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BABY DOCTOR - RSV and Bronchiolitis

Dr. Susan Kressly is a board-certified pediatrician and a fellow of the American Academy of Pediatrics. She has a private practice in pediatrics and adolescent medicine and is Chairman – Department of Pediatrics at Doylestown Hospital in Pennsylvania.

Respiratory illnesses caused by viruses are some of the most common health problems in childhood and infancy. From October through March, respiratory syncytial virus is a respiratory virus that can cause a significant amount of problems. In most adults and children, it presents itself as a cold with congestion, runny nose, sneezing and coughing. In infants, the virus is more likely to cause bronchiolitis, which is an infection of the small breathing tubes (bronchioles) of the lungs. (Not to be confused with bronchitis, which is an infection of the larger, more central airways.)

The infection causes the small airways in the lungs to swell. This blocks the flow of air through the lungs and can make it hard for your baby to breathe. This is because their airways are physically smaller, and are more easily blocked. Often the infant will developed a high-pitched musical cough and wheezing (the sound made by squeezing air through a narrowed tube.)

Infants who have RSV bronchiolitis may develop asthma later in life. It is possible that RSV infection is the first trigger for asthma. It is also possible that infants who are “genetically programmed” to have asthma, are the ones that wheeze/develop bronchiolitis when they are exposed to RSV. RSV is spread by contact with the respiratory droplets (mucous or saliva) of someone who is infected. It often spreads rapidly through families and child-care centers. CAREFUL HAND WASHING is your best defense to help prevent the spread of this infection.

Treatment for RSV bronchiolitis is mainly supportive: running a COOL mist humidifier/vaporizer, encouraging liquids, rest, and lots of TLC. Some children will benefit from medicines called “bronchodilators”, which dilate or open-up the bronchioles. Most often these medications are administered through a nebulizer treatment. If your child has respiratory symptoms, it is important to avoid airway irritants. Stay away from fireplaces, wood stoves, scented candles, potpourri, paint, strong perfumes and tobacco smoke.

Call your doctor immediately if your child is having trouble breathing. You may notice that he is squeezing the muscles under his rib cage or widening his nostrils to get more air in and out of his lungs. He may grunt and tighten his stomach muscles. He may not be drinking well because he is working so hard to breathe that he has trouble sucking and swallowing.

RSV can be especially dangerous for premature infants, and those with chronic medical conditions such as cystic fibrosis, congenital heart disease, or those on chemotherapy. There is an approved prevention strategy for a SELECT group of high-risk infants called “Synagis” which contains antibodies against RSV. It must be given by injection monthly during the RSV season (www.synagis.com).

Remember your best defense against RSV and other respiratory illnesses is good hand washing and “smart visiting.” If possible, avoid places where crowds of potentially ill people gather, like shopping malls. If you are visiting family/friends, ask them if they are feeling well. If not, stay home. Aunt Edna’s cold may just give you the sniffles, but could be potentially dangerous to your infant.

As always, if you have concerns or questions about RSV or your child’s health, don’t hesitate to call your doctor.

Good Luck and Good Health!

Susan J. Kressly, MD, F.A.A.P.

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NOTE: for more on RSV see the video now playing on BabyMeTV.

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User Comments:
Murlikumar Ganapur said:
This article gave me almost all the information that i am looking for. Thanks!! God bless you...
Linnie said:
My son is turning 2 years old. He has had pneumonia 5 times since he was born. He was 6 weeks early and spend a week in the hospital for his lungs. He has been on Singulair & Pulmicort for about 1.5 years and Xopenex /AccuNeb when he has a trouble breathing or when he has pneumonia. It always start the same, clear runny nose for a week then it turns green with a cough and fever. He does not get to lethargic. I am told very time it is a sinus infection and sent home with amoxicilln or antibiotic then three to four days later we are in the ER getting chest xrays and he has pneumonia. The last 2 times it has been lower loob (sp?) pneumonia, in Sept it was the left & now it is the right. He is a good little boy, he is always in a good mood and never apprears to sick even when he is. I get alot of doctors thinking I am out of my mind when we get there until the x-rays come back. He has had about 12 xrays, 10 of the chest and 2 of the head. He is never around smokers. We have a dog and live in a somewhat woody area. No carpet in the house, just tile & wood floors. He started day school 3 months ago, he has missed alot since he has been sick. I don't feel like I am getting anywhere. How good is it for him to have so many x-rays? Is there something I need to try at home. Is there something I need to ask the doctors...tests, blood work?
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