During cold and flu season our pediatric practice is full of babies with respiratory viruses. Often, especially in the young babies, these viruses spread into the chest causing wheezing and trouble breathing. There are no medications that we can give these babies to make the virus go away. Thankfully, there are things we can do to help prevent bronchiolitis and ways we can support these little guys as their bodies fight off the virus.
What Happens in the Body?
The virus infects the upper respiratory tract. The body reacts by making extra mucus. Symptoms include a runny nose and nasal congestion. Since babies under 4-6 months primarily breathe out of their nose, they will tend to cry and pull away when trying to feed. A few days later, the virus will work its way down into the lower respiratory tract. Some of the skin cells that line the small air tubes can die and plug the small airways. Babies will have some coughing, wheezing and trouble breathing. Most babies will gradually improve over the next 3-5 days and be much better by 7 days. However, some babies will worsen and will require oxygen or to be monitored in the hospital.
How Can I Support my Baby With Bronchiolitis?
- Smaller more frequent feeds– Since it’s difficult for babies with bronchiolitis to both eat and breathe, they can’t usually breastfeed or take a full bottle as usual. Instead they do better if you offer the bottle or breast for small sips more frequently.
- Keep your baby hydrated– Some babies get dehydrated from the body’s increased needs for fluids and decreased intake. You may offer your baby a bottle of Pedialyte or ORS between feeds if showing signs of dehydration.
- Clean out the nasal secretions– The thick nasal mucus can make it harder to breathe. You can squirt a few saline drops in the nose and suction it out with a bulb suction. A lot of parents like the nose Frida, which is a tube where one end goes in the baby’s nostril and the parent sucks on the other end (don’t worry, there’s a filter in between!)
- Watch your baby closely for respiratory distress– There may be 3-5 days that you will want to watch your baby most closely. Ask family and friends to help you with other responsibilities so that you can focus on your baby. The best way to evaluate how well your baby is breathing is by lifting up the shirt and looking directly at the ribs and chest. A baby that is struggling to breathe needs to be seen right away. Signs that a baby is struggling to breathe include:
- nasal flaring where the nostrils go in and out,
- retractions (skin sucks in between the ribs and above the rib cage as they breathe)
- grunting
- breathing faster
- using extra muscles to breathe (the belly seems to go up and down really big with each breath)
- Watch for other concerning signs that require help–
- lethargy- If your baby is difficult to wake up and shows no sign of wanting to feed, interact, and/or has a weak effort to breathe then get help right away.
- dehydration- healthy babies should have about 6-8 wet diapers per day or shouldn’t go more than 4 hours without a wet diaper. If your baby has decreased urine output then give your baby some ORS or Pedialyte. If no wet diaper within the hour, then come be seen.
How Can I Prevent Bronchiolitis?
When a person with the respiratory virus coughs or sneezes, these droplets can get directly in your eyes or nose. The droplets can also go on surfaces. If you touch these surfaces, then your face or nose you can spread them that way.
Here are some practical things you can do to prevent the spread of viruses:
- Wash your hands with soap and water regularly
- Avoid kissing your baby’s face. Ask your older children to kiss your baby’s feet instead of their face to keep from spreading viruses.
- Clean frequently touched surfaces
- During pregnancy, if able get the RSV vaccine from week 32-36 weeks of pregnancy during RSV season
- In some countries babies younger than 8 months, entering into the RSV season qualify for the RSV antibody immunization. If this is available to you then I encourage you to get it. I have seen first hand how this has kept newborns from getting serious bronchiolitis from RSV. (If you received the RSV vaccine during pregnancy then your baby doesn’t need the RSV antibody)
What About Antibiotics, Steroids and Breathing Treatments, Will These Help my Baby Breathe Better?
No antibiotics– Bronchiolitis is caused by a virus. Antibiotics are not effective against viruses. There are side effects to antibiotics such as diarrhea, allergic reaction, or resistance that could cause more problems. There are times when babies may have a secondary infection that could benefit from an antibiotic. If your child has a high fever, is lethargic or seemed to get better then worse, then see your healthcare provider.
No Steroids- Many research studies have been done to show that steroids do not help these babies get better. Steroids are effective to decrease inflammation in kids with asthma, but they are do not help little babies with bronchiolitis. Their airways are just too small to see a positive effect. Steroids can also keep the immune system from working as effectively to fight off the virus.
No Bronchodilators- Bronchodilators, such as albuterol, are given through a nebulizer machine or a spacer. The medication is designed to open the airways that have gotten smaller, such as during asthma. The side effects include increased heart rate and jitteriness. Studies have shown that they do not help babies with bronchiolitis breathe better.
(In can be quite confusing, because babies over the age of one year that have viral induced recurrent wheezing or, reactive airway disease, may in fact have early presentation of what may progress to asthma and are treated differently than babies under eight months that have wheezing related to bronchiolitis. These older babies that have reactive airway disease need steroids and breathing treatments, but it is not helpful and could in fact be harmful to young babies with bronchiolitis.)
Supportive Care is Best– When a baby is hospitalized with bronchiolitis we monitor them closely and if needed give oxygen and fluids (either through a tube from the nose into the stomach or with IV fluids), while their body fights off the virus.
You are not alone
Please know that your healthcare providers want to walk alongside you and your baby during bronchiolitis. Every country I have lived has had the ability to watch babies with bronchiolitis in the hospital and provide oxygen and IV fluids if needed. Find out which hospitals are in your area and where you would go if your baby needs help. In our practice during the flu and cold season we hold more appointment slots so we can work these babies into our schedule for same day appointments. Don’t hesitate to bring your baby in to be seen by your healthcare provider.
Healthy Global Kids 