Background Limited data are available on the economic costs of respiratory syncytial virus (RSV) infections among infants and young children in the United States. Methods We performed a systematic literature review of 10 key databases to identify studies published between 1 January 2014 and 2 August 2021 that reported RSV-related costs in US children aged 0–59 months. Costs were extracted and a systematic analysis was performed. Results Seventeen studies were included. Although an RSV hospitalization (RSVH) of an extremely premature infant costs 5.6 times that of a full-term infant (10214),full-terminfantsaccountedfor82%ofRSVHsand70%ofRSVHcosts.Medicaid-insuredinfantswere91%morelikelythancommerciallyinsuredinfantstobehospitalizedforRSVtreatmentintheirfirstyearoflife.Medicaidfinanced61%ofinfantRSVHs.Paying32%lessperhospitalizationthancommercialinsurance,Medicaidpaid51%ofinfantRSVHcosts.Infants’RSVtreatmentcosts 709.6 million annually, representing 187peroverallbirthand 227 per publicly funded birth. Conclusions Public sources pay for more than half of infants’ RSV medical costs, constituting the highest rate of RSVHs and the highest expenditure per birth. Full-term infants are the predominant source of infant RSVHs and costs.