Respiratory syncytial virus is the major respiratory pathogen in infants and young children. Every year, this unique and ubiquitous virus accounts for substantial morbidity and occasional mortality in this age group. Until recently, therapy for respiratory syncytial virus infections was limited to supportive measures such as hydration, supplemental oxygen, and assisted ventilation. Therefore, the licensure of ribavirin in 1986 for treatment of respiratory syncytial virus infections raised hopes for specific and effective therapy. However, the use of ribavirin has been the subject of continuing controversy and debate. Despite at least eight controlled clinical trials involving collectively over 170 patients treated with ribavirin since 1983, no clear consensus has developed regarding which patients should be treated with ribavirin. Major issues are weaknesses in the design and methodology of studies that claim treatment efficacy, the clinical significance of the demonstrated treatment effects, potential teratogenicity to health care workers exposed to aerosolized ribavirin, and cost-effectiveness of the intervention. This review will explore each of these areas of controversy and consider the unanswered questions to which future research must be directed.