RSV and Bronchiolitis: Tips for Every Parent
So many parents have questions about RSV and bronchiolitis, and it can be hard to know where to turn for reliable information. Here’s everything you need to know, with some helpful tips if you’re going through it.
What is Bronchiolitis?
RSV, or respiratory syncytial virus, is one of the viruses that can cause bronchiolitis (inflammation of the bronchioles in the lower airway) or pneumonia (infection in the lungs) in young children. Though we often use the terms ‘RSV’ and ‘bronchiolitis’ interchangeably, a lot of different viruses can cause bronchiolitis.
Bronchiolitis often affects younger children more severely, because they have smaller airways that can get more easily blocked off with mucous or inflammation.
Some children (younger than 2 years old, premature, immunocompromised, with other medical conditions) and adults (with chronic medical conditions, the elderly) are at higher risk for serious symptoms.
What Does It Look Like?
For many children, bronchiolitis looks just like a common cold.
Kids may have fever, cough, lots of nasal congestion, irritability or fatigue, noisy breathing and sometimes wheezing.
It can last 7-10 days (and sometimes with mild symptoms after that time).
A Quick Note:
Symptoms are often worst on days 4-5 - knowing this can help you know what to expect during the course of your child’s illness.
Can You Test for It?
Most pediatricians can diagnose bronchiolitis based on your child’s history and physical exam.
But there is a test for RSV that uses nasal fluids to identify the virus. The test is usually done by using a cotton swab or suction with a bulb syringe to get a sample.
Different offices have different kinds of tests - there is a rapid test and a more traditional PCR test.
How Contagious is It?
It is contagious, because it spreads through droplets (coughing, sneezing, saliva) AND surfaces. And, like many illnesses, it is common for people to pass it back and forth between a family.
Tips to Prevent Spread
Frequent hand washing (with soap + water for at least 20 seconds)
Coughing or sneezing into elbows as much as possible (for older children)
Avoid touching your face with unwashed hands
Avoid sharing things like cups, water bottles + eating utensils
Daily cleaning of high contact surfaces (toys, doorknobs, kitchen counters, phones, etc.)
When Can My Child Return to School or Daycare?
Per the CDC, RSV is technically contagious for 3-8 days. Some kids have symptoms for a bit longer than that (almost 10 days at times).
Every school has different policies - check with yours for their rules. In general, most kids can often return after a week, as long as they are fever-free (typically for at last 24 hours without a fever-reducing medication) AND symptoms are improving.
Do Kids Build Immunity to RSV?
While kids can build some immunity after an illness, it’s not known exactly how long it lasts and it is not lifelong. This means that it is possible to get RSV or bronchiolitis more than once in childhood.
How Can I Care for My Child at Home?
Kids need time and supportive care to heal from bronchiolitis. Here are some tips to help at home:
STEAM. Steam in the bathroom every night and a cool-mist humidifier can help a lot with congestion.
NASAL SUCTION. Use nasal saline drops + suction as needed for your child’s comfort. Focus on suctioning when they need it most - before feeds, if they seem uncomfortable with breathing and before bed.
COMFORT. Keep your child as comfortable as possible. You can use fever-reducing medications for fever if your little one seems really uncomfortable. Honey (for kids over 1 year old) helps a lot with congestion and sore throat.
HYDRATION. Fluids help so much -- when little ones have a lot of cough and congestion, they lose a lot of fluid. Focus on hydration however your little one will take it -- breastmilk, formula, water, pedialyte, pedialyte popsicles, warm apple juice, coconut water, etc.
NOURISHING FOODS. Foods and drinks with Vitamin C (found in oranges, orange juice, strawberries, etc.), Vitamin A, zinc, and cysteine (like chicken soup or broths) nurture your child’s immune system.
If there is a strong family history of atopy (asthma, allergies, eczema), your pediatrician may try breathing treatments or other medications - work with your care team to make a plan.
When Should I Seek Medical Help?
You should seek medical assistance if your child is/has:
Trouble breathing or increased work of breathing (respiratory distress, see my “breathing” highlight on Instagram)
Wheezing
Change of color (pale, blue/purple, etc. around the mouth)
Drooling or trouble swallowing
Lethargy (very tired or hard to arouse)
Dehydration
Fever for more than 3 days
Symptoms that are worsening after 10 days
Other medical conditions
With any questions or concerns
Important Updates
In 2023, tools for preventing RSV in babies and the elderly became available. The RSV monoclonal antibody (Beyfortus, or nirsevimab) is widely available for healthy infants up to 8 months old or babies/toddlers with other medical conditions from 8 months to 19 months old. This is a great overview from my colleagues at the Children’s Hospital of Philadelphia.
Knowing what to do at home and when to seek help will help you feel confident caring for your sick child. You’re doing great.