Respiratory syncytial virus (RSV) is the leading cause of viral respiratory tract infections in infants and young children. Although the course of RSV infection is usually benign, a small proportion of infants require mechanical ventilation for respiratory failure. We describe an eight-month-old previously healthy female who developed bilateral pneumothorax and acute respiratory distress syndrome (ARDS) secondary to RSV infection. Because of the severe hypoxemia, three doses of surfactant were administered and prone positioning was implemented for nine days. After a prolonged course of mechanical ventilation, she was extubated at day 21 and discharged from the pediatric intensive care unit four days later. We conclude that RSV infections can be severe, and some patients may require mechanical ventilation. Supportive therapies like surfactant replacement therapy and prone positioning can be beneficial in patients with ARDS in whom severe hypoxemia persists despite high levels of positive end-expiratory pressure (PEEP) and plateau pressures.