RSV-Bronchiolitis
Is this your child's symptom?
- Your child has been diagnosed with bronchiolitis
 - It's an infection of the smallest airways in the lungs
 - Caused by a virus called RSV (respiratory syncytial virus)
 - Wheezing during the first 2 years of life is often caused by bronchiolitis
 - You wonder if your child needs to be seen again
 
- If NOT, try one of these: 
 - Asthma Attack
 - Wheezing (Other Than Asthma)
 
Symptoms of Bronchiolitis
- Wheezing is the main symptom that helps with diagnosis. Wheezing is a high-pitched purring or whistling sound.
 - You can hear it best when your child is breathing out.
 - Rapid breathing at a rate of over 40 breaths per minute.
 - Tight breathing (having to work hard to push air out).
 - Coughing (may cough up very sticky mucus).
 - Fever and a runny nose often start before the breathing problems.
 - The average age for getting bronchiolitis is 6 months (range: birth to 2 years).
 - Symptoms are like asthma.
 - About 30% of children with bronchiolitis later do develop asthma. This is more likely if they have close family members with asthma. Also likely if they have bronchiolitis more than 2 times.
 
Cause of Bronchiolitis
- A narrowing of the smallest airways in the lung (bronchioles) causes wheezing. This narrowing results from swelling caused by a virus.
 - The respiratory syncytial virus (RSV) causes most bronchiolitis. RSV occurs in epidemics almost every winter.
 - People do not develop life-long immunity to the RSV virus. This means they can be infected many times.
 
Trouble Breathing: How to Tell
Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about:
- Struggling for each breath or short of breath.
 - Tight breathing so that your child can barely speak or cry.
 - Ribs are pulling in with each breath (called retractions).
 - Breathing has become noisy (such as wheezes).
 - Breathing is much faster than normal.
 - Lips or face turn a blue color.
 
Diagnosis of Bronchiolitis
- A doctor can diagnose bronchiolitis by listening to the chest with a stethoscope.
 
Prevention of Spread to Others
- Cover the nose and mouth with a tissue when coughing or sneezing.
 - Wash hands often. After coughing or sneezing are important times.
 
When to Call for RSV-Bronchiolitis
 Call 911 Now
 Call Doctor or Seek Care Now
  |  
  Contact Doctor Within 24 Hours
 Contact Doctor During Office Hours
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  Self Care at Home
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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
 
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 for Bronchiolitis
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:
- Any age: breathe warm mist (such as with warm shower running in a closed bathroom).
 - Age less than 1 year: give smaller, more frequent feedings with breastmilk or formula.
 - Age 1 year and older: give warm fluids to drink, such as apple juice and herbal tea.
 - Reason: relax the airway and loosen up any phlegm.
 
Homemade Cough Medicine:
- Do not give any over-the-counter cough medicine to children with wheezing.
 - Age 1 year and older: use honey ½ to 1 teaspoon (2 to 5 mL) as needed. It works as a homemade cough medicine. It can thin the mucus and loosen the cough.
 
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
 
Remember! Contact your doctor if you or your child develop any "Contact Your Doctor" symptoms.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2025 Schmitt Pediatric Guidelines LLC.
Reviewed: 5/1/2025 Updated: 1/25/2025

