Is Your Child SickTM?

RSV-Bronchiolitis

Is this your child's symptom?

  • 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

If NOT, try one of these:


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.

When to Call for RSV-Bronchiolitis

When to Call for RSV-Bronchiolitis

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

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

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

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

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.

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