Advice: Bronchiolitis

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Bronchiolitis

Bronchiolitis basics

Bronchiolitis is a lower respiratory tract infection typically caused by the Respiratory Syncytial Virus (RSV) though other viruses can cause it, too. RSV bronchiolitis is classically most prevalent from December through March, though the pandemic has caused very unpredictable timing over the past few years.
Bronchiolitis is caused by excessive mucus production in the nose, throat, and lungs. This creates symptoms like runny nose, cough that is typically ‘junky’, increased work of breathing and/or rapid breathing, fever, and fatigue.
Certain children can get very sick from bronchiolitis. Specifically, infants less than six months old, infants born premature, infants with underlying medical conditions like heart disease, chronic lung disease, neurodevelopmental disorders, and others.
RSV infection in older children typically causes much milder cold-like symptoms. Most healthy older children have a very low risk of becoming very ill from RSV.
Symptoms of RSV bronchiolitis typically worsens until the fifth day of illness and then slowly improves. Cough, especially in the mornings and overnight, will linger for up to 3-4 weeks.
Prevention is Key! There are new vaccines and medications that can help protect your babies against RSV. Abrysvo is a new vaccine for pregnant women that passes RSV protection to their babies when born. Beyfortus is a new monoclonal antibody given to babies less than 8 months old that provides long-lasting protection against RSV!

Treatment

Bronchiolitis is caused by a viral infection. Antibiotics, steroids, and breathing treatments are generally not helpful in the treatment of bronchiolitis.
Fever/Pain control: Use Acetaminophen and Ibuprofen for fever control. Fevers are not dangerous, but they make your child feel bad which impacts their ability to drink and stay hydrated. Acetaminophen can be used every 4 - 6 hours (up to 4 times/day). Ibuprofen may also be used every 6 hours if your child is older than 6 months. These may be alternated or given together.
Hydration: Encourage small/frequent sips of formula/breast milk, Pedialyte, and/or and water (if older than 6 months). Make sure child is peeing at least 4 times in 24 hours
Nasal hygiene: Frequent nasal suctioning with a bulb suction or ‘NoseFrida’, humidifiers, steam showers all help clear the nose and help with breathing. This is the most important and effective treatment for bronchiolitis.
Cough: Mucous clearance with nasal hygiene will also help with cough. Honey, for children older than 1 year, is the only recommended cough medication.

Expectations for Improvement

Symptoms associated with RSV bronchiolitis tend to worsen from onset through Day 5 of illness and slowly improve from there. Non-RSV bronchiolitis may improve more quickly.
Congestion and cough, especially overnight and in the mornings, often linger for 3-4 weeks after RSV bronchiolitis, or 2-3 weeks after non-RSV bronchiolitis. It takes time for the body to 'clean-up' the mucous, debris, and inflammation in the nose and airways caused by the virus.
Your child is NOT contagious during this 'clean-up' phase and may return to school and activities

When to seek care

If your child is less than 3 months old and has any fever.
If your child is less than 6 months or has any high risk medical conditions and showing signs of bronchiolitis.
If fever lasts more than 4-5 days.
If your child is not urinating at least 4 times/day
If your child is breathing faster than normal, harder than normal, or has retractions or breathing has worsened since your last visit
If your child develops ear pain.
If your child has worsened or developed new symptoms since your last visit
If you are concerned.

When to go to the Emergency Departent

If your child is in respiratory distress (nostrils flaring, ribs showing, significant belly breathing, head bobbing, grunting, or very fast breathing)
If your child is lethargic or difficult to arouse
If your child is showing signs of severe dehydration: lethargy, little/no urine output, dry lips, sunken fontanelle (soft spot)
If you are worried

Additional Resrouces

Potomac Pediatrics will always be fully focused on helping your child and you to overcome any healthcare hurdle, with innovative, comprehensive and compassionate care.