Bronchiolitis (Respiratory Syncytial Virus)

Definition

• Wheezing: a high-pitched whistling sound produced during breathing out
• Rapid breathing with a rate of over 40 breaths/minute
• Tight breathing (your child has to push the air out)
• Coughing, often with very sticky mucus
• Onset of lung symptoms often preceded by fever and a runny nose
• Lots of sticky nasal mucus is a problem
• An average age of 6 months, always less than 2 years
• Symptoms similar to asthma
• This diagnosis must be confirmed by a physician

Cause

The wheezing is caused by a narrowing of the smallest airways in the lung (bronchioles). This narrowing results from inflammation (swelling) caused by any of a number of viruses, usually the respiratory syncytial virus (RSV). RSV occurs in epidemics almost every winter. Whereas infants with RSV develop bronchiolitis, children over 2 years of age and adults just develop cold symptoms. This virus is found in nasal secretions of infected individuals. It is spread by sneezing or coughing at a range of less than 6 feet or by hand-to-nose or hand-to-eye contact. People do not develop permanent immunity to the virus.

Expected Course

Wheezing and tight breathing (difficulty breathing out) become worse for 2 or 3 days and then begin to improve. Overall, the wheezing lasts approximately 7 days and the cough about 14 days. The most common complication of bronchiolitis is an ear infection, occurring in some 20% of infants. Bacterial pneumonia is an uncommon complication. Only 1% or 2% of children with bronchiolitis are hospitalized because they need oxygen or intravenous fluids. In the long run, approximately 30% of the children who develop bronchiolitis go on to develop asthma. Recurrences of wheezing (asthma) occur mainly in children who come from families where close relatives have asthma. Asthma is very treatable with current medications.

Home Treatment For Bronchiolitis

Medicines

Some children with bronchiolitis respond to asthma medicines; others do not. Continue the bronchiolitis medicine until your child’s wheezing is gone for 24 hours. In addition, your child can be given acetaminophen every 4 to 6 hours if the fever is over 102°F (39°C).

Warm Fluids for Coughing Spasms

Coughing spasms are often caused by sticky secretions in the back of the throat. Warm liquids usually relax the airway and loosen the secretions. Offer warm lemonade, warm apple juice or warm herbal tea if your child is over 4 months old. In addition, breathing warm moist air helps to loosen the sticky mucus that may be choking your child. You can provide warm mist by placing a warm wet washcloth loosely over your child’s nose and mouth, or you can fill a humidifier with warm water and have your child breathe in the warm mist it produces. Avoid steam vaporizers because they can cause burns.

Humidity

Dry air tends to make coughs worse. Use a humidifier in your child’s bedroom. The new ultrasonic humidifiers not only have the advantage of quietness, but also kill molds and most bacteria that might be in the water.

Nasal Washes for a Blocked Nose

If the nose is blocked up, your child will not be able to drink from a bottle or nurse. Most stuffy noses are blocked by dry or sticky mucus. Suction alone cannot remove dry secretions. Warm tap water or saline nose drops (nasal washes) are better than any medicine you can buy for loosening up mucus. Place three drops of warm water or saline in each nostril. After about 1 minute, use a soft rubber suction bulb to suck it out. You can repeat this procedure several times until your child’s breathing through the nose becomes quiet and easy.

Feedings

Encourage your child to drink adequate fluids. Eating is often tiring, so offer your child formula or breast milk in smaller amounts at more frequent intervals. If your child vomits during a coughing spasm, feed the child again.

No Smoking

Tobacco smoke aggravates coughing. The incidence of wheezing increases greatly in children who have an RSV infection and are exposed to passive smoking. Don’t let anyone smoke around your child. In fact, try not to let anybody smoke inside your home.

Call our office immediately:

• Breathing becomes labored or difficult.
• Breathing becomes faster than 60 breaths/minute (when your child is not crying).
• Your child starts acting very sick.

Within 24 hours if:

• There is any suggestion of an earache.
• A fever lasts more than 3 days.
• You have other questions or concerns.