Bronchiolitis: Separating Fact From Fiction - WTOP

Posted: 30 Oct 2019 03:07 AM PDT

Bronchiolitis can be a terrifying word for families of young children. This common viral lung infection is notorious for causing a terrible cough lasting many worrisome nights, and an illness that can lead to hospitalization. However, while bronchiolitis is indeed an infection that can be dangerous to young children, there are many myths surrounding it that cause unneeded concern and unnecessary doctor visits. Avoid worry by learning the facts.

Bronchiolitis is an infection of the smallest lung tubes (called bronchioles) caused by a variety of virus types. Although RSV, or respiratory syncytial virus, is the most common cause of bronchiolitis, the reality is that many viruses can cause the spectrum of disease known as bronchiolitis. During the course of this disease, the virus attacks the cells lining the small lung tubes, causing irritation and inflammation. Once inflammation begins, the sensitive skin cells make a bunch of mucus that can clog the air tubes, triggering the well-known coughing and wheezing of bronchiolitis.

The reason bronchiolitis causes so much trouble is simply physics. If you have tiny tubes in your lungs, it takes a small amount of mucus to clog them up and make breathing difficult. The youngest children (aged 2 to 6 months) are most at risk of needing to be hospitalized for bronchiolitis. As you get older and physically bigger, more mucous production is required to clog the lung tubes and change lung function significantly. Once children reach the age of 24 months, viral bronchiolitis rarely leads to significant respiratory distress or hospitalization, since bigger lung tubes mean fewer problems.

[READ: What Is Bronchitis?]

Since bronchiolitis is a spectrum of a disease characterized entirely by mucous production, classic symptoms include a very runny nose and wet cough or wheeze. Most kids will also run a fever during the early part of the illness. The combination of snot and persisting cough can make eating difficult for small children, increasing the risk of dehydration during the peak days of the disease. The symptoms of bronchiolitis ramp up very quickly, with day three to day four being the most symptomatic. It is in the first few days of the illness that young kids need the most attention and care.

Fortunately, the vast majority of children with bronchiolitis can be safely and effectively treated at home. Home care focuses on snot removal and basic comfort measures. Using nasal saline spray and nasal suction is critical to support a child with bronchiolitis. Especially before mealtime and naps or bedtime, sucking out as much snot from the nose and mouth as possible will allow your child to rest comfortably and stay hydrated.

Over-the-counter fever reducers (acetaminophen and ibuprofen) are helpful to decrease fever and calm a child's respiration rate. Also, smaller and more frequent feedings are useful to keep a child hydrated when the child is ill.

Parents should watch closely for signs of respiratory distress (irritability, breathing more than 60 times per minute, increased fatigue) and dehydration (refusing to feed or peeing less). Respiratory distress and dehydration are the most common reasons that children will need medical support. If you are concerned about your child's breathing for any reason, it's time to call the doctor.

[Read: 12 Things You Should Know About Stomach Flu in Children.]

Many parents get frustrated that the cough and wheeze classic to bronchiolitis seems to last "forever." While kids develop symptoms rapidly, the resolution time (or time to return to normal) for viral bronchiolitis can take many weeks. Meanwhile, during this resolution phase, children can develop symptoms from a "new" cough or cold, perpetuating cold-like symptoms for seemingly months at a time. Patience is a virtue while supporting your child when they need it most. As cold and flu season begins to disappear, so will your child's cough and wheeze.

Although some past research suggested that if a child gets RSV that may increase the chances the child would develop asthma later, there doesn't appear to be a link between the two. More recent studies conducted during the last decade don't find any connection between getting RSV as a child and going on to develop asthma.

As a pediatrician, I see many children who continue to have sensitive lungs for many months after their initial bronchiolitis infection when respiratory illnesses strike. But as the bronchioles in their lungs continue to grow over time, these children are less susceptible to significant symptoms.

Finally, it's important to note that for children at the highest risk of RSV-related hospitalization, there is a vaccine available. Children who may qualify to receive this vaccine include those who are significantly premature or have a medical condition that directly affects respiratory function.

The RSV vaccine is not like other routine vaccines of childhood since it contains active antibodies against the virus to protect the baby from the illness. This type of protection requires monthly injections throughout the entire bronchitis season. Talk to your doctor about your baby's possible qualification for this protective medication.

[READ: Does My Child Have Strep Throat?]

If you are ever worried or concerned about your child during a respiratory illness, please call your pediatrician's office for advice. These illnesses can be tricky, and children can change very quickly. With the astute care that most parents provide, however, the majority of children with bronchiolitis can be managed happily and safely at home.

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