Respiratory Syncytial Virus and Bronchiolitis- causes, symptoms, diagnosis, treatment, pathology (September 2018).

What is bronchiolitis?

Bronchiolitis is an inflammation of the small and the smallest branches of the bronchi, the so-called bronchioles. This inflammation causes swelling of the bronchioles and the exchange of breathing air is made more difficult.

Bronchiolitis is mostly caused by viruses. About every third baby undergoes this infection in his first year of life (NHS 2010, Patient UK 2009). The most common causes are RS viruses (respiratory syncytial virus), but also rhinoviruses and adenoviruses are possible. These viruses can also cause middle ear infections, pseudo-Krupp and pneumonia.

Mostly the virus occurs in the winter months, during the typical cold period between October and March.

The disease begins with flu-like symptoms and mild fever. The children cough and are restricted. Usually everything is over after a week and the inflammation usually heals without consequences. But it can also very quickly create a life-threatening situation. The oxygen saturation drops, the children breathe very fast, often there is no breath sound above the lungs (bad sign!), Breathing is absorbed - in short, it is a dangerous condition for infants and toddlers.

How do I know if my baby has bronchiolitis?

Bronchiolitis is usually a bit stronger than a common cold. But the first symptoms are the same:

  • runny or stuffy nose
  • dry cough
  • elevated temperature between 37, 5 and 38 degrees C
  • loss of appetite
  • (DH 2009, NHS 2010)

The symptoms can get worse very fast (NHS 2010, Patient UK 2009):

  • the cough becomes more persistent
  • the breathing gets faster, shallower and strained
  • the heart beats faster than usual
  • feeding could be more difficult Maybe your child refuses to eat.

When should I take my baby to the doctor?

If you're not sure if it's a bronchiolitis or a cold, then go to the pediatrician. He / she will then measure the oxygen in the blood and then decide whether the child may need to be hospitalized. But although the symptoms are dangerous and you understandably worry, most cases of bronchiolitis are harmless and can be treated well at home.

Only about two percent of babies develop severe bronchiolitis and need hospital treatment. Go to the doctor immediately if you notice the following symptoms on your baby:

  • It has been drinking only half the usual amount of milk in the last 24 hours
  • It shows signs of dehydration - no wet diaper for six hours or longer or mouth and lips are dry
  • the fever rises above 38 degrees C
  • it seems drowsy and lethargic
  • it has difficulty breathing (see below)
  • (NHS 2010, NHS 2008 , Patient UK 2009)

Severe bronchiolitis causes respiratory problems, so keep an eye on your baby and immediately call the ambulance or go directly to the clinic if your baby has any of the following symptoms:

  • it is wheezing ( a croaking, whistling sound when breathing); the nostrils are puffing up; the skin between the ribs, at the clavicle, or under the costal arch, is apparently sucked inward with every breath; it groans, or its abdominal muscles contract at eachBreath together
  • his lips and fingernails turn blue
  • breathing accelerates to more than 60 breaths per minute
  • breathing occasionally stops for a few seconds
  • (CKS 2009, NHS 2010, NHS 2008, Patient UK 2009, SIGN 2006)
  • Some babies have a higher risk of getting severe bronchiolitis than others.Go to a pediatrician if you think your child has bronchiolitis and:
  • is less than three months
  • was a premature baby

has health problems since birth, such as lung or heart problems

  • has a weakened immune system
  • has needed extra oxygen in the past
  • (CKS 2009, DH 2009, NHS 2010, SIGN 2006)
  • How Can I Treat Bronchiolitis at Home?
  • Since bronchiolitis is a viral infection, you can not do much except wait for the immune system to do its job. In most cases, bronchiolitis clears after one to two weeks.
  • Most doctors recommend the same treatment as a cold. Here's what you can do to ease your baby's suffering:

Encourage your baby to drink a lot. If you are breastfeeding, give him as many breasts as possible. If your baby gets baby food or solid food, then you can also give him extra water. If it has breathing problems, your child will not want to drink much at once. Therefore, offer him a few sips often, so that it does not dehydrate and the fever is lowered.

