Hem Bronchiolitis (and RSV) in children and babies – symptoms and infection

Bronchiolitis (and RSV) in children and babies – symptoms and infection

Baby with RS virus receiving inhaler

This post is also available in: Svenska

Facts and advice about bronchiolitis (and RS virus) in babies. Written by pediatricians for parents. Every winter RSV returns, and parents don’t know what to think. What are the symptoms of bronchiolitis? Do you need to seek medical care for a sniffling newborn in case of RSV? Can siblings go to kindergarten? Can a mother’s cold infect their child?

Bronchiolitis in babies

Bronchiolitis is a viral infection which produces unusually thick mucus. It is commonly caused by respiratory syncytial virus (RSV). All children contract RSV before they turn three years old. After having bronchiolitis, you have a certain immunity or protection against a new RSV infection. In about 1 in 100 children, especially infants, the thick mucus will provide so much breathing problems that they need to go into hospital. Most babies can handle their bronchiolitis themselves. The older they are, the better they are at fighting off the infection. The disease gets worse and worse within five days and then slowly improves.

Difficulty breathing or eating with bronchiolitis

The two symptoms where bronchiolitis leads to hospital treatment are: difficulty eating or breathing. Both symptoms are due to the fact that the mucus clogs babies’ small airways. At home, you can relieve this by flushing their nose with saline. Read about saline flushing in the post below called cold babies. If your baby can eat and breathe without too much effort, you can stay at home and continue clearing their nasal passages with saline.

Read more about colds in babies here

Hospitalization for severe bronchiolitis in babies

In hospitals or home care, babies are fed via a tube called nasogastric tube. It goes into the stomach through the nose. Their breathing, on the other hand, is assisted by inhalers. You can also assist your baby’s breathing by holding them in your arms and bouncing on a large Pilates ball.

Read more about difficulty breathing in children

In a few children, nasogastric feeding, inhalers and bouncing are not enough. Instead, they may need High Flow Oxygen Therapy (HFOT) or CPAP. In isolated cases, children may also need respiratory treatment for a few days. Of those children, many have some risk factor for a severe illness, such as premature birth, heart failure or lung disease.

Inhalations with saline can help against RS virus
Children at risk of severe bronchiolitis

Some children are at risk of RSV causing more life-threatening bronchiolitis. These children include very premature babies (before week 26 and who are under 6 months); children with severe heart disease; severe lung diseases; brain diseases that prevent them from coughing properly; and have impaired respiratory function. The same applies to babies with severe, rare immunodeficiency disorders.

If a baby requires a ventilator after heart surgery, then RSV can be really dangerous.

If your child belongs to one of these groups, it may be appropriate to give Synagis (palivizumab) for prevention against a severe RSV infection. The child receives the medication as an injection once a month during the RSV season. The medicine is expensive, and only children belonging to a risk group receive the medicine. If you have any questions, please contact your child’s doctor. Synagis reduces the risk of hospitalization for RSV by about 50%.

RS virus infection

RSV are found in masses in saliva and snot. It is spread through direct contact. For example, let’s say you’re carrying your baby, you cough/sneeze into your hand and suddenly your baby is sucking on your thumb. The RS virus will have spread from your sneeze, to your hand, and finally to your baby. Coughing and sneezing contains millions of microscopic saliva drops that all contain RSV. Anyone within 1-2 meters of a sneeze can be infected.

Sick older siblings often infect babies with RS virus
Protecting babies from bronchiolitis

The important thing is to avoid direct contact with a sick person. That’s easier for adults to adhere to. But with older siblings, it’s much harder. You can only do your best. Here are some useful ground rules:

  1. Do not allow sick people near the baby. Parents are excluded. Not because they can’t infect the baby, but because the baby needs its parents even if they have a cold. Older siblings who are sick, shouldn’t touch their baby siblings, if possible.
  2. Sick parents should always wash their hands before they hold their baby.
  3. Coughs and sneezes are to be directed into the arm folds more than one meter away (preferably further) from the baby.

There is a lot of advice about avoiding public transport, crowds, cafes and public places. Assess for yourself if there is a high risk of someone coughing or sneezing within one meter of the child. In that case, I think you should consider choosing another means of transport or activity. But as I said, RSV is not hanging in the air unless someone sneezes or coughs. So in an uncrowded bus, cafe or library, the risk of infection is small.

Should you keep older siblings at home from kindergarten to protect the baby from RSV?

A newborn is less likely to be infected with RSV or other cold virus if the older sibling does not go to kindergarten. But having a new sibling in the family is often hard enough for a 2-3 year old. Being expelled from friends at preschool is more than many siblings can handle.

As long as you do not have a baby that is particularly susceptible to infection (extremely premature, non-operated severe heart defects, etc.), I would recommend letting the older sibling go to preschool. Colds, and even bronchiolitis, is a part of life. But the overall situation in the family is important. So, if you feel better about having both children at home – do it.

Who should be protected against RSV?

Try to protect babies under three months, as much as you can. Premature children require care at neonatal wards until they are at least 6 months. Children with severe heart and lung diseases or immune deficiencies require a longer time, but talk to their doctor for individual advice.

Who should not be protected against RSV?

When a healthy child starts preschool after the age of one, the infections will begin to come. Then the risk of serious bronchiolitis that require hospitalization is also very low. When a younger sibling turns 6 months, the older siblings can touch the baby after washing their hands, even if the older sibling has a cold.

Every year during the winter season, you can read weekly reports on how prevalent RSV is in society.

Read more about the RS virus weekly report in Sweden

Read more:

Colds in babies – snotty and stuffy nose – how to help?

Wheezing or strained breathing – a guide for when your child has difficulty breathing

How a baby’s immune system works – about breastfeeding and antibodies.

Cough in children – a guide to diseases and home remedies

Intrinsic asthma in children – Symptoms and Treatments

Read more about scurvy in babies

Leave a Reply

Your email address will not be published. Required fields are marked *