Definition: Bronchiolitis is often diagnosed when your child has a cough that may have very sticky mucus and is often preceded by cold symptoms for a few days. There may be wheezing (a high-pitched whistling sound produced during exhalation) and rapid breathing with a rate over 40 breaths per minute. It usually occurs in children age 6 months to 2 years.
Cause: The wheezing is caused by a narrowing of the smallest airways in the lung (bronchioles). This narrowing results from inflammation caused by any number of viruses, including the respiratory syncytial virus (RSV). When children under age 2 have RSV, they may develop bronchiolitis. Older children and adults usually just develop a cold. The virus is found in the nasal secretions of infected individuals. When someone with a cold coughs or sneezes, the virus can be spread through the air directly to another person. The virus can also be spread onto surfaces such as tables, counters or children’s toys. If the surface is touched, the virus can be spread from the surface to the person who touched the object.
Expected course: An illness from RSV causes very large amounts of mucus from the nose. Young infants may have difficulty handling these large amounts of mucus and can have difficulty feeding or breathing. Wheezing and tight breathing from bronchiolitis become worse for 2 to 7 days and then begin to improve. Overall, the wheezing may last approximately 7 days and the cough up to 21 days.
Home Care and Treatment
Saline nose drops: Warm salt-water nose drops can help soothe the nasal passage and break up secretions that cause congestion. Saline nose drops may be purchased over the counter or made at home by mixing ¼ teaspoon of salt with 1 cup of water. Place 2-3 drops of the solution in each of your child’s nostrils every 30 minutes to an hour when your child is awake. When the drops run out of your child’s nose, wipe them away with a tissue.
Suctioning: Sometimes frequent and/or vigorous suctioning can cause swelling of the nasal airway and increased mucous production, which can cause an increase in congestion. Occasionally, however, parents find that their child is not able to handle the mucous and feel that suctioning is needed. If necessary, use of a blue bulb syringe may sometimes help clear the nose of children who cannot blow their nose. It is important to suction very gently after using the saline nose drops. Try to suction gently only once or twice a day and only if you feel it is really needed.
Humidifier: It should be noted that sometimes children do worse when a humidifier is used. If you find this to be the case, then you shouldn’t use a humidifier in your child’s treatment. Sometimes the use of a humidifier in your child’s bedroom can help thin the secretions that cause cough and congestion. In order to help prevent bacteria from growing in the water, change the water in the unit every day. We recommend a cool mist humidifier. If you have a vaporizer that uses heat, it is VERY important to use care so that your child is not at risk of being burned by the steam or the vaporizer.
Feedings: Encourage your child to drink adequate fluids. Eating is often tiring, so offer your child formula or breast milk in smaller amounts at more frequent intervals. Increased spitting up (regurgitation) is common. If your child spits up during a coughing spasm, allow your child to rest for about ½ hour and then offer the feed again. If spitting up continues, call our office.
Warm fluids for coughing spasms: Sometimes coughing spasms may be due to sticky mucus caught on the vocal cords. For older children, warm, clear fluids, such as apple juice or lemonade, may help relax the airway and loosen the mucus.
No smoking: Tobacco smoke aggravates coughing. The incidence of wheezing increases greatly in children who have an RSV infection and are exposed to passive smoking. Don’t let anybody smoke around your child. In fact, try not to let anybody smoke inside your home, car or at any other time.
Asthma medicines: Some children with bronchiolitis respond to asthma medicines; others do not. If your doctor prescribes asthma medicine for your child, continue the medicine until your child’s wheezing is gone for 24 hours.
Acetaminophen and Ibuprofen: Using over-the-counter pain and fever reducing medications such as Tylenol or Motrin (Motrin if your child is over 6 months of age) may help decrease your child’s fussiness and/or fever.
Cough syrups: Coughing is the body’s way to remove mucous from the throat and lungs and may help prevent development of pneumonia or bronchitis. We advise against using cough medications, especially in children under 1-2 years of age.
Camphor rubs: Medications that contain camphor, such as Vicks VapoRub, have been known to cause seizures in some children. We advise against the use of these medications.
Call the office…
• Breathing becomes labored or difficult
• Breathing becomes faster than 60 breaths per minute when your child is not crying. (To count the number of respirations, watch your child’s chest rise and fall, counting each breath he/she takes for a full minute.)
• The retractions (the chest and/or abdomen pulling in and out with each breath) become worse.
• Your child starts to act very sick.
During regular office hours if:
• Your child is not drinking enough fluids.
• A fever lasts more than 72 hours.
• The cough is worsening despite treatment as outlined.
• You have other questions or concerns.