You can give your baby a fever suppository or a ibuprofen or acetaminophen suitable for children if it is older than three months (CKS 2009, NHS 2010). Read the package leaflet and talk to your doctor or pharmacist if you are unsure about the dose. Paracetamol and ibuprofen reduce the fever and relieve sore throat, which will make your baby easier to eat and drink.

If your baby has feeding problems because of its stuffy nose, keep it upright when eating (CKS n. D.). You can also buy nasal drops with saline solution at the pharmacy to clear the nose (MRHS 2009, NHS 2010). Drop the solution into the nostrils 15 minutes before each feeding.

  • Lightly lift the head of the cradle or cot or let your baby sleep in the car seat if it is over six months old (smaller children usually hang in the car seat, collapsing the breathing). If you raise your baby's head, it gets better air despite the blocked nose.
  • Steam inhalation can open your baby's respiratory tract and relieve the cough (CKS n. D.). Nevertheless, you should not expose your baby to direct steam because it could scald (Murphy et al 2004). The safer method is to take your baby to the bathroom. Turn on the hot water in the shower and stay in the steam for a few minutes (CKS 2009, NHS 2009). Afterwards you have to put on your baby of course something dry.
  • If possible, do not give your children over the age of six any over-the-counter cold medications because of the likely side effects (MHRA 2009).Before you try with any medication, ask your pediatrician. Above all, never give your child a cold remedy intended for adults.
  • Can Bronchiolitis Lead to Complications?
  • After bronchiolitis, some babies have more wheezing or coughing, especially during a cold (NHS 2008, Patient UK 2009). Asthma and other respiratory problems have been linked to bronchiolitis by researchers (Sigurs et al 2000).

Very rarely, bronchiolitis causes pneumonia in babies. In babies with congenital heart or lung defects, bronchiolitis can aggravate the condition.

How can I prevent bronchiolitis?

As the disease spreads as a droplet infection, it is often passed on to nurseries, offices and even the circle of acquaintances. The virus survives in the air or on the palms for about six hours, so hygiene is important. Wash hands frequently with warm water and antibacterial soap. Insist that anyone who touches your baby should also wash their hands first.

Keep your baby away from cold people and avoid large crowds.

For risk children, ie children with heart defects, lung diseases and chronic illnesses or extreme premature births, there is a kind of vaccination that can be given to very immature children. These are antibodies to the virus. This ""vaccine"" lasts about four weeks and then has to be refreshed in winter.


CKS. 2009. NHS Clinical Knowledge Summaries.

Clinical topic - Cough: acute with chest signs in children

. www. cks. nhs. uk [as of February 2011]

CKS. n. d. NHS Clinical Knowledge Summaries. Patient information leaflet - Bronchiolitis. www. cks. nhs. uk [February 2011] DH. 2009. Department of Health. Birth to five: Chapter 8 Treating Illnesses, Infections and Injuries

. www. ie. gov. uk [as of February 2011]

MHRA. 2009. Medicines and Healthcare products Regulatory Agency. Children's over-the-counter cough and colds medicines: new advice . www. MHRA. gov. [February 2011]

Murphy SM, Murray D, Smith S, et al. 2004. Burns caused by steam inhalation for respiratory tract infections in children. BMJ 328: 757

NHS. 2010. Bronchiolitis . NHS Choices, Health A-Z. www. nhs. uk [as of February 2011]

NHS. 2009. Common cold . NHS Choices, Health A-Z. www. nhs. uk [as of February 2011]

NHS 2008. Bronchiolitis - advice for parents or carers . NHS Trust, Children's Services. www. nlg. nhs. uk [pdf file, accessed February 2010]

Patient UK. 2009. Bronchiolitis . www. patient. co. uk [February 2011]

SIGN. 2006. Scottish Intercollegiate Guidelines Network. Bronchiolitis in children: a national clinical guideline . www. uk [as of February 2011]

Sigur N, Bjarnason R, Sigurbergsson F, et al. 2000. Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age seven. Am. J. Respir. Crit. Care Med. 161 (5): 1501-1507

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