Bronchiolitis-RSV

When To Call

Call 911 Now

• Severe trouble breathing (struggling for each breath, can barely speak or cry)
• Passed out or stopped breathing
• Lips or face are bluish when not coughing
• You think your child has a life-threatening emergency

Go to ER Now

• Your child looks like they did when hospitalized before with bronchiolitis
• Ribs are pulling in with each breath (called retractions)
• Not alert when awake ("out of it")

Call Doctor or Seek Care Now

• Trouble breathing, but not severe
• Lips or face have turned bluish during coughing
• New harsh sound with breathing in (called stridor)
• Wheezing (purring or whistling sound) is worse than when seen
• Breathing is much faster than when seen
• Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth, and no tears.
• Milk taken is less than half of normal amount
• High-risk child (such as chronic lung disease) and getting worse
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Age less than 6 months old and worse in any way
• Fever higher than 104° F (40° C)
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Nonstop coughing spells
• Trouble feeding worse than when seen
• Earache or ear drainage
• Fever lasts more than 3 days
• Fever returns after being gone more than 24 hours
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Coughing causes vomiting 3 or more times
• Mild wheezing sounds last more than 7 days
• Cough lasts more than 3 weeks
• You have other questions or concerns

Self Care at Home

• Bronchiolitis same or better than when last seen

Care Advice

What You Should Know About Bronchiolitis:

• Bronchiolitis is common during the first 2 years of life.
• Most children just have coughing and fast breathing.
• Some develop wheezing. This means the lower airway is getting tight.
• If you were given a follow-up appointment, be sure to keep it.
• Here is some care advice that should help.

Asthma Medicines:

• Some children with bronchiolitis are helped by asthma-type medicines. Most children are not helped by these medicines.
• If one has been prescribed for your child, give it as instructed.
• Keep giving the medicine until your child's wheezing is gone for 24 hours.

Coughing Fits or Spells:

• Breathe warm mist (such as with shower running in a closed bathroom).
• Give warm clear fluids to drink. Examples are apple juice and lemonade.
• Age less than 6 months, only give breast milk or formula.
• Amount. If 6 - 12 months of age, give 1-2 teaspoons (5-10 mL) each time. Limit to 4 times per day. If over 1 year of age, give as much as needed.
• Reason: both relax the airway and loosen up any phlegm.

Homemade Cough Medicine:

• Do not give any over-the-counter cough medicine to children with wheezing. Instead, treat the cough using these tips:
• Age 6 months to 1 year: give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: use a dose of 1-2 teaspoons (5-10 mL). Give 4 times per day when coughing. Caution: do not use honey until 1 year old.
• Age 1 year and older: use honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the mucus and loosen the cough. If you don't have any honey, you can use corn syrup.

Nasal Saline to Open a Blocked Nose:

• Your baby can't nurse or drink from a bottle if the nose is blocked. Suction alone can't remove dry or sticky mucus.
• Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of bottled water or clean tap water. If under 1 year old, use bottled water or boiled tap water.
• Step 1: put 3 drops in each nostril. (If age under 1 year old, use 1 drop).
• Step 2: suction each nostril out while closing off the other nostril. Then, do the other side.
• Step 3: repeat nose drops and suctioning until the discharge is clear.
• How often: do nasal saline when your child can't breathe through the nose. Limit: no more than 4 times per day.
• Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
• Other option: use a warm shower to loosen mucus. Breathe in the moist air, then suction.

Humidifier:

• If the air in your home is dry, use a humidifier. Reason: dry air makes coughs worse.

Smaller Feedings:

• Use small, frequent feedings whenever your child has the energy to drink.
• Reason: children with wheezing don't have enough energy for long feedings.
• Offer enough fluids to prevent dehydration.

Avoid Tobacco Smoke:

• Tobacco smoke makes coughs and wheezing much worse.
• Don't let anyone smoke around your child.

What to Expect:

• Wheezing and rapid breathing most often improve over 2 or 3 days.
• Mild wheezing sounds can last up to 1 week.
• Coughing may last 3 weeks.
• Some children (2%) with bronchiolitis need to be in the hospital. These children need oxygen or fluids given through a vein.

Return to Child Care:

• Your child is contagious for 7 days after the cough first started.
• Your child can return to child care after this time.

Call Your Doctor If:

• Trouble breathing occurs
• Wheezing gets worse (becomes tight)
• Trouble feeding occurs
• Fever lasts more than 3 days
• You think your child needs to be seen
• Your child becomes worse

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