania and nationwide, and levels are higher than usual for this time of year (See PAHAN 668-10-27-ADV: 2022-PAHAN-668-10-27-RSV_1.pdf).

Child care providers need to be aware of this dramatic rise in RSV cases because

some children can get very sick and need hospitalization. 

RSV is a virus which usually causes common cold symptoms in most children and adults. But it’s important to know that babies 12 weeks old or younger are at much higher risk for complications from RSV. 

Factors that put children at risk for severe RSV infections include:

  • 3 months of age or younger (due to difficulty clearing mucus from smaller airways)
  • Being around children in a child care setting 
  • Exposure to secondhand smoke
  • Children with a history of weakened immune symptoms, preterm birth, or heart or lung problems

Children or adults with RSV might not look sick, but could be unknowingly infecting others with the virus, as it is spread by respiratory droplets falling on surfaces and when talking, coughing, or sneezing. RSV may be spread before obvious signs or symptoms appear, much like COVID-19.

It is particularly concerning right now because the spread of RSV and other seasonal respiratory illnesses like influenza (flu) has started earlier than usual this year. We know that COVID-19 is still circulating, too. Mitigation strategies for COVID-19, like strict hand washing and sanitation practices, along with masking, can limit the spread of viral illnesses, such as RSV and flu, in child care settings.

RSV-Like Signs and Symptoms Child Care Providers Need To Report to Parents

Respiratory Signs/Symptoms

URGENT Signs/Symptoms

Parents need to communicate any of these signs/symptoms to a medical provider:

Child must be seen immediately by a medical provider if any of these occur:

Runny nose

Fast breathing

Poor feeding

Flaring of the nostrils


Head bobbing with breathing


Rhythmic grunting during breathing

Cough (dry or wet sounding)

Belly breathing, tugging between the ribs, and/or the lower neck

Fussiness, irritability


Fever (temperature of 100.4 or higher)


Skin/lips turning blue (cyanosis)

Recommendations from the PA Department of Health (PA DOH)

PA DOH recommends “persons with respiratory symptoms should stay home while ill, especially those who work in child care, even if they have tested negative for SARS-CoV-2, to prevent exposing vulnerable and high-risk groups to RSV.”


PA DOH recommends “encouraging parents and caregivers to keep young children with respiratory illnesses out of child care, even if they have tested negative for SARS-CoV-2.” (See PAHAN 668-10-27-ADV: 2022-PAHAN-668-10-27-RSV_1.pdf)

While there are no vaccines yet to prevent RSV infections, PA DOH strongly recommends seasonal influenza vaccine and COVID-19 vaccine to help protect persons six months and older, especially individuals with high risk for complications of respiratory infections.


Contact your Certification Representative with questions about DHS Regulatory Requirements for managing infectious diseases in child care settings.  

Additional Resources