Bronchiolitis is an infection of the lower respiratory tract, most commonly caused by RSV (respiratory syncytial virus). Seasonal outbreaks of the infection typically occur from November through April in the northern hemisphere and from May through September in the southern hemisphere. By 2 years of age, almost all children have been infected by RSV; unfortunately, long-lasting immunity doesn’t occur after infection, and reinfection is common, but less severe.
Initially, RSV will present with typical cold symptoms – fever, runny nose, watery eyes, and cough, usually for 1-2 days. The infection then presents with lower airway involvement, characterized by wheezing and rapid breathing (tachypnea). A child with more severe breathing problems may present with flaring of nostrils, rib pulling (retractions), ‘crackles’, (rales), prolonged exhaling, and even breathing cessation (apnea). Many children who have RSV bronchiolitis will continue to have recurrent wheezing for years to come.
Care is usually supportive, as it has been shown that medications typically used to treat wheezing such as albuterol and steroids are ineffective at treating bronchiolitis. Parents can help the baby to breathe easier by keeping the baby’s nasal passage as clear as possible with saline drops and a nasal aspirator. A humidifier at the side of the crib can also help thin airway secretions. Feeding is another area of concern for babies with bronchiolitis, as airway congestion and narrowing can make it even more difficult for the baby to feed properly.
After a baby is diagnosed with RSV bronchiolitis in the office, close follow up is essential. Typically, babies will have more breathing problems a few days after diagnosis, and the cough could persist for a few weeks.
If a baby is showing signs of labored breathing, hospitalization may be necessary for close monitoring and to receive extra oxygen. The oxygen level in the bloodstream can accurately and painlessly be measured with a probe placed on the finger or toe. A reading of less than 90% will be associated with respiratory distress requiring supplemental, humidified oxygen for the baby in a hospital setting
In summary, RSV is an extremely common winter virus, which can cause breathing problems for infants. Caregivers need to be able to recognize signs of respiratory distress and to contact their healthcare providers if they suspect their baby is having difficulty breathing.
Mark C. Garabedian, M.D., F.A.A.P.
Dr. Garabedian received his medical degree from New York Medical College and completed his residency in Pediatrics at North Shore University Hospital and Cornell University Medical Center. He is board certified by the American Academy of Pediatrics. Prior to joining Bon Secours Medical Group, Dr. Garabedian was in private practice in Southampton, New York, for 16 years.