Bronchiolitis

Bronchiolitis is an acute viral illness of the lower respiratory tract most often signaled by the onset of rapid, noisy breathing.

Bronchiolitis most often occurs during the fall, winter, and early spring months. The term bronchiolitis refers to a viral infection of the lower respiratory tract. There are a number of different viruses that cause bronchiolitis, the most common being RSV (respiratory syncitial virus). This infection primarily involves children under the age of 2 years. Eighty percent of all children are infected within the first 12 months of life. As with most viral infections, the illness is spread by direct contact with infected secretions.

Bronchiolitis begins with symptoms of a usual “cold” (runny nose, thick nasal secretions, cough) that quickly moves into the chest. The early cough of the illness progresses to a deep, wet cough of increasing frequency. It is often at this time that the infants and children develop noisy, “junky” breathing and possibly even high pitched whistling sounds (wheezing), as well as, rapid breathing. This cough and congestion is the result of the virus causing a large amount of mucous production in the lower airways. Other symptoms include hoarseness, low grade fever, and restlessness.

“What can I expect?”

Bronchiolitis begins as a regular cold and quickly develops into a deeper, thicker cough. Most cases are mild and are easily treated at home. The infants and children often sound worse than they appear – “the happy wheezer.” Patients with bronchiolitis usually improve within 3 to 5 days. The remainder of the illness is manifested by the cough which may take up to one to two weeks to improve.

“When should I worry?”

Bronchiolitis involves the infection and congestion of the lower airway, so most of the worrisome symptoms will be related to breathing – some include flaring of the nostrils, rapid breathing, tugging between the ribs when breathing, bluish lips, inability to take feeds, listlessness, and irritability. As with any illness, monitor your child’s fluid intake, output, and activity level. Please call us if any of these symptoms become apparent.

“What can I do at home?”

Some of the most useful home remedies involve helping to keep your child comfortable – a cool mist humidifier to loosen secretions, nasal saline drops to help clear nasal debris, and elevation of the head of the bed for sleep. Acetaminophen (Tylenol) and Ibuprofen (Motrin, Advil) are useful for fever. Fluids are important for hydration.

“What will the physician/nurse practitioner prescribe ?”

Most children will require nothing more than supportive care and close observation at home. As bronchiolitis is a viral infection, antibiotics are not helpful and do not change the duration of symptoms. Some children with pronounced wheezing may benefit from a bronchodilator (breathing treatment) to help control the wheezing – some respond to the medicine though most do not. If your provider feels like it might be useful in your child’s case, we will administer a trial dosing in the office, and, if it helps, can be given by the family at home for a few days.

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