Children's Hospital Colorado

Bronchiolitis-RSV

  • Your child has been diagnosed with bronchiolitis
  • It's an infection of the smallest airways in the lungs
  • Caused by a virus called RSV
  • Wheezing during the first 2 years of life is often caused by bronchiolitis
  • You wonder if your child needs to be seen again

Symptoms of Bronchiolitis

  • Wheezing is the main symptom that helps with diagnosis. 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 work hard to push air out).
  • Coughing (may cough up very sticky mucus).
  • Fever and a runny nose often start before the breathing problems.
  • The average age for getting bronchiolitis is 6 months (range: birth to 2 years).
  • Symptoms are like asthma.
  • About 30% of children with bronchiolitis later do develop asthma. This is more likely if they have close family members with asthma. Also likely if they have bronchiolitis more than 2 times.

Cause of Bronchiolitis

  • 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.

Trouble Breathing: How to Tell

Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about:

  • Struggling for each breath or short of breath.
  • Tight breathing so that your child can barely speak or cry.
  • Ribs are pulling in with each breath (called retractions).
  • Breathing has become noisy (such as wheezes).
  • Breathing is much faster than normal.
  • Lips or face turn a blue color.

Diagnosis of Bronchiolitis

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

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.

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Passed out or stopped breathing
  • Lips or face are bluish when not coughing
  • You think your child has a life-threatening emergency

Go to ER Now

  • Your child looks like they did when hospitalized before with bronchiolitis

Call Doctor or Seek Care Now

  • Trouble breathing. Exception: if it happens only when coughing.
  • Lips or face have turned bluish, but only during coughing
  • Ribs are pulling in with each breath (retractions)
  • New harsh sound with breathing in (called stridor)
  • Wheezing (purring or whistling sound) is worse than when seen
  • Breathing is much faster than when seen
  • Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth, no tears.
  • Not alert when awake ("out of it")
  • High-risk child (such as chronic lung disease) and getting worse
  • Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.
  • Age less than 6 months old and worse in any way
  • Fever over 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Nonstop coughing spells
  • Trouble feeding worse than when seen
  • Earache or ear drainage
  • Fever lasts more than 3 days
  • Fever returns after being gone more than 24 hours
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Coughing causes vomiting 3 or more times
  • Mild wheezing sounds lasts more than 7 days
  • Cough lasts more than 3 weeks
  • You have other questions or concerns

Self Care at Home

  • Bronchiolitis same or better than when last seen

Care Advice for Bronchiolitis

  1. What You Should Know About Bronchiolitis:
    • 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 getting tight.
    • If you were given a follow-up appointment, be sure to keep it.
    • Here is some care advice that should help.
  2. 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 instructed.
    • Keep giving the medicine until your child's wheezing is gone for 24 hours.
  3. 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.
  4. 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 mucus and loosen the cough. If you don't have any honey, you can use corn syrup.
  5. 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.
  6. Humidifier:
    • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
  7. 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.
  8. Avoid Tobacco Smoke:
    • Tobacco smoke makes coughs and wheezing much worse.
    • Don't let anyone smoke around your child.
  9. What to Expect:
    • Wheezing and rapid breathing most often improve over 2 or 3 days.
    • Mild wheezing sounds can last up to 1 week.
    • Coughing may last 3 weeks.
    • Some children (2%) with bronchiolitis need to be in the hospital. These children need oxygen or fluids given through a vein.
  10. Return to Child Care:
    • Your child can return to child care after the wheezing and fever are gone.
  11. Call Your Doctor If:
    • Trouble breathing occurs
    • Wheezing gets worse (becomes tight)
    • Trouble feeding occurs
    • Fever lasts more than 3 days
    • You think your child needs to be seen
    • Your child becomes worse

Disclaimer

The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

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