UNPRECEDENTED WINTER VIRUSES RE-EMERGING THIS SUMMER
Most states in the U.S. have re-opened in recent months, including daycares, summer camps, sports programs, vacations, and family gatherings. With this re-opening, we as pediatricians, are seeing unprecedented numbers of viral illnesses this summer that are typically seen in the cold months. Especially common thus far, have been RSV and bronchiolitis, particularly in children under age 5. Let's discuss what bronchiolitis is, how it's treated, and when to be concerned.
What are RSV and bronchiolitis?
Bronchiolitis is a viral infection common in young children, usually age 5 and under, that causes inflammation and congestion of the smallest airways (bronchioles) of a child's lungs. These small airways become inflamed, swollen, and filled with mucous, leading to lots of cough, congestion and runny nose, and sometimes, wheezing or trouble breathing. Fever for up to 5 days can also be seen with bronchiolitis.
Due to the fact that the smaller a child is, the smaller their airways are, smaller children tend to have more severe symptoms than older children (typically a 4-5 year old's symptoms will be milder than a newborn's symptoms). However, having underlying respiratory conditions, such as asthma, or other chronic medical conditions, can make symptoms worse, regardless of age. Some children may also be more prone to developing bacterial infections, such as pneumonia, and ear infections, on top of the bronchiolitis.
RSV stands for respiratory syncytial virus, and is the most common virus to cause bronchiolitis. However, there are several other viruses, that can cause bronchiolitis as well.
Bronchiolitis follows a very typical course. Once symptoms begin, symptoms may initially worsen and are typically at their worst during days 3-5 of illness. However, once over this hump, symptoms typically slowly improve (sometimes, very slowly) over the next 2-3 weeks. Yes, 2-3 weeks! Unlike many other common cold viruses that typically clear up in about 1 week, bronchiolitis may linger on for longer, especially in children under age 3.
What are the symptoms of bronchiolitis?
Mild symptoms of bronchiolitis may include:
Cough (often, wet-sounding)
Lots of runny nose and nasal congestion
Decreased activity level
Fussier than usual or very clingy
Moderate-severe symptoms may include:
Coughing fits, coughing up mucus, or trouble sleeping due to persistent cough
Wheezing (a high-pitched whistling sound when child exhales)
Trouble breathing, which may include fast breathing, belly or ribs sucking in while breathing (retractions), or blue/purple discoloration around mouth or lips (cyanosis)
Inability to eat or drink (due to cough, congestion, or trouble breathing) and decreased wet diapers/urine output
Lethargy (too tired to cry or fuss, limp arms or legs, won't wake up or get up when trying to awaken)
How are the viruses that cause bronchiolitis spread?
Bronchiolitis is spread through respiratory droplets, much like other common cold viruses, and the COVID-19 virus.
How is bronchiolitis treated?
Since bronchiolitis is caused by a virus, there is no treatment to make the virus go away faster. Most viruses simply need time for the body's immune system to eventually rid of the virus. However, there are things that may help your child's symptoms and help them feel more comfortable while their body is doing the work of fighting off the virus.
For fever: You can treat your child's fever with fever-reducing medications as recommended by your child's pediatrician or by following the medication label(s).
For cough and congestion:
Nasal suctioning and nasal saline drops or sprays can help to keep your child's nasal passage clear and help with their comfort of breathing, eating, and sleeping. *Avoid over-suctioning or cleaning your child's nose too frequently or too harshly to avoid bleeding and trauma to the area.
Running a cool mist humidifier, especially while sleeping or keeping your child's room cool (with a fan or air conditioning) can help with their comfort of breathing while sleeping. *Be cautious of using vaporizers, especially those with menthol-containing products as this is not typically recommended for small children.
Consult with your child's pediatrician before giving any over-the-counter cough and cold medications. Many of these medications are not helpful or are not recommended for certain ages, and some may cause more harm than good.
For trouble breathing:
IF YOUR CHILD HAS TROUBLE BREATHING, YOU SHOULD ALWAYS SEEK MEDICAL ATTENTION AS SOON AS POSSIBLE
Your child's doctor may prescribe medications to help with mild-moderate breathing issues (however, there is some controversy on whether or not medications are necessary or helpful at all with bronchiolitis).
Severe breathing issues may require oxygen and/or hospitalization
For decreased appetite:
Focus on hydrating your child over age 1 with CLEAR fluids, such as water and electrolyte solutions. Milk may be more difficult to handle if your child is very congested. For children under age 1, encourage clear fluids IN ADDITION to their usual milk, as their milk is still an important source of hydration and calories under age 1.
Monitor their urine output. If they are still making a normal amount of wet diapers or urine, this is a good sign that they are well hydrated. If their urine output has decreased, talk to their doctor right away or seek medical care.
If your child becomes severely dehydrated, they may require IV fluids in a hospital.
When should I be worried?
If your child has any of these symptoms, even if you have already seen or spoken to their pediatrician, you should call the pediatrician's office:
Has symptoms that are getting worse, not better, after the first 5 days of illness
Has fever that lasts for more than 5 days
Has fever that developed AFTER the first 5 days of illness
Has any other symptoms that concern you
RSV and bronchiolitis can cause severe illness in some children that requires hospitalization. If your child is experiencing any of these symptoms, you should seek immediate medical care by calling 911, taking your child directly to the ED, and/or speaking to your child's pediatrician right away.
Trouble breathing, which may include fast breathing, belly or ribs sucking in while breathing, or blue/purple discoloration around mouth or lips
Is unable to drink fluids (or unable to hold them down due to vomiting)
Has stopped making urine/wet diapers
Is lethargic (too tired to cry or fuss, limp arms or legs, or won't wake up or get up when trying to awaken)
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