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Doc Talk Bronchiolitis a common illness in young children

  • Published Tuesday, Jan. 28, 2014, at 12 a.m.

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You may have heard that a lot of children are hospitalized for RSV this time of year. RSV outbreaks usually occur from November to April, peaking in January and February.

RSV stands for respiratory syncytial virus. It causes a lower respiratory tract infection called bronchiolitis in children younger than 2 years old. Bronchiolitis is not the same as bronchitis.

Bronchiolitis caused by RSV leads to inflammation of the small airways (bronchioles) in the lungs. The inflammation partially or completely blocks the airways, causing wheezing – a whistling sound heard as the child breathes out. Less oxygen enters the lungs, potentially causing a decrease in the oxygen level of blood. To increase the oxygen level, the child tends to breathe faster.

Bronchiolitis is a common illness and is the leading cause of hospitalization in infants and young children. Virtually everyone will be infected with RSV by the age of 3 years, but only 3 percent will require hospitalization. It is common to be infected more than once, even in the same RSV season; however, subsequent infections are usually milder. Children who are older than 2 years typically do not develop bronchiolitis.

Bronchiolitis usually develops following one to three days of common cold symptoms that include nasal congestion and discharge, a mild cough, fever and decreased appetite. As the viral infection progresses and the lower airways are inflamed, other symptoms may develop, including rapid breathing, wheezing, persistent coughing and difficulty feeding due to nasal congestion and rapid breathing. The child can become dehydrated. Apnea – a pause in breathing for more than 15 or 20 seconds – can be the first sign of bronchiolitis. Parents should contact their child’s health care provider to determine if an office visit is needed.

Signs of severe bronchiolitis include sucking in of the skin around the ribs and the base of the throat, flaring of the nostrils and grunting. The effort required to breathe faster and harder is tiring. Children who have severe cases may be unable to continue breathing on their own.

Parents should seek immediate medical attention if the child has severe symptoms. A child who is grunting, appears to be tiring, struggling to breathe, is severely agitated or has blue-colored skin needs urgent medical attention. Do not drive the child to the hospital; call 911 instead.

There is no cure for bronchiolitis. Antibiotics do not affect viruses. However, antibiotics may be necessary if the bronchiolitis is complicated by a bacterial infection, such as an ear infection or bacterial pneumonia, which is rare. Treatment of bronchiolitis is aimed at the symptoms.

Treatment at home usually includes making sure the child drinks enough liquids and using saline nose drops for congestion and runny nose. Acetaminophen, such as Tylenol, is used to treat fever. Ibuprofen, such as Advil, can be given to ease discomfort in children older than 6 months. Aspirin should not be given to any child younger than 18 years.

Cough medicines and decongestants are not helpful. Coughing is one way the body clears the lungs, and it normally does not need to be treated. As the lungs heal, the coughing lessens. Smoking in the home or around the child should be avoided. In some cases, an inhaled medication is recommended to open the child’s airways. Keeping the child’s head elevated with an extra pillow may reduce the work of breathing. Pillows should not be used with infants younger than 12 months.

Children who are hospitalized with bronchiolitis may be given supplemental oxygen by placing a tube (called a nasal cannula) under the child’s nose or by placing a face mask over the nose and mouth. If a child is severely ill and unable to breathe, a ventilator may be used until the child improves.

Most children with bronchiolitis who are otherwise healthy begin to improve within two to five days.

There are several ways to prevent severe bronchiolitis:

• Avoid smoking around the child.

• Wash hands frequently or use alcohol-based hand sanitizer, especially before touching an infant.

• Avoid adults and children who have upper respiratory infection.

• Infants born prematurely or who have specific types of chronic lung disease may be given a special medication to protect the lungs from severe infection by RSV.

Your child’s health care provider can give you more information about RSV and ways to keep your child’s lungs healthy.

Manish Bajracharya is a pediatric critical care specialist with Wesley Medical Center.

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