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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

A Parent's Life A Parent's Life

RSV, Bronchiolitis And Colds

September 12, 2013

By Henry H. Bernstein D.O.

Every year in late fall and early winter, along with dropping temperatures, we start to see lots of sniffles, coughs and colds.

One common winter virus, respiratory syncytial virus (RSV), causes mild cold symptoms in adults and older children, but can cause more serious respiratory (lung) infections in infants and children under 2 years. In fact, up to 125,000 infants are hospitalized each year due to RSV disease, with countless more seen in doctors' offices and emergency rooms around the country.

Risk factors for developing RSV include living with school-aged brothers or sisters, attending day care, being exposed to tobacco smoke, and living in crowded conditions. Interestingly, by the time a child reaches her third birthday, it is likely that she will have experienced at least one RSV infection, even without any of these risk factors.

Humans carry RSV, which spreads easily through physical contact, such as touching, kissing or shaking hands with infected people and their secretions (for example, from a runny nose). Infants generally catch this virus from a sibling, parent or friend with a cold. The virus can live for half an hour or more on the hands, and up to five hours on countertops, toys and other surfaces, increasing the possibility for spread.

With this in mind, you can understand how careful hygiene and regular housecleaning can help to prevent illness. Caregivers should wash hands often, scrubbing with soap and warm water for at least 15 seconds, or using one of the alcohol-based hand cleaners (even though they are called antibacterial gels, they also kill viruses). Use disposable tissues when wiping noses, and wear a mask if coughing or sneezing frequently. Regularly wipe down surfaces, including toys, with a virus-killing disinfectant.

When RSV does infect a young infant, it often causes bronchiolitis (inflammation and swelling of the linings of the small airways in the lungs). In its early stages, bronchiolitis seems to be just a normal cold. However, over the course of two to three days, the infant may show more serious signs and symptoms, including lots of nasal discharge (runny nose), a “tight” or harsh-sounding cough, breathing difficulty, wheezing, and breathing faster than usual (tachypnea). Many infants with bronchiolitis become irritable, look anxious and uncomfortable, and have a hard time eating or do not eat as much as usual. Breathing may become so difficult that parents notice their child’s nostrils flaring and the chest muscles pulling in (retracting), or they may hear grunting noises with each breath. Parents should contact their child’s doctor at the first signs of breathing difficulty, breathing too fast (more than 40 breaths per minute), not eating well, and/or bluish discoloration to the lips or skin (cyanosis).

For some children, including premature infants, those with chronic lung disease, those who can’t fight infection well (immunocompromised), and those with certain forms of heart disease, RSV infections can be even more serious. Therefore, a special substance in the blood (antibody) that fights against RSV infections has been developed for prevention of RSV infections in children with these risk factors. The American Academy of Pediatrics has developed a set of recommendations concerning the use of this special antibody. Parents of premature infants or young children with serious medical problems should discuss their child’s risk of RSV infection with the doctor as soon as possible, and ask whether this antibody would be helpful for their child.

Most children with RSV bronchiolitis recover completely in about one to two weeks, and breathing problems may improve as early as the third day. Treatment involves making the child more comfortable. Children should get plenty of rest. Parents should keep their child well hydrated and allow any nasal secretions to drain out in order to make breathing easier. Bulb suction and warm water or nasal saline drops can be helpful for babies. Use a cool-mist vaporizer in the room where the child sleeps to add moisture to the air, which also helps to keep the nasal passages open. Avoid exposure to tobacco smoke. In very young, extremely ill infants, antiviral medicines such as ribavirin are sometimes prescribed. Since a virus causes this infection, antibiotics are not used to treat RSV.

Most children will not get bronchiolitis again in the same year, although many infants may go on to develop periodic wheezing and coughing over the next few years each time they get a cold. Doctors may then treat these symptoms with asthma-type medicines, if they seem to be helpful. Therefore, be sure that any child age 6 months and older who has ever wheezed in his lifetime gets a flu shot every year, since he is at higher risk for a problem if he were to get the flu.

Since bronchiolitis in children younger than age 2 is so common each winter, parents should learn the signs and symptoms of RSV. Always wash your hands frequently and take other steps to prevent the spread of this infection. Avoid exposing your child to RSV if you can, or at least know how to manage the illness if your child gets it. Do not hesitate to call your child’s doctor if you have any questions or concerns.

Henry H. Bernstein, D.O. is a Senior Lecturer in Pediatrics at Harvard Medical School. In addition, he is chief of General Academic Pediatrics at Children's Hospital at Dartmouth and Professor of Pediatrics at Dartmouth Medical School. He is the former associate chief of General Pediatrics and director of Primary Care at Children's Hospital Boston.

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