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Dr. Sri Explains Bronchiolitis

By Dr. Sri Narayanan, MD

It’s autumn. The weather is getting cooler, the leaves are changing colors and here at Children’s of Alabama, the gloves and gowns are on for bronchiolitis season.

Bronchiolitis is a viral respiratory illness that affects children under two years of age, most often between November and February. Viruses such as Respiratory Syncytial Virus (RSV) and influenza are the most common causes and full healing could take two weeks or more. The symptoms of bronchiolitis usually follow this timeline:

  • Days 1-3: coughing and nasal congestion with low-grade fevers
  • Days 4-7: wheezing, difficulty breathing and sometimes poor feeding or vomiting from thick nasal congestion and persistent coughing
  • Days 8-14 (sometimes longer): gradual recovery with slowly improving cough and wheezing

If you suspect your child has bronchiolitis, focus on consuming fluids and nasal suctioning. Our suctioning tip: use a couple of saline drops in each nostril followed by bulb suctioning, up to 3 times a day if nasal congestion is severe. This will temporarily clear nasal passages, giving you the opportunity to feed your child and for them to get some much needed sleep. Your child may not want to drink as much as usual, but an ounce or two of Pedialyte every one to two hours can take care of hydration in the short-term.

Despite our best efforts, some children with bronchiolitis require urgent medical care and even hospitalization. Seek medical attention if your child is:

  • breathing rapidly (count for 15 seconds – if you count more than 15 breaths, this is a cause for concern),
  • breathing with increased effort, especially pulling in under the ribcage or neck,
  • not making enough wet diapers (at least one every 6 hours),
  • turning blue around the mouth or lips or
  • is under two months of age and has a fever (rectal temperature over 100.4 degrees F).

Your physician may check your child’s  oxygen level, take a chest X-ray or give your child a breathing treatment. Hospitalization may also be needed if you child has:

  • oxygen levels under 90 percent
  • dehydration requiring IV fluids
  • continued difficulty breathing, even after an albuterol or epinephrine treatment

What should you expect if your child is hospitalized? We’ve found that less is more. Medications such as steroids, antibiotics, cough suppressants and regularly-scheduled breathing treatments are not effective to treat bronchiolitis. Like the common cold, the viruses that cause bronchiolitis just need to run their course.

If hospitalized, your child will receive IV fluids and oxygen if needed, nasal suctioning under a nurse’s supervision and close monitoring of vital signs. We may take a chest X-ray or a nasal swab to check for RSV or influenza but usually only if the diagnosis is unclear or your child is under 2 months old. After being discharged, your child may still have some noisy wheezing and a cough, but if it’s not bothering him, don’t let it bother you.

Bronchiolitis can be a scary illness to watch your child go through. Stick to the basics of hydration and nasal suctioning and you will give your child the best chance of a quick recovery. This will relieve them of their symptoms and help you both to enjoy the rest of the winter.

Sri Narayanan has been an inpatient physician at Children’s of Alabama since 2008.

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