RSV and Bronchiolitis

Infants are at risk to develop bronchiolitis. Bronchiolitis is the name given to
infections in the small passageways within your infants lungs. These are called
bronchioles. The most common cause is an infection caused by the RSV
(respiratory syncitial virus).  Most of these infections start off as a minor
cold with a clear runny nose and a mild cough. Over several days the cough
increases and often becomes repetitive and staccato. Often your child will gag
and choke due to the coughing. Feeding may decrease and breathing will increase
in effort and rate.  You may notice retractions between your infants ribs or
above their collarbone or sternum. They may have a seesawing breathing pattern
called tummy breathing where their chest moves in while their abdomen pushes
out. All of these are signs of increased breathing effort. In these situations
you must talk to your pediatrician. Often these infants will have a normal body
temperature and when not coughing they may smile and be playful. As her work of
breathing increases, however, she will become irritable and her sleep pattern
will be disrupted.

Your pediatrician will decide if your infant needs to
receive any support to help with the infection. Support options include
admission to the hospital for intravenous fluids and oxygen. Antibiotics do not
help since the cause is a viral infection. An Xray is often done and sometimes
antibiotics are given while waiting for culture results. Nebulized medication
may be given via a mask over her nose and mouth. This helps the pediatrician
decide if any bronchospasm is present. Bronchospasm is the name given to the
tightening of the small airways in your child’s lungs. Her lungs are like two
upside down oak trees. Each branch is covered by bark which can become
constricted due to inflammation from a viral infection. The mist that comes out
of the nebulizer has a medication in it called albuterol. It relaxes the bark
and increases the size of the branches for air and oxygen to enter the lungs.
Another medication is racemic epinephrine. This medication is similar to
chemicals released in your body when you become scared or frightened. This
chemical is called adrenaline. It allows you to breathe deeper and take in more
oxygen and is part of what is called your body’s “fight or flight”

This illness can last for several weeks. It usually peaks in severity over 3-5 days and the cough gradually fades over several weeks. If your child has bronchiolitis good hand washing and not sharing any bed clothes or toys that are exposed to the infant is very important. Most of the time if adults develop an RSV infection it will be a minor cold, but, young infants are at risk for more serious symptoms.  RSV infections are frequent in day care facilities. It is important infants do not share toys and that all caretakers
use good hand washing practices. Premature infants and infants with underlying
heart or lung problems may be given during RSV season (winter and early spring)
a monthly medication called Synagis. It increases the bodies ability to fight off an RSV infection.

Infants with RSV almost always respond well and heal themselves. Some of these infants are at higher risk for developing asthma as they become toddlers and preschoolers. Most of the time, however, your infant will do well and will begin to develop an immunity to infection that will protect her for years to come. This illness and many others will give you the first of many opportunities to learn how she is in charge of her own destiny. A destiny you will always be part of but not responsible for. From the day she was born this process of letting go began. RSV will become part of this journey.