Signs and Symptoms of RSV and Bronchiolitis

Bronchiolitis is a lung infection that's usually caused by the respiratory syncytial virus (RSV), which produces swelling and mucus production in the small breathing tubes of your child's lungs. Infections are most common during the winter and typically affect children under two years of age. Symptoms can last from days to weeks, but most children are able to recover at home.

Symptoms

It takes from a few days to a week for symptoms to begin once your child develops an infection—what's known as the incubation period. After developing a runny and/or stuffy nose, a mild cough, and possibly a fever of 100.4 degrees or more, over the next few days, your child's cough will worsen and become more persistent.

The child will also develop other RSV symptoms like wheezing and difficulty breathing, including pauses of more than 15 to 20 seconds in between breaths. Breathing difficulties can lead to feeding problems and dehydration. Coughing may last for two weeks or longer, and wheezing usually lasts around a week. 

You should see your healthcare provider if your child is having difficulty breathing, especially if they are under the age of 12 months and/or was premature.

Causes

Bronchiolitis is usually spread from the secretions from another person that has RSV, either another infant with bronchiolitis or an adult who may just have a cold. RSV affects almost every child by two to three years of age, but other viruses like influenza and adenovirus sometimes cause bronchiolitis, too.

Certain factors can increase the chances of your child developing bronchiolitis. Among them:

• Babies under three months due to immature immune systems
• Premature birth
• Exposure to crowds, sick siblings, or children at daycare
• Compromised immune system
• Not being breastfed (as breast milk provides immunity to diseases)
• An underlying condition such as lung or heart disease
• Exposure to tobacco smoke

Treatment

There is no cure for bronchiolitis, although some children do improve with breathing treatments of albuterol nebulizer solution. Keep an eye on your child and monitor her symptoms to make sure she isn't getting worse.

You can also work to make your child more comfortable by giving her a pain and fever reliever such as Tylenol (acetaminophen), making sure she gets plenty of fluids, using a cool mist humidifier, and administering saline nasal drops with frequent suctioning to help relieve congestion. You can give your child Motrin (ibuprofen) if over six months of age

Antibiotics are not effective for bronchiolitis because the disease is caused by a virus and these drugs are only effective against bacteria. Your healthcare provider may prescribe an antibiotic if your child develops a secondary bacterial infection, such as an ear infection (common) or pneumonia (rare).

Some experts dispute the effectiveness of using corticosteroids as a treatment for bronchiolitis, but they may be used if your child also has asthma or reactive airway disease.

Prevention

Frequent hand washing, keeping surfaces in your home clean (especially those that sick people have touched), and avoiding others who are ill can decrease your child's chances of getting this common infection. In addition, you should be diligent about staying away from anyone who even has a cold for the first two months of your baby's life, especially if they are premature because the risk of getting RSV and developing severe bronchiolitis is higher.

Synagis (palivizumab) is a shot that can help protect certain infants and children 2 years old and younger who are at high risk of serious complications from RSV. It's given once a month during the RSV season. Palivizumab is not a vaccine and cannot cure or treat a child diagnosed with RSV. If your child is at very high risk for RSV infection, your pediatrician may discuss this option with you.

Influenza viruses can cause the clinical picture of bronchiolitis just like RSV, in addition to the more traditional flu illness. So, if your baby is 6 months old or older, consider getting a flu shot, which can help prevent bronchiolitis. Also, keep in mind that respiratory infections are not nearly as common in breastfed babies.

When to Get Help

If your child is recovering at home but is refusing to eat and/or drink for a long period of time, isn't urinating as often as usual, or vomits when coughing, call your healthcare provider right away. Contact your healthcare provider if your child develops a fever, which is a temperature of 100.4 degrees or above, especially if the child is less than three months old.

While most children can be treated at home when they have bronchiolitis, around 3% do need to be hospitalized for treatment and monitoring. If your child has RSV and seems to be getting worse, you should seek emergency care right away.

Treatments in the hospital may include supplemental oxygen, intravenous (IV) fluids, chest physiotherapy (CPT), and frequent suctioning of excess mucus and sputum. Occasionally, a child with severe difficulty breathing may need to be intubated and placed on a ventilator.

Your child will need to be isolated in order to avoid spreading RSV to others, which means siblings and friends won't be able to visit (though you will).