It's cold and flu season...or is it "bronchiolitis season?"
Most people call this time of year “cold and flu season” but for us pediatricians, we know it more as “bronchiolitis season." Bronchiolitis is not a well-known illness since it typically only affects children under the age of 2 years. So what is bronchiolitis and how is it treated?
What is bronchiolitis?
Bronchiolitis is inflammation and congestion of the bronchioles, the small airways in the lungs, and is caused by a virus. There are many viruses that can cause bronchiolitis, the most common of which is Respiratory Syncytial Virus (RSV). Doctors will typically diagnose the illness based on symptoms and findings on physical exam. Children under the age of 2 years and infants in particular, are most at risk of developing the illness due to the immaturity of their lungs and small size of their bronchioles. Older children and adults, if infected with the same virus, will develop cold symptoms. Children with the following risk factors are at higher risk for developing the illness or having more severe symptoms:
- Premature birth
- An underlying heart, lung, or immune system condition
- Smoke exposure
- Being in day care or having siblings in day care or school
- Never having received maternal breast-milk
What are the symptoms of bronchiolitis?
The illness typically starts with cold symptoms such as runny nose, nasal congestion, cough and mild fever. After a few days, the cough may worsen and wheezing or breathing difficulty may develop. Affected children may also have difficulty feeding due to the respiratory symptoms.
What are the complications of bronchiolitis?
Most children with bronchiolitis have symptoms for 10-14 days and improve on their own. A small number of children with the illness will develop complications that may require hospitalization. These complications are:
- Hypoxia where the child’s oxygen saturation drops due to poor exchange of oxygen in the lungs. This is most often detected by a doctor checking the oxygen saturation during a physical exam. When severe, the child’s skin or lips may appear blue which is known as cyanosis.
- Respiratory distress or increased work of breathing. The child may have fast breathing, noisy breathing, flaring of the nostrils, or retractions where the tissue around the ribs pulls in with breathing.
- Dehydration due to poor feeding
- Apnea or long pauses in breathing. This typically affects infants under 2 months of age.
- Bacterial infections such as pneumonia or ear infections
- Respiratory failure
What is the treatment for bronchiolitis?
Unfortunately, there is no cure or specific treatment for bronchiolitis. In the vast majority of cases, supportive care at home (nasal saline drops and nose suctioning, fever-reducing medicines) is all that is needed to help the child through the illness.
Studies have evaluated the effectiveness of multiple medications in the treatment of bronchiolitis. Antiviral medications, steroids and inhaled medications, such as albuterol, have been shown to be ineffective for the treatment of bronchiolitis. A small subset of patients who are prone to wheezing may respond to albuterol so doctors may still try this treatment in those patients. In the small number of children needing hospitalization, they may receive extra oxygen to help with their breathing and fluids through an IV or nasogastric (tube that goes through the nose down into the stomach) to help with dehydration.
How can I prevent my child from getting bronchiolitis?
If you have questions about bronchiolitis, speak with your child’s primary care provider. Chances are they just finished seeing a child with the illness!
- Good hand-washing is the best way to prevent the spread of the viruses that cause bronchiolitis. Carry hand sanitizer with you for times when soap and water are not immediately available.
- Limiting contact with others who are ill is also important as the virus spreads via person to person contact. If you have a young infant (<2 months) or your baby was born prematurely, it is best to avoid exposure to anyone who is ill.
- In select premature or other high risk infants, they can be given a medication, palivizumab, which helps decrease the likelihood of contracting RSV, the most common virus that causes bronchiolitis.
- Get vaccinated for influenza to help prevent spreading the virus. The influenza virus can cause bronchiolitis in infants, many of whom are too young to get the vaccine themselves.
- Provide breast milk for your baby as it shares good antibodies that your immune system has made in fighting infections.