Bronchiolitis

What is Bronchiolitis?

Bronchiolitis is infection and inflammation (swelling) of the small breathing tubes (bronchioles) in the lung.

What causes Bronchiolitis?

This condition is most often due to a viral infection of the small airways, which makes it difficult for your child to breathe.  Bronchiolitis most often occurs children less than 2 years of age, with infants under 6 months of age being most severely infected.

From October to March, this illness is most often due to infection with Respiratory Syncytial Virus (RSV).  Older children and adults can be infected with this virus, but it usually only causes cold symptoms.  The virus is found in nasal secretions, and can be spread via respiratory droplets (sneezing or coughing) or direct contact (hand-to-mouth or hand-to-eye).  Frequent hand washing is key to preventing spreading of this virus.

What is the usual course of the illness?

This illness often begins with fever and a runny nose.  These symptoms are quickly followed by lung symptoms, which include wheezing and difficulty breathing.  You may notice that your child is breathing rapidly (faster than 40 breaths per minute), and working harder to breathe (nostrils flaring, retractions of the muscles in the rib cage).  Coughing is also commonly seen.

These symptoms tend to worsen for a few days, but then improve gradually.  Overall, the symptoms last about 7 days, but the coughing may persist for up to 14 days.

Ear infections can be a complication of bronchiolitis.  Up to 1-2% of children may require hospitalization for oxygen or intravenous fluids.  A long-term complication of bronchiolitis is asthma in up to 30% of children.

What is appropriate management of Bronchiolitis?

1.  Medications:

-Bronchiolitis is a viral infection, and antibiotics will not treat the infection.

-You may use acetominophen (Tylenol) or ibuprofen (Motrin or Advil) in children older than 6 months) to treat your child's fever.  No infant under 4 months of age should be given any medication without consulting your doctor.

-Occasionally, your doctor may use an asthma medication (Albuterol) to treat the wheezing.  Since only a very small percentage of children with bronchiolitis are helped by this medication, your doctor may not use it.

2.  Humidity:

-Dry air will often aggravate the cough

-A humidifier (rather than a vaporizer) will help keep the air moist, and thus lessen the cough somewhat.  It may also help to loosen up the thick mucus that is causing the cough.

3.  Saline nose drops and the bulb syringe:

-Due to the congestion that is seen with this infection, your child may have difficulty feeding.  Keeping your child's nose relatively free of secretions will help with feeding and resting more comfortably.

-Use saline drops (1-2 drops/nostril), wait about 30 sec. to 1 min., and then use the bulb syringe to suction.

-You can do this as often as you need to, but be aware that you can cause nose bleeds if you are too aggressive!

4.  Fluids/Feeding:

-As previously stated your child will likely not be as interested in feeding due to the effort required.  You must encourage small, frequent feeds.

-Monitor closely for signs and symptoms of dehydration: decreased urine output, no tears when crying, inside of mouth looking dry.

-If your child vomits because of a coughing spasm, wait about 30 minutes and feed again, as tolerated.

5.  NO SMOKING:

-Smoke will aggravate the coughing spasms and wheezing, so please do not smoke or let anyone else smoke around your child.  If you must smoke, go outside, since smoke can travel through the ventilating system inside your home.

Call our office IMMEDIATELY for the following:

-Your child is working harder to breathe (nostrils flaring consistently, severe pulling in muscles of rib cage).

-Your child is breathing faster than 60 breaths/minute (when not crying).

-Any bluish discoloration of the lips or around the mouth.

-Any grunting noises or "see-saw" breathing (the stomach and chest are moving in opposite directions when your child breathes).