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 the age of 2 years. Symptoms can last from days to weeks, but most children are able to recover at home.

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 the age of 2 or 3 years, but other viruses like influenza and adenovirus sometimes cause bronchiolitis too.

Infants ages 2 to 12 months are the most likely to develop bronchiolitis. Although older children can also become infected with RSV, they don't normally develop bronchiolitis and their symptoms are similar to that of a common cold, such as a runny nose, wheezing, and mild cough.

Certain factors can increase the chances of your child developing bronchiolitis or of developing a severe case. These risk factors include:

• Babies under 3 months of age are especially at risk because their immune systems and lungs are still developing.
• Premature birth
• Exposure to crowds and/or other children at daycare; school-age siblings who may be sick
• Compromised immune system
• Not being breastfed, as breast milk provides immunities to diseases
• An underlying condition such as lung or heart disease, especially in infants under the age of 1 year
• Having been exposed to tobacco smoke

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. He or she may also develop other RSV symptoms like wheezing and difficulty breathing, including pauses of more than 15 to 20 seconds in between breaths. The difficulty breathing can lead to difficulty feeding, which can cause 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 he or she is under the age of 12 months and/or was premature. You can tell your child is having a difficult time breathing if he or she is breathing faster than usual (between 60 and 80 times a minute); you can see the muscles in between the ribs or at the base of the neck moving in and out (retractions); he or she has nasal flaring; or is very irritable or lethargic.

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 she's over 6 months old.

Don't give your child over-the-counter decongestants or cough suppressants. A cold medicine health alert from the U.S. Food and Drug Administration (FDA) has advised against their use in children ages 2 years and younger because the side effects can have severe and even life-threatening consequences for these young children. Avoid products that have codeine in them as well since these medications can lead to life-threatening breathing problems.

Antibiotics are not effective for bronchiolitis because it's 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.

While most children do very well when they have bronchiolitis, around 3 percent 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.

Complications of severe bronchiolitis, which are also signs that the infection is getting worse, include:

• A blue tinge to your child's skin called cyanosis
• More rapid breathing or pauses in breathing
• Seeming tired and worn out from trying to breathe
• A severe cough
• Being unable to breathe at all

If any of these symptoms occur, call 911. Getting your child treated as soon as possible will help her outcome.

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 she coughs, 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 she is less than 3 months old.

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

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 medication called Synagis (palivizumab) that can be given as a monthly injection before and during the peak season of RSV. If your baby was premature or if he or she already has lung or heart disease or other risk factors that could make an RSV infection serious, this medicine may be necessary.​