BRONCHIOLITIS

DEFINITION: Bronchiolitis is a viral infection, usually seen in the winter months, which causes infants and small children to and . It is often caused by the Respiratory Syncitial , or RSV. Because of its viral nature, will not cure it.

EXPECTED COURSE: Bronchiolitis usually starts out with a runny nose and/or mild cough. The virus then causes swelling and inflammation in the smallest of the bronchial tubes, called . This results in wheezing, rapid breathing, and a tight cough. As the symptoms progress into the chest, there may be a . Over the next several days, as the swelling goes down in the bronchioles, the phlegm starts to collect in them. The wheezing becomes more rattly; the cough becomes looser and more productive. The babies will often choke on, or vomit the mucus at this stage. Finally, over the next several days, all the phlegm comes up. Eventually, the clear, and the cough and wheezing subsides. The children are back to normal in two to three weeks. Most babies remain relatively perky throughout this course of events. Some of the children do get more ill however, and may need to be hospitalized.

HOME TREATMENT: Treatment is aimed at relieving symptoms and is not curative. • Offer plenty of fluids, preferably clear liquids. The baby's appetite may be down for a few days. • You may give acetaminophen (eg Tylenol) for fever if the child is over 2 months old. • A humidifier may help some of the nasal and the chest congestion. • Chest percussion: Place the baby face down over your knees, with his head slightly lower than his behind. Cup your hands and gently pound on his back on either side of his backbone, above his waist. This will help to vibrate loose the mucus that is in his bronchial tubes, which he may cough and swallow, or vomit. • The doctor may prescribe a medication aimed at dilating the bronchial tubes. In some cases this may help; in others it may not be very helpful and just cause side effects. Antibiotics may be prescribed if the baby has an associated bacterial infection, such as an ear infection.

Bronchiolitis is contagious like the . It is primarily an illness of children under the age of two. Babies may get bronchiolitis more than once, however. Repeated episodes of bronchiolitis, or those cases that occur in the summertime, or over the age of two years repeatedly, may be associated with the later development of .

CALL OUR OFFICE IMMEDIATELY if: • Your child is not taking fluids well enough to soak a diaper every 6-8 hours. • Her color is not good. (e.g. the baby turns purple with cry or is unusually pale in the lips, or gray). • He has significantly decreased activity (true “lethargy” or difficulty arousing) or is very irritable. • Fever is greater than 101.5°F lasting over 72 hours, or any fever greater than 100.3°F rectally if your child is under 2 months of age. • Breathing becomes more labored and difficult. Take the shirt off to observe breathing while the child is at rest. Call if you observe the following: o Retractions (caving in above the collarbone, between the ribs or below the ribcage). o Grunting or flaring (widening) of the with each breath. o Rapid breathing at rest: Count breaths taken in 60 seconds. Call if your child’s breathing is: • Greater than 60 if <6 months • Greater than 50 if 6-12 months • Greater than 40 if 1-3 years

During regular hours if: •A fever lasts more than 3 days and the baby is over 2 months old. •The cough lasts more than 3 weeks. •You have other concerns or questions. (Revised 4/07)

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