American Academy of Pediatrics Publishes Interim Guidance on Pediatric RSV


The updated recommendations during a surge in cases emphasize the need to enhance emergency readiness daily to not interrupt continuous care of children’s mental and physical well-being.

The American Academy of Pediatrics (AAP) has published 2 sets of interim guidance on prophylaxis for children at high risk of complications from respiratory syncytial virus (RSV) and in handling the surge of individuals filling doctor’s offices, emergency departments (EDs), and hospital beds.

The updated guidance for the care of patients during the surge was focused on inpatient and outpatient settings and emphasized the need to enhance emergency readiness on a day-to-day basis to avoid interrupting continuous care of children’s mental and physical well-being.

In the updated RSV guidance, the organization supports providing eligible infants with more than 5 consecutive doses of palivizumab for those in regions with intense and widespread RSV circulation.

Palivizumab is a monoclonal antibody that helps prevent severe lung infections, which can be provided to eligible infants throughout the 2022-2023 RSV season, the AAP said.

Infants who are eligible for palivizumab include some pre-term infants who are in their first RSV seasons as well as other infants with certain chronic conditions. Other ways to prevent RSV can include keeping infants away from large groups, secondhand smoke, and secondhand smoke. The AAP also recommends washing hands thoroughly to help keep infants safe.

Additionally, there is no cure for RSV, and medications, including antibiotics and steroids, are not effective against the virus.

However, influenza, RSV, and other respiratory illnesses for children can be managed them safely at home.

“For most children, treating RSV at home is similar to treating a bad cold,” Sean O’Leary, MD, MPH, FAAP, chair of the AAP Committee on Infectious Diseases, said in a statement.

“In children older than 6 months, acetaminophen or ibuprofen can help with low-grade fevers,” he said. “If your child seems to be struggling to breathe, such as if they seem to be breathing too fast or their chest is sucking in with each breath, you should call your pediatrician right away.”

O’Leary also suggested that families be vaccinated against COVID-19 and influenza, which can help prevent the most severe disease and hospitalization.

Furthermore, there should be no delays in chronic disease management, immunizations, or routine pediatric care, the AAP said.

Staff members who typically assist adults can be cross trained to help provide care to pediatric patients, the AAP said.

Referrals to hospitals should also be reserved for children whose illness severity or associated medical disorders require a higher level of care to avoid ED overcrowding, extended wait times, and delay of care, according to the AAP.

Children with medical complexity and special health care needs are affected during surge events, the AAP said.

That includes COVID-19, influenza, RSV, and other infectious diseases, as well as an influx of pediatric individuals with mental health concerns.

Previously the AAP and the Children’s Hospital Association urged Xavier Becerra, secretary of the US Health & Human Services department, and President Joseph R. Biden to declare a national emergency related to the continuing children’s mental health emergency and the surge of pediatric respiratory illnesses.


American Academy of Pediatrics offers guidance on RSV prophylaxis, handling surge of pediatric patients with respiratory infections. American Academy of Pediatrics. News release. November 18, 2022. Accessed December 13, 2022.

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