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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.
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.
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.
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 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.
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:
- 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.
- Sick parents should always wash their hands before they hold their baby.
- 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 scurvy in babies