Fort Worth, Texas,
14:38 PM

'Is it RSV?'

The Doc Smitty examines bronchiolitis

RSV has arrived at Cook Children's.

Last week, 178 kids tested positive for RSV, compared to only two who tested positive for Influenza A.

RSV is a virus. It’s short for respiratory syncytial virus. It causes a disease in young children (especially those less than 2 years) called bronchiolitisThe RSV season usually begins around mid-August and runs through March.

Bronchiolitis is a disease of the lower respiratory tract which causes children to wheeze. They are wheezy because their small airways have swelling and junk (mucous and cells from the lining of the airway) in them.

The smaller airways are similar to the area where a child with asthma has issues (which is why they wheeze). The difference is that children with asthma have a squeezing down of the walls of the airway (which is what a breathing treatment reverses). This is why breathing treatments in children with bronchiolitis usually don’t work.

Bronchiolitis is not just caused by RSV. There is a long list of viruses that can cause the same symptoms:

  • RSV
  • Rhinovirus (usually a cause of the common cold)
  • Parainfluenza
  • Human metapneumovirus
  • Influenza (Flu)
  • Coronavirus
  • Human bocavirus
  • Human polyomavirus

Here are some answers to the most common questions I hear from parents:

What are the symptoms of bronchiolitis?

Typically the child starts with runny nose and cough. This will progressively worsen over a few days and possibly develop into difficulty breathing and difficulty with eating. The symptoms typically last a total of about 5-7 days with the worst day being the day in the middle. It is not uncommon for the cough and runny nose from bronchiolitis to last 2-3 weeks.

How do we treat bronchiolitis?

In most children, treatment is done at home and consists of sucking snot (click here for more advice on this) and counting wet diapers. This isn’t very fancy but, unfortunately, until someone invents TamiRSV we don’t have anything more specific. As far as wet diapers go…I am looking for a wet diaper about every 6 hours.

Who goes to the hospital?

Getting admitted for bronchiolitis is usually based on: dehydration, severe difficulty breathing or low oxygen levels.

Children who can’t eat because they are breathing fast and are puking because of all the mucous draining into their belly are at risk for dehydration. Unfortunately, the only way to fix this is to put them in the hospital for intravenous (IV) fluids until they are able to drink better.

A child who is having severe difficulty breathing also needs to be observed in the hospital. Unfortunately, babies with severe bronchiolitis can get tired from all the heavy breathing they are doing and this can progress to needing ICU care. It is best to have those babies who are breathing that hard in the hospital so that they can be monitored closely by people who know what they are looking for…

Babies with bronchiolitis often need extra help keeping their oxygen level up by getting extra oxygen. We monitor these babies closely and I put them on oxygen for severe difficulty breathing or if their oxygen level is less than 90 percent.


  1. Bronchiolitis stinks, it makes kids sick and I don’t have much to offer.
  2. Whether it’s RSV or not often doesn’t matter.
  3. Watch for difficulty breathing and decreased wet diapers.

For more information on bronchiolitis and RSV, read this post from one of our hospitalists.


Get to know Justin Smith, M.D.

Justin Smith, M.D., is a pediatrician in Trophy Club  and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. Dr. Smith is an experienced keynote speaker for a variety of topics including pediatric/parenting topics, healthcare social media and physician leadership. If you are interested in having Dr. Smith present to your conference or meeting, please contact him at

He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” open now. Click to learn more. To make an appointment, call 817-347-8100.


Comments 1 - 7 (7)
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My daughter is 2 months and has RSV now she was on the floor for a day and she started getting worse with her breathing so they put her in ICU and its a very scary illness...
Peggy McMullin
So are say bronchitis is contagious?.. what about adults that have it?
My one year just got released fro the hosp. earlier this week he has broncholitis he also has Tracheomalacia. It was and still is very rough. He almost didn't make it. More parents need to understand it. And yes it shows a lot of the same signs as RSV. But I will say my nephew had RSV and even tho he was admitted to hosp it was nowhere near as bad what my son just went thru. Thank you for this article.
Is RSV (and other respiratory illnesses) more dangerous in children with laryngomalacia or other airway malformations?
Tammy Coach
My son who today is 13 had RSV when he was three weeks old is walking proof that healing is possible. The good Lord pulled us through that trying time He was just three weeks old and spent his first Christmas at Cook Children's Hospital. I will never forget how sweet and informative the staff was and kept us in the loop of what was happening with our child. He was also born with two holes in his heart which called for a VSD and a ASD repair. A narrowing in his aorta and he had a aortic coartation done while fighting the RSV. I Thank God everyday for those doctors and nurses that saved our son.
Dr. Justin Smith
So sorry to hear about your experience with RSV. Certainly, there are children who do get very sick with it as well as many of the other causes of bronchiolitis I listed in the article. I did not mean to minimize any bad experience a family has had with RSV. I am concerned about children (especially young children) with bronchiolitis and made a point to spend a lot of time discussing how we treat it (including RSV) and the signs and symptoms to watch out for that would lead to hospitalization. When I say, “I don’t care if it is RSV,” it is reflection of my experience dealing with really sick children who tested negative for RSV yet still needed significant amounts of help to get over their illness. Again, sorry if you felt that the post minimized what you have been through, that was certainly not the intent.
I don't agree with this article at all...rsv is a big deal and this article is saying the opposite. Correct that 95% of cases are treated from home and my 6 month old was part of that 95% a month ago but my 3 year old when she was 3months old was dx with it and was hospitalized for 11 days and was transferred to Riley children's hositpAl so to say that naming the infection isn't a big deal it is a huge deal so you know what you are dealing with