By Dr. Rebecca Winderman M.D.

Every year thousands of young previously healthy children across the country are hospitalized for breathing difficulties due to a virus called Respiratory Syncytial Virus (RSV) which causes bronchiolitis (inflammation of the small airways). 

The virus usually presents itself like the common cold with a cough and runny nose, however it can quickly take a turn for the worse causing breathing difficulties requiring hospitalizations and occasionally mechanical ventilation. The virus usually takes a 10 day course, with days 5-7 of illness being the worst.

People often visit their pediatricians within the first few days of illness when they do not appear their sickest and are diagnosed with a common cold and sent home. As a result of the evolving nature of the virus these same patients who were seen by their pediatrician may find themselves in a hospital days after in moderate to severe respiratory distress. Therefore it is important for parents to have an understanding of some of the basics regarding the virus and what to expect in terms of anticipatory guidance.

RSV Bronchiolitis is the most common cause of lower respiratory tract infections among young children usually under 2 years of age, in the US and worldwide. The virus usually impacts premature babies the most severely but in recent years full term babies have also become equally affected. In New York RSV season occurs from December to February. Most of the time the virus presents itself as common cold symptoms which go away on its own. It can very quickly escalate into respiratory distress and arrest leading to hospitalization. The virus affects the small branching tubes of the lungs that carry air into and out of the lungs. When these tubes are infected, they become swollen and full of mucous which in turn makes it difficult to breathe.

RSV Bronchiolitis usually starts off with regular cold symptoms such as stuffy or runny nose, cough, fever (temperature higher than 100.4 measured rectally), and a decreased appetite. As it progresses patients often develop fast or labored breathing, wheezing and severe cough. Important symptoms to look out for are the following: working hard to breathe, grunting, nostrils get bigger when breathing in or out (flaring), fever more than 2 days, or a decreased number of wet diapers. If a child experiences any of these symptoms you should seek medical attention immediately. Any signs of respiratory distress such as fast breathing, labored breathing, grunting, or turning blue should prompt an immediate phone call to 911 or hatzolah.

RSV Bronchiolitis usually runs a 10 day course with days 5 to 7 being the worse and then the child should start to improve. Diagnosing RSV Bronchiolitis requires a nasal swab, and because it’s viral antibiotics are not useful. Medical interventions are often necessary due to signs of respiratory distress.

What can you do to help your child feel better? If your child does not fall into the category of needing medical attention there are a few things that you can do to help your child:
Make sure your child is getting enough fluids (this can be measured by the number of wet diapers the baby is producing).
Use a humidifier in your child’s bedroom.
Keep the fever well controlled with Tylenol or Motrin (call your doctor for dosing).
Use saline nose spray or drops and suction mucus with a nose bulb syringe twice daily.
Most importantly you must monitor your child for signs of difficulty breathing. (if your child’s ribs are visible while breathing, your child is using his/her stomach to breathe, your child’s nostrils are flaring while breathing, or your child is grunting)

How can I prevent bronchiolitis? The virus is spread easily from person to person via air droplets (i.e. coughing or sneezing), therefore:
Wash your hands and your child’s hands often with soap and water.
Staying away from other people who are sick.
Do not send your kid to daycare or school if your child has any of these symptoms.

In general if you have any doubt about your child’s symptoms you should seek medical attention. 

Written for the 2014-15 winter season