DIET & NUTRITION 
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GUIDELINES/RECOMMENDATIONS ✅ Guideline Update
The American Academy of Pediatrics updated its recommendations for respiratory syncytial virus (RSV) prevention in infants and young children. Although first-season immunization recommendations remain unchanged, the guidance expands eligibility for children aged 8 to 19 months entering a second RSV season by adding several new high-risk groups. The update broadens access to RSV immunization for children with select prematurity, congenital, pulmonary, neuromuscular, and chromosomal risk factors.
Clinical Considerations
- RSV immunization remains recommended for eligible infants younger than 8 months entering their first RSV season unless protected through maternal RSV vaccination.
- Children born at less than 32 weeks’ gestation now qualify for second-season immunization regardless of ongoing medication use or respiratory support needs.
- Hemodynamically significant congenital heart disease has been added to second-season eligibility criteria.
- Children with anatomic pulmonary abnormalities or neuromuscular disorders that increase RSV risk are now included among high-risk populations.
- Down syndrome and other chromosomal differences associated with increased RSV severity have been added to eligibility recommendations.
- Existing indications remain unchanged, including severe immunocompromise, cystic fibrosis with severe disease, and chronic lung disease of prematurity requiring ongoing medical support.
Practice Applications
- Review second-season RSV eligibility criteria before seasonal RSV circulation begins.
- Identify previously ineligible children who may now qualify under the expanded high-risk definition.
- Discuss RSV prevention options with families of children with congenital, chromosomal, pulmonary, and neuromuscular conditions.
- Coordinate seasonal immunization planning for eligible infants and high-risk toddlers entering a second RSV season.
- Monitor future regulatory decisions regarding expanded second-season indications for clesrovimab.
