'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 bronchiolitis. The 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:
- Rhinovirus (usually a cause of the common cold)
- Human metapneumovirus
- Influenza (Flu)
- 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.
- Bronchiolitis stinks, it makes kids sick and I don’t have much to offer.
- Whether it’s RSV or not often doesn’t matter.
- 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 firstname.lastname@example.org.
He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. 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.