Bronchiolitis/RSV

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Respiratory Syncytial Virus (RSV) is another viral illness that causes lower respiratory tract infection, particularly in children under age 2 years.  You might also hear it called bronchiolitis because it causes inflammation in a young child’s small airways called bronchioles. It is not the same as bronchitis that affects the larger airways in older children and adults. Bronchiolitis can be a serious illness for young infants and infants/toddlers who have heart or lung disease.

Bronchiolitis is a common cause of illness and a leading cause of hospitalization in infants and toddlers. The inflammation that occurs in the small airways can partially or completely block the airway. Sometimes it can cause wheezing – a whistling sound that you can hear when your child breathes out. When the airways are swollen because of the inflammation and filled with mucus, less oxygen can get to the body. They may have fever over 100.4F. Days 3 to 5 of the illness are the worst, and your infant usually slowly improves after that. It can take up to 14 days for your infant to get back to their norm.

Although RSV is now seen year round most outbreaks are from November to April. It usually peaks in January or February. By the time a child is 3 years of age they have had RSV at least once. You can get it more than once but subsequent infections are usually milder than the first. In older children and adults RSV resembles a cold with a lot of mucus and coughing. Infants who have had RSV will often wheeze every time they get any upper respiratory infection until they are 2 or 3 years of age.

There is no cure for bronchiolitis so we treat the symptoms, the difficulty breathing due to increased nasal congestion/mucus and the fever. One of the most important actions you can take is to suction your infant’s nostrils before they eat and before sleep. Place 5-6 saline drops or sprays in your infant’s nostrils then use the bulb suction to remove mucus. You may have to repeat the process a couple of times particularly when the mucus is thick. Always suction your infant before feeding, they can nurse or take a bottle better if they can breathe easy. Infants with specific types of lung disease, or who were born before 29 weeks or who have specific types of heart disease may be given a special medication called Synagis that helps protect the lungs from severe infection from RSV.

Things you can do to help prevent severe bronchiolitis include not smoking or allowing any smoking in your home. Exposure to secondhand smoke increases a child’s risk of respiratory illnesses. Keep your infant/child away from or at least limit contact with anyone with an upper respiratory infection. This is hard to do particularly if your child is in daycare. If you have a young infant always have anyone who picks them up, feeds them or plays with them wash their hands first. If your child is ill keep them out of daycare or school. Wipe down any toys or books or solid surfaces daily as the virus can live on surfaces for up to 72 hours.

When do you call your pediatrician or head to the ER? If your infant/child seems to be worsening, and the signs of a worsening condition include:  they are grunting, breathing rapidly, pausing in their breathing for more than 15-20 seconds, the skin between their ribs is sucking in with each breath, they appear to be tiring or if their lips, tip of their nose, fingernails or toenails are blue tinged. These are signs that your child needs urgent medical attention.