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Bronchiolitis (RSV and wheezing in infants)

Bronchiolitis is a viral infection of the lungs, which affects primarily infants and toddlers. Some or all of the following symptoms are present with bronchiolitis.

  1. Wheezing: a high-pitched whistling noise when your child breathes out. You may actually hear this yourself, or a physician may hear wheezing when she listens to your child.
  2. Rapid breathing: at a rate of 40 breaths per minute or faster.
  3. Hard or Labored breathing: You may notice that your child looks like he is pulling in around the rib cage, or the ribs are visible with breathing. Also, look for abdominal breathing, where the belly is going in and out with each breath.
  4. Cough: a very prominent component of bronchiolitis. The cough is usually frequent, tight, and productive of mucous.
  5. Fever: may or may not be present, and may be as high as 104-105 degrees.
  6. Runny nose and congestion: is usually present, and usually there is A LOT of nasal drainage.


Bronchiolitis is caused by a narrowing and congestion of the smallest airways in the lung (the bronchioles). It is a viral infection, and there is no medication or antibiotic that will treat the virus itself. Any respiratory virus can cause bronchiolitis, but the Respiratory Syncytial Virus (RSV) is the most common cause. Older children and adults can catch RSV, but their symptoms are usually mild, like a common cold. It is spread by coughing or sneezing at a range of six feet or less, or by hand-to-nose or hand-to-eye contact. People do not develop permanent immunity to the virus, which means they can be infected more than once. Subsequent infections are usually less severe. People often confuse bronchitis with bronchiolitis. They are not the same thing. Adults may be treated with antibiotics for bronchitis. Bronchiolitis does not respond to antibiotics.

Expected Course

Bronchiolitis usually starts with a runny nose and congestion. Within 2-3 days, the patient starts coughing, wheezing, and potentially breathing hard. The wheezing and tight breathing usually become worse over 2-3 days and then begin to improve. Overall, the wheeze may last up to 7 days, and the cough up to two weeks. The most common complication (which occurs in about 20% of infants) is an ear infection. A lesser complication (which occurs in about 1-2% of children) is bacterial pneumonia. Fever usually comes at the beginning of the infection. If your child develops a new fever over 100.4 for more than 24 hours later in the course of the illness, it may signify a secondary infection, and your child should be seen.

Home Treatment

  1. Your child can be given Tylenol every 4-6 hours, or Motrin every 6-8 hours as needed for fever or comfort.
  2. Warm fluids for coughing spasms - Thick sticky secretions in the back of the throat can cause coughing spasms. Warm liquids relax the airway and loosen the secretions. Offer warm juice if your child is over 4 months old. Infants less than 4 months can have warmed Pedialyte or Infalyte.
  3. Humidity - Since dry air may make a cough worse, running a cool mist humidifier in your child's room may help.
  4. Suctioning the nose - With a congested nose your child may not be able to drink. Since most stuffy noses are blocked by dry secretions, suctioning may not be enough. Saline nasal drops or warm tap water will help loosen the mucous. Place 2-3 drops of saline in each nostril, wait about one minute, then bulb suction out. You can occlude the other nostril to get better suction. You can repeat this several times until breathing through the nose becomes more comfortable. Avoid over-suctioning, which may produce swelling or bleeding in the nasal passageway. You can also try putting your child in a very steamy bathroom to facilitate nasal drainage.
  5. Feeding - Encourage your child to drink plenty of fluids. You may have to offer smaller, more frequent feedings.
  6. DON'T SMOKE! Tobacco smoke aggravates coughing. Do not let anyone smoke around your child or in your home. Unfortunately, even an adult who smokes outside and then comes into a home exposes a child to a large amount of pollutants that are very aggravating to the lungs of infants of children.

Call our office if:

  1. Breathing becomes labored or difficult. A good clue that your child is getting into trouble with his breathing is if he seems to be too tired from his breathing to drink fluids or play.
  2. Breathing becomes faster than 60 breaths per minute (when NOT crying).
  3. Wheezing becomes severe (very tight).
  4. If fever lasts more than 3 days.
  5. New signs or symptoms develop to indicate an ear infection (irritability, restless sleep, new fever, etc.)
  6. Any additional questions or concerns.