Blasting Away Bronchiolitis

Your one-year-old daughter has had a runny nose and a fever for two days. In addition to that, she has a congested cough and trouble breathing. She may have bronchiolitis.

Bronchiolitis refers to an acute infection of the lower respiratory tract, in particular the bronchiole tubes, the smallest branches of the respiratory tract. Normally, these breathing tubes carry air from the large airways to the lung’s air sacs. When the bronchiole tubes become inflamed and narrow, a high-pitched whistling sound, called a wheeze, is produced during expiration.

Respirations become rapid (more than 40 a minute), and breathing is often labored since the infant has trouble pushing air out. Retractions (tugging in between the ribs) and a heaving seesaw motion of the chest and abdomen may also be noted.

Fever, if present, is usually not high. The infant with bronchiolitis is prone to dehydration because of difficulty sucking and swallowing while having trouble breathing.

The cause of bronchiolitis is the respiratory syncytial virus but other viruses may cause it as well. The illness is particular to children under the age of 2.

The onset might have symptoms similar to the common cold, with a couple of days of runny nose and fever, culminating in cough, wheezing and labored breathing.

Most infants with bronchiolitis improve within seven days even though the cough may linger for up to three weeks. During this recovery time, parents should avoid exposing their infant to other sick children (nurseries, day-care centers, babysitters, etc.), since a second flare-up usually produces a more severe episode of the illness.

Home treatment for children with bronchiolitis consists of maintaining adequate hydration and close observation. Moisture in one form or another is probably the best treatment.

Fluids given by mouth replenish those that are lost through rapid breathing. Breathing warm, moist air helps promote the thinning and drainage of the thick respiratory secretions produced by the infection.

Parents can fill a humidifier with warm water which allows the child to breathe in heated mist. Some physicians may recommend using a bronchodilator either orally or by aerosol and, if an allergy component is present, a short course of steroids may be given.

Equally important is avoid irritants in the air that can make the secretions worse. One example is second-hand cigarette smoke. This pollutant aggravates coughing, increases wheezing and prevents the clearing of your child’s airway.

Each year, 1 to 2 percent of children younger than 12 months of age are hospitalized for bronchiolitis. Some experts believe that most hospitalized cases are exposed to second-hand smoke in the household.

You should contact your child’s health care provider if any of the following occur:

§  Increasing shortness of breath.

§  Changes in color of the fingernails or toenails to dusky or blue (cyanosis).

§  Signs of dehydration—dry mouth, taking fewer fluids than normal, less urinating than normal.

§  The wheezing becomes severe and tight or the child is unable to eat or sleep because of the wheezing.

§  Your child gets worse within two days after symptoms begin.

Children who require hospitalization are usually treated with intravenous fluids and oxygen. An antiviral agent, ribavirin, may be administered through a special breathing mask over the child’s face. Antibiotics are of no value unless the child develops a bacterial infection like an ear infection.

It is rare to develop complications from bronchiolitis, but a child may have recurrent wheezing episodes and asthma. It is unclear whether the asthma results from viral damage to the respiratory tract or whether the bronchiolitis was the first trigger for the child’s initial asthma attack. And bronchiolitis is contagious in close quarters though many times other children in the household escape infection.

Parents and caregivers are advised to practice good hygiene and wash their hands frequently when dealing with a child who may have this illness. Caregivers should avoid keeping sick children in closed spaces where there may be people suffering from the cold or flu. Don’t bring infected children to day-care centers or schools until healed from this illness. Please note that breastfeeding may reduce the risk of bronchiolitis in babies.