Bronchiolitis

By Karla Schlimgen, MD, FAAP
Pediatrics
Oak Leaf Pediatrics, Eau Claire

As the weather cools and the children return to school, we start to see more respiratory infections. For most children, these are nothing more than a nuisance "common cold" with a runny nose, nasal congestion, low grade fever and a cough. But, for smaller children, or children with asthma, even the common cold could make them wheeze.

The wheezing or whistling sound produced by the lungs is due to inflammation in the airway branches (bronchioles) of the lungs, making them narrow. In addition to the inflammation and mucous, the circular muscles around these branches become hyper reactive and can cause very persistent coughing. If this occurs, a child either has an asthma flare or bronchiolitis.

Doctors know that the common cold virus, rhinovirus, can cause a simple cold, an asthma flare-up or bronchiolitis. There are other viruses that can act similarly. Doctors expect one particularly troublesome virus to arrive, somewhere between November and April, annually. This is the respiratory syncytial virus or RSV.

RSV is one of the leading causes of bronchiolitis in small children. It may appear as just a cold in an older child or adult. Very young children (less than 2 years of age) or asthmatics may be hospitalized with RSV or, require specialized breathing treatments that aim at opening up the airways and calming down the muscle reactivity. Oxygen supplementation may be required in the more severe cases.

The extra work required to breathe can interfere with one's ability to eat and sleep well. Infants may need to drink smaller amounts more frequently, and older children may have minimal appetites. It is very important for all ages to drink plenty of fluids during such an illness. The body has to work harder to breathe so sleep is also very important. We often recommend elevating the head of the bed and running a humidifier in the child's bedroom to help keep the nose clear and mucous thin to promote better sleep.

Bronchiolitis typically lasts about two weeks. The first week is usually more difficult. Sometimes a child can have lingering symptoms beyond two weeks. This should be brought to their health care provider's attention and may require further medical management.

How can we avoid getting and spreading these respiratory infections? The best means of protection is good hand washing. If you know of an outbreak, avoid heavily populated settings when with susceptible children. There is an increased incidence of infection in daycare centers so avoiding these, when possible, will also help. Young premature infants can actually get a monthly preventative immunization against RSV during the season. Other children can get an influenza vaccine which can decrease the likelihood of wheezing from influenza. If you do find yourself with a wheezing child, contact your primary care physician for an appointment.

For more information, or to schedule an appointment with Dr. Karla Schlimgen » 715.830.0732, Oak Leaf Pediatrics