Bronchiolitis is a very common condition in children under two. It’s commonly referred to as “RSV,” which is one of many viruses that can cause bronchiolitis.
Learn more about bronchiolitis – symptoms, tips for managing it at home, when to seek medical care, and what interventions there are.
Check out the PedsDocTalk YouTube Video: RSV in Babies and Kids, for more detailed information and guidance on bronchiolitis, RSV, symptoms, signs of difficulty breathing, diagnosis, what to monitor at home, and what happens in the ER or office for bronchiolitis, prescriptions, and how to prevent transmission.
Bronchiolitis is an infection that causes the small tubes of the lungs to get inflamed (or swollen).
This makes it harder for babies to breathe. It is more common in infants or younger children under two because of their smaller airways. Bronchiolitis is different than bronchitis. Bronchitis is something that we see in adults but children, especially children under two, rarely or never get bronchitis.
Bronchiolitis is commonly referred to as RSV.
RSV is the Respiratory Syncytial Virus. It is one of the viruses that can cause bronchiolitis. Bronchiolitis is a medical condition that can be caused by multiple viruses. Things like the flu, rhinovirus and enterovirus, etc. can all cause bronchiolitis. RSV is one of the most common viruses that cause this condition. It is notorious for causing bronchiolitis because RSV causes a lot of congestion, which causes a lot of mucus. This causes a lot of inflammation that can affect the bronchioles leading to bronchiolitis. RSV in adults can seem like a very bad cold with a lot of congestion and maybe a cough. In children, especially infants and toddlers under two, it can cause difficulty breathing and wheezing. Not all infants with RSV will develop bronchiolitis symptoms, but some kids do.
What time of year does it happen?
The younger the child, the more concerned we are going to be with RSV and bronchiolitis. This has to do with their anatomy and the size of their airways. If an adult gets RSV, they’re likely going to be okay because their airway (including the bronchioles) are much larger. However, a baby and a toddler can have a harder time clearing that mucus. This can lead to the complications of bronchiolitis. A typical RSV season runs from late fall to winter with a peak usually in February.
Interestingly enough, states like Florida see their peak much earlier so their RSV season ends by November. Because of the pandemic, we are seeing shifts in the season of RSV.
What are the symptoms?
Bronchiolitis is a pretty classic presentation. It can start like a common cold that looks like a runny or stuffy nose with or without fever. By day two or three, the child may have shortness of breath, difficulty breathing and their cough may be getting worse. Think of it as a cold that has gone deeper into the chest. It’s not bacterial that needs antibiotics; it’s a virus that has caused so much congestion and inflammation that it’s impacting the bronchioles.
Symptoms can appear anywhere from two to eight days after initial exposure. The duration of symptoms can vary child by child. Watch out for that day two to three where we see that difficulty breathing start to peak. If you’re noticing difficulty breathing on day 2 or 3 or even day 4 of illness, seek medical attention.
Is it contagious?
RSV is spread by person-to-person contact or touching shared services. You can return to school or daycare once your child is fever-free without any medicine for 24 hours. This means eating, drinking and pretty much being close to baseline.
What to watch out for
RSV is diagnosed by clinical presentation. If your child is sent home with bronchiolitis, we will ask you to monitor their breathing difficulty, hydration and fever. If anything changes or you are concerned, seek medical attention. Watch my YouTube videos on cough and cold symptoms and fever 101 for more information.
- Overall well-being? If your child is very mildly labored (meaning that they’re comfortable but you see some tugging in their chest), they’re hydrated, their oxygen saturations are normal and their fever is there, then your child’s clinician may just recommend nasal suctioning. This helps alleviate that mucus from the nose. They may recommend a humidifier, too.
- Dehydrated? If your child is dehydrated and not making as many wet diapers or seems fragile or listless, seek medical attention.
- Difficulty breathing? If your child is having severe difficulty breathing or looking dehydrated, your child may be admitted for observation to make sure that their breathing status and hydration improves.
- Listless or low energy? If your child is very listless and having very low energy, I’d go to the emergency room. They will evaluate if your child needs IV fluids and if they need any support for oxygen for their breathing.
- Albuterol/Saline nebs-In some situations, the clinician may trial albuterol or saline nebs. This is older recommendations, however has clinically helped some children who are having difficulty breathing. Follow your clinician’s guidance as they will discuss benefit and risk of any intervention.
- Nasal Cannula – If a child is not really working hard to breathe but has a lower oxygen they may recommend oxygen via something called a nasal cannula – this is something that goes into the nose and helps deliver oxygen to support the lungs.
- CPAP Machine – In cases where the child is having a lot of difficulty breathing there may be other interventions, like a CPAP machine.
- Intubation – In very severe cases it may be something called intubation. Intubation is where a breathing tube is placed to support the child while they recover.
Remember bronchiolitis is usually caused by a viral process – so there’s no antibiotic that is needed but we need to support the child so their body can heal itself. For this reason, things like intubation and oxygen support the child so that their body can heal and that you all can go home! Another possibility is something called nebulized saline where saline can be administered through a nebulizer machine and, can, in many ways, help break up that mucus.
If your child has to go to the hospital, remember this!
If you go to the hospital and your child needs admission, rest assured the reason for this admission is to monitor all the things. Sometimes being in the hospital can be the best thing for your child so that they can recover. I know as a mom that it can be very scary when your child is admitted to a hospital but sometimes it can be the best place for their body to heal. Over 50,000 children get admitted to the hospital with bronchiolitis every year.
The best preventions
The best prevention for RSV and bronchiolitis (and all of the other viruses that can cause this!) are the same things we would do for any respiratory virus. That includes things like hand washing, covering our nose and our mouth when we sneeze and limiting visitors (especially to our newborns and our premature babies!). If you must have visitors, you can have them wear a mask and confirm that no one is sick.
The take home message!
Remember, RSV is one of the many viruses that cause bronchiolitis but we do end up calling it the same thing! Other viruses can cause bronchiolitis. Always remember what to look out for – difficulty breathing, the dehydration, etc. – all of the things that we would want you to look out for for every virus! The best way that we can prevent the spread of RSV is good hand hygiene. The same things that we’re doing in this pandemic! Let’s always protect our youngest children. Bronchiolitis affects children usually under two years of age more so because their size of their airways. We want to do the best we can to reduce the risk!