Springdale Mason Pediatrics

Bronchiolitis (RSV)

Definition

  • A viral infection of the smallest airways in the lungs
  • Wheezing is the main symptom
  • Average age for getting bronchiolitis is 6 months (Range: birth to 2 years)

Call or Return If

  • Trouble breathing occurs
  • Wheezing gets worse (becomes tight)
  • Fever lasts more than 3 days
  • You think your child needs to be seen
  • Your child becomes worse

About This Topic

Symptoms

  • Wheezing is a high-pitched purring or whistling sound
  • You can hear it best when your child is breathing out
  • Rapid breathing at a rate of over 40 breaths per minute
  • Tight breathing (having to push the air out)
  • Coughing (may cough up very sticky mucus)
  • Fever and a runny nose often precede the breathing problems.
  • Symptoms are similar to asthma. About 30% of children with bronchiolitis later develop asthma. This is more likely if they have close relatives with asthma. Also likely if they have bronchiolitis more than 2 times.

Diagnosis

  • A doctor can diagnose bronchiolitis by listening to the chest with a stethoscope.

Cause

  • A narrowing of the smallest airways in the lung (bronchioles) causes wheezing. This narrowing results from swelling caused by a virus.
  • The respiratory syncytial virus (RSV) causes most bronchiolitis. RSV occurs in epidemics almost every winter.
  • People do not develop life-long immunity to the RSV virus. This means they can be infected many times.

Prevention of Spread to Others

  • Cover the nose and mouth with a tissue when coughing or sneezing.
  • Wash hands often. After coughing or sneezing are important times.

After Care Advice

Overview:
  • Bronchiolitis is common during the first 2 years of life.
  • Most children just have coughing and fast breathing.
  • Some develop wheezing. This means the lower airway is becoming tight.
  • Here is some care advice that should help.
Asthma Medicines:
  • Some children with bronchiolitis are helped by asthma-type medicines. Most children are not helped by these medicines.
  • If one has been prescribed for your child, give it as directed.
  • Continue the medicine until your child's wheezing is gone for 24 hours.
Coughing Fits or Spells:
  • Breathe warm mist (such as with shower running in a closed bathroom).
  • Give warm clear fluids to drink. Examples are apple juice and lemonade.
  • Amount. If 3 - 12 months of age, give 1 ounce (30 ml) each time. Limit to 4 times per day. If over 1 year of age, give as much as needed.
  • Reason: Both relax the airway and loosen up any phlegm.
Homemade Cough Medicine:
  • Do not give any over-the-counter cough medicine to children with wheezing. Instead, treat the cough using the these tips:
  • AGE 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 ml). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.
  • AGE 1 year and older: Use HONEY ½ to 1 teaspoon (2-5 ml) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup.
Nasal Saline To Open a Blocked Nose:
  • Your baby can't nurse or drink from a bottle if the nose is blocked. Suction alone can't remove dry or sticky mucus.
  • Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of bottled water or clean tap water. (If under 1 year old, use bottled water or boiled tap water.)
  • STEP 1: Put 3 drops in each nostril. (If age under 1 year old, use 1 drop).
  • STEP 2: Suction each nostril out while closing off the other nostril. Then, do the other side.
  • STEP 3: Repeat nose drops and suctioning until the discharge is clear.
  • How often: Do nasal saline when your child can't breathe through the nose. Limit: No more than 4 times per day.
  • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
  • Other option: use a warm shower to loosen mucus. Breathe in the moist air, then suction.
Humidifier:
  • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
Smaller Feedings:
  • Use small, frequent feedings whenever your child has the energy to drink.
  • Reason: Children with wheezing don't have enough energy for long feedings.
  • Offer enough fluids to prevent dehydration.
Avoid Tobacco Smoke:
  • Tobacco smoke makes coughs and wheezing much worse.
  • Don't let anyone smoke around your child.
What to Expect:
  • Wheezing and rapid breathing usually improve over 2 or 3 days.
  • Mild wheezing may come and go for up to a week.
  • Coughing may last 3 to 4 weeks.
  • Recovery is gradual. Symptoms last longer in young infants.
  • Some children (2%) with bronchiolitis need to be in the hospital. These children need oxygen or fluids given through a vein.
Return to Child Care:
  • Your child can return to child care after the wheezing and fever are gone.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2020 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
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