Bronchiolitis

RSV / BRONCHIOLITIS
Have you ever picked up your child from daycare and been notified that a child in the class has RSV? Or maybe a friend, a few days after a playdate, calls to tell you that their infant came down with a really awful cold and the pediatrician said it was likely caused by RSV? As a parent of a young child, it is important to understand what RSV is and how to prevent this viral illness.

What is Bronchiolitis?  RSV, which stands for Respiratory Syncytial Virus, is the leading cause of bronchiolitis. When a child has bronchiolitis, the inflammation in the smaller airways causes wheezing, fast breathing and difficulty
breathing. Children with bronchiolitis need to be seen urgently when these symptoms develop, or when there is a concern for dehydration. According to the CDC, almost all children will have RSV, by 2-3 years of age. RSV is typically seen between November through April, with the number of cases peaking in January and February. About 3% of children with bronchiolitis require hospital care. Young infants, premature infants, and infants with chronic heart or lung disease are at greatest risk of severe disease.

Symptoms and Progression of Illness
Once a child is exposed to RSV, if infected, it will take 4-6 days for symptoms to develop. First, parents will notice their little one has a profuse runny nose, a large amount of thick nasal secretions, and/or decreased appetite. One to three days later, cough and fever develop. In many cases, wheezing (which can last for a week) and retractions also may develop at this time. In general, symptoms generally peak on days 3-4 of illness and most children feel better after 1 week, although symptoms (including
cough) can persist for 3-4 weeks.

Management of RSV and Bronchiolitis
While your child is ill with a virus, managing their symptoms will help them feel better although it will take time for the virus to run its course. Saline nasal spray/drops and bulb suction can help remove thick mucus from the nose. This can be helpful as needed before your infant nurses or takes a bottle. Breathing in the steam from hot showers and humidifiers is also helpful for nasal congestion. Maintaining hydration is very important as well. Sometimes parents will be instructed to give “breathing treatments” to their children with bronchiolitis. A breathing treatment just means that a nebulizer machine is used to administer medication (called albuterol) into the lungs to help a child who is wheezing AND having difficulty breathing.

Contagiousness
Children are typically contagious for 3 to 8 days. A child can return to daycare when he/she is fever free for 24 hours without fever reducers (such as Tylenol / Motrin) and no longer wheezing.

Follow-Up Care
Your child needs to be seen urgently for any of the following:

(1) difficulty breathing (fast breathing, retractions, grunting),

(2) poor fluid intake or decreased wet diapers,

(3) irritability,

(4) fever is lasting 3 or more days or any concerns.

Commonly Asked Questions
1. Can my child have RSV more than once? Yes, your child can have RSV more than once, but typically the subsequent infections are not as severe as the first time.
2. My doctor / nurse practitioner decided not to do an RSV test in the office. Should I be concerned?
RSV testing can be done in most doctors’ offices, but it is not vital that all children are tested for RSV. A positive or negative result would not change the plan of care for most children. A positive test only tells us that RSV is the cause of your child’s symptoms. However, a negative test tells us that a different virus is causing your child’s symptoms. Occasionally, your PCP will decide to test for RSV in a child at risk for
severe disease, as this information would be helpful in managing the illness.
3. What is the best way to prevent RSV? Good hand-washing is the best way to prevent RSV and many other viruses. RSV can stay on your hands for several hours.
4. My child is wheezing for the first time. Does this mean he/she has asthma? Your provider will be concerned about asthma when your child exhibits recurrent wheezing episodes. Children who develop asthma often have a family member with asthma, and the child may even have eczema and/or allergies.

References

https://www.cdc.gov/rsv/index.html
https://www.uptodate.com/contents/bronchiolitis-in-infants-and-children-treatment-outcome-and-prevention

Helpful Parent Handout

https://www.uptodate.com/contents/bronchiolitis-and-rsv-in-infants-and-children-beyond-the-basics