Signs and Symptoms of RSV and Bronchiolitis

What parents should know about this common childhood infection

In This Article

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.

Respiratory Syncytial Virus Symptoms
Verywell / Gary Ferster

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 doctor if your child is having difficulty breathing, especially if they are under the age of 12 months and/or was premature.

How to Recognize Difficulty Breathing

  • The child's breathing rate is faster than 60 to 80 breaths per minute.
  • The muscles between the ribs or at the base of the neck are moving in and out (called retractions).
  • There is nasal flaring.

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

Infants two to 12 months of age are the most likely to develop bronchiolitis. While older kids can also get an RSV infection, they don't normally develop bronchiolitis but instead have cold-like symptoms, such as a runny nose and cough.

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 doctor 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.

The U.S. Food and Drug Administration strongly advises against the use of over-the-counter decongestants and cough suppressants in kids two years of age and under due to the risk of severe side effects, including slowed breathing.

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. You should be especially diligent about staying away from anyone who even has a cold for the first two months of your baby's life, especially if he was premature because the risk of getting RSV and developing a serious case of bronchiolitis is higher.

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.

There is a preventative drug called Synagis (palivizumab) that can be given as a monthly injection during peak RSV season to premature babies and children at risk of complications, such as those with lung or heart disease.

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 doctor right away. Contact your doctor 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).

When to Call 911

Seek emergency care if any of the following occurs:

  • Rapid breathing (over 60 breaths per minute)
  • Significant pauses in breathing
  • A blue-ish tinge to your child's skin (cyanosis)
  • Fever over 100.4 F
  • Seeming worn out from the trying to breathe
  • Coughing with vomiting
  • Inability to breathe
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Article Sources

  1. U.S. Food and Drug Administration. When to Give Kids Medicine for Coughs and Colds. Silver Spring, Maryland; updated November 27, 2018.


